A fragile compromise on President Bush’s international AIDS relief package passed the House Wednesday, but it’s unclear whether the agreement will survive opposition from both the left and the right in the Senate.

The bill would authorize $50 billion over five years for the President’s Emergency Plan for Aids Relief, an ongoing initiative to combat the spread of AIDS, Tuberculosis and Malaria, primarily in Africa. The bill more than triples the $15 billion allotted for the original five-year program, which expires this fall.

The measure, which passed the House by a 308 to 116 vote after an intense push from the White House, is the result of a compromise that was years in the making, the brainchild of two recently deceased former chairmen of the House Foreign Affairs Committee, Reps. Tom Lantos (D-Calif.) and Henry Hyde (R-Ill.).

The conservative Hyde broke with many pro-life advocates in 2003 by agreeing to give up a provision that would have prohibited funding from going to family planning organizations abroad that performed abortions. In exchange, Lantos agreed that a certain percentage of funds would be earmarked for abstinence-only programs.

The updated compromise — negotiated primarily by Lantos and Hyde’s successor on the committee, Rep. Ileana Ros-Lehtinen (R-Fla.) — increases the total budget for the program and removes the provision requiring 33 percent of all prevention funds go to abstinence- only programs but requires a report to Congress if spending on abstinence falls below certain levels. The deal however, keeps a contentious requirement that groups must have a policy opposing prostitution in order to receive funding.

The delicate agreement now faces challenges from both sides of the aisle in the Senate. Fiscal conservatives have balked at its $50 billion price tag, while some liberals are calling for more funding for family planning initiatives, which many experts believe can help greatly reduce AIDS rates by helping HIV-positive women avoid unplanned pregnancies.

“The Senate will be playing with fire if it takes this carefully crafted compromise and blows it apart,” said one House GOP aide who was involved in the negotiations.

The bill has already passed out of the Senate Foreign Relations Committee, and Senate Majority Leader Harry Reid (D-Nev.), who supports it, intends to take it up “as quickly as possible,” according to his spokesman, Jim Manley.

But Reid faces many tough decisions, especially over what amendments will be included in the Senate’s version of the bill.

“It is a very, very delicate balance right now,” said White House spokesman Tony Fratto.

So far, the Senate bill makes no mention of family planning, but advocates are pinning their hopes on Sen. Barbara Boxer (D-Calif.), who is contemplating an amendment to expand family planning funding that could potentially reopen the abortion fight and endanger the support of many conservatives.

“I hope the Democrats get their act together, stand strong on these issues and not cave,” said Serra Sippel, the executive director of the Center for Health and Gender Equity, a public health watchdog group that favors an expanded role for family planning in AIDS prevention.

Boxer said Tuesday she has not yet made up her mind on how to proceed.

“Either we will introduce the amendment or we will make it clear that family planning is not impacted by this bill in any way,” she said.

Although the $50 billion price tag has turned off some budget hawks on the right, the AIDS program’s success to date has won over all but the most hard-core fiscal conservatives.

So far, the program has provided AIDS drugs to more than 1.4 million people and care for more than 6.6 million, prompting former Bush speechwriter Michael Gerson to call it “perhaps the most successful foreign assistance effort since the Marshall Plan.”

Behind the scenes, the White House is working furiously to make sure the Senate doesn’t undo the House compromise. Getting PEPFAR passed, the White House believes, is a way to help secure the president’s legacy.

“This is one of the president’s highest priorities,” said Fratto. “We do lots of programs in [the international arena], but few others provide such direct dollars to a sick person who is very likely to do die. ... This is saving lives."

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