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.”