Mixed Signals

The Bush administration continues to disappoint in the global fight against HIV/AIDS.

The thinness of the U.S. delegation to this year's weeklong International AIDS Conference in Bangkok, which opened on Sunday, gave little assurance to AIDS activists hoping that President Bush's $15 billion AIDS initiative would mark a new phase in the U.S.'s commitment to tackling the global epidemic.

The Bush administration, citing fiscal responsibility, cut the U.S. delegation to just 50 representatives compared to 236 in 2002. Worse, the White House -- which has championed abstinence as the only acceptable form of sex education and has protected Western pharmaceutical companies from competition from manufacturers of generic antiretroviral drugs manufacturers -- seems to have excluded some of the delegates on the ground that they dissented from its orthodoxies.

The setting of the conference was a reminder that while Africa remains the continent worst hit by HIV/AIDS, Eurasia is on the verge of an explosion in AIDS cases, with India leading the way and China and Russia not far behind.

And unlike Africa, Eurasia's epidemic is harder for the West to ignore. Russia is in Western Europe's backyard. China and India are key U.S. trading partners, and were the economic devastation that accompanied the epidemic in Africa to occur here, the U.S. economy will suffer. Further, these are huge military powers -- and in case of India and Russia -- nuclear powers. As Nicholas Eberstadt of the conservative American Enterprise Institute argued in Foreign Affairs back in 2002 :

The coming Eurasian pandemic threatens to derail the economic prospects of billions and alter the global military balance. And although the devastating costs of HIV/AIDS are clear, it is unclear that much will be done to head off the looming catastrophe."

Women have grown to account for 50 percent of new HIV infections, a fact that has some AIDS activists especially worried, given the Bush administration's antipathy toward comprehensive sex-education programs. White House's model program goes along the lines of Ugandan President Yoweri Museveni's ABC campaign -- "Abstinence," "Be faithful" and "use Condoms where appropriate" -- with its strong emphasis on abstinence and the use of condoms as a means of last resort. Uganda has been successful in cutting its rate of infection in a continent where good news has been scarce. Yet it is Thailand –- whose government has implemented a sex education program heretical to the White House -- that is often cited as the world's success story in battling the epidemic. As Time reports, when high rates of HIV-infections among prostitutes were detected in the 1980s:

The Thai government launched a comprehensive education and prevention campaign. Brothels started using condoms. Public-service messages were broadcast on radio and television every two hours. Anti-AIDS messages — often served with a healthy dose of sanuk, the Thai sense of playfulness — were spread in schools, hospitals, police stations and courthouses. After peaking at 143,000 in 1991, the annual number of new cases of HIV infection fell to 19,000 in 2003. That still leaves 600,000 Thais living with HIV or AIDS, but it could have been much, much worse."

Unfortunately, as the article goes on to point out, that success is now being undermined as a result of funding cuts, complacency, and drug use. AIDS activists worry that the premises of the White House's advocacy of abstinence programs – that abstinence is an option and that it is an option that is likely to be followed – often do not hold true, especially in developing countries. As U.S. Congresswoman Barbara Lee, speaking at the conference put it: "In an age where 5 million people are newly infected each year, and women and girls too often do not even have the choice to abstain, an 'abstinence until marriage' program is not only irresponsible but is really inhumane."

Internationally, the Bush administration mandated that one-third of funds devoted to sex education in its $15 billion initiative must go toward programs advocating abstinence. Nationally, as the New York Times recently reported, groups rejecting White House's abstinence gospel are coming under unprecedented political pressure -- seeing their funding reviewed or cut. As James Wagoner, the president of Advocates for Youth told the New York Times: "For 20 years, it was about health and science, and now we have a political, ideological approach. Never have we experienced a climate of intimidation and censorship as we have today."

Only around 10 percent of the 38 million people carrying HIV/AIDS are receiving the drugs they need and the W.H.O. is behind on its goal to provide the medication to 3 million people in developing countries by 2005. The Bush administration has balked at funding for generics, arguing that more testing is needed to prove their effectiveness, perpetuating the near-monopoly of Western drug companies whose products are prohibitively costly to most outside the West. A recent study overseen by the French National Agency for Research on AIDS, however, supported the W.H.O.'s argument that the generics are just as effective as their costlier, Western counterparts.

The findings bolster the case for the April deal reached by President Bill Clinton which will make generic drugs available for millions of HIV/AIDS patients in 122 countries served by the Global Fund to Fight AIDS, Tuberculosis and Malaria. In an initiative co-sponsored by the Global Fund, the World Bank, UNICEF and the Clinton Foundation, Indian and South African companies will supply the medicines at one-third the price of the cheapest ones available in the West, while U.S. companies will provide diagnostic tests at one-fifth the market price.

Scientific findings affirming the safety and effectiveness of generic antiretroviral drugs will, one hopes, persuade the Bush administration to use its allocated AIDS funding to provide medication to as many of those who need it. (However, if the recent past is any indication, this is a slim hope.)

Meanwhile, several trade agreements on the verge of being sealed, will make it harder for HIV/AIDS patients in the U.S. to receive affordable treatment. Under a bill currently in Congress, Australian drug manufacturers won't be able to ship their products into the U.S. -- so much for free and fair trade. As for HIV/AIDS patients in developing countries, as the Wall Street Journal recently reported:

"As public-health groups urge wider use of generic drugs to lower the cost of treating AIDS and other diseases in developing countries, U.S. trade negotiators -- prodded by the drug industry -- are taking the opposite stance in new trade pacts, seeking to strengthen protections for costlier brand-name drugs.

In many countries, including the U.S., makers of generic drugs often can win approval simply by proving that their products are equivalent to the original drugs. But the key provision sought by the U.S. in new agreements restricts trading partners from approving for five years a generic-drug application if it relies on test data compiled by the original drug's manufacturer. In essence, that grants branded drug-makers temporary exclusivity, already available inside the U.S.

The goal is to shore up new global protections for U.S. drug makers in other countries.”