The World vs. AIDS, 2004

AIDS and the Politics of Baby Steps

An Australian man writes a message to a friend who died of AIDS
A man writes a message to a friend who died from AIDS at the annual Candlelight AIDS Memorial in Sydney, Nov. 22, 2003 (Photo: Torsten Blackwood/AFP-Getty Images).

Dec. 1, 2003, the 16th World AIDS Day—and the catastrophe goes on. An estimated 40 million people across the globe are infected with HIV, a little more than 26 million of them in sub-Saharan Africa: desperate numbers indeed. Peter Piot, executive director of UNAIDS, the United Nations joint program on HIV/AIDS, knows the statistics well: Of every 50 HIV/AIDS victims in Africa, only one on average has access to treatment—this on a continent where more than half the victims are women, where 10 million of the victims are between 15 and 24, and where just 1 percent of pregnant women are treated so as to avoid the transmission of the virus to their newborns.

This year, the grim figures have risen again. By the end of the year, HIV will have infected an additional 5 million people and will have killed 3 million. Fully 95 percent of the victims live in developing countries—and eventually, China and India could surpass Africa in the incidence of AIDS cases. Piot warns of a threat that “could wipe out entire generations of economically productive young adults, on whom entire societies are dependent.” He wants a kind of Marshall Plan to fight AIDS. “If we don’t act today, we’ll pay for it tomorrow,” he says.

Piot isn’t the only one who thinks AIDS could bring about a dangerous world, where desperate people are refused care even though treatments exist. Khalil Elouardighi, an activist in France with Act Up, one of the most radical organizations in the fight against AIDS, is categorical: “America’s National Security Council and the CIA are the best allies for activists like Act Up. These American security organizations are the first to point it out: Careful, things could go very far indeed in Africa and Asia. The social situation will be unmanageable, sovereign states will disappear, there’s a risk that street children orphaned by AIDS will form uncontrollable armed gangs.” Succinctly put: If compassion and generosity aren’t enough to elicit money and energy from rich countries, it’s time to mobilize instead in the name of world security.

Given his preoccupation with international security, George Bush is at least coherent on this point. In 2001, Kofi Annan, the secretary-general of the U.N., put forward the figure of US$10 billion a year to defeat HIV/AIDS. In January, Bush announced in his State of the Union address that the United States was going to assume its responsibilities in the battle: $3 billion a year for five years. There followed a series of struggles in Congress to nail down how the money would be spent. Pretty much everybody agreed the United States should send antiretroviral drugs that would presumably be bought from U.S. pharmaceutical companies. But the sticking point turned out to be the nature of the AIDS prevention campaigns to be financed.

Conservatives were in favor of preaching the good word in the African countryside: abstinence and conjugal fidelity. But they balked at the idea of what they called a “condom airlift” for the Third World, or at financing family-planning clinics that might also carry out abortions. For these people, it’s fine to fight AIDS, but only if it’s done in the name of the strictest moral order.

For their part, the president’s advisers meant to keep control of the AIDS money: no question of giving it to the brand-new Global Fund to Fight AIDS, Tuberculosis, and Malaria set up by the U.N. Despite the fact that the U.S. secretary of health and human services is the chairman of the fund’s board, it is still too multilateral to please the president’s men. At most, the U.N. fund would get $1 billion of the $15 billion total. Congressional bargaining is still going on. But an indisputable effort has been made. And George Bush, attending the G-8 summit in Evian, France, in June, had every intention of showing what “American generosity” could mean, before an audience of Europeans who’ve given him only niggardly support in Iraq.

It must be acknowledged that Europe has been less impressive than the United States on the AIDS front. At the G-8 meeting, France committed itself to spending $150 million a year. If France had made an effort proportional to America’s, it would have put up $500 million. But it didn’t, and organizations like Act Up have protested the French “betrayal.” Still, countries like Germany and Britain, or Japan, have been much stingier. And the world fund is cruelly lacking in money to finance the programs it has set up in some 120 countries.

At the most recent international conference on AIDS in Africa, held in Nairobi, Annan’s special representative strongly denounced the “grotesque obscenity” of a world where governments come up with $200 billion to combat terrorism but can’t find the cash to provide medicine.

That said, not all the news is bad—far from it. First, because, even if it hasn’t received all the money it needs yet, the world fund is putting an additional $2.1 billion a year into the fight against AIDS. Eventually, this will make itself felt. The World Health Organi-zation understands this: WHO has set a goal of treating 3 million victims in 2005, six times the current rate. And, there’s the recent agreement on the use of generic drugs by developing countries, which was signed at the World Trade Organization’s meeting in Cancún, Mexico. “We’ve been waiting for this for two years,” exults Germán Velásquez, a pharmaceuticals specialist for WHO.

Last, there have been encouraging local developments. South Africa, which has more than 5 million people infected with HIV/AIDS, finally decided last week to treat HIV/AIDS victims other than with a concoction of olive oil and the root known as the African potato (which has been advanced by that country’s health minister as an immune-system-bolstering therapy). Until now, President Thabo Mbeki had refused to accept that AIDS was a fatal illness and claimed that antiretroviral drugs were “worse than the disease itself.”

Also, a few months ago, the Chinese agreed to acknowledge—at last—that there were AIDS sufferers in China and that they had to be cared for. Another piece of good news: The foundation of former President Bill Clinton has negotiated an agreement with Indian and South African generic drug manufacturers to further reduce the price of triple-drug cocktails for AIDS victims in Africa to just $130 a year. Not that long ago, the same treatment cost $2,000 a year.

Let’s also recall some encouraging statistics: In Uganda, the percentage of town-dwelling women aged 20-24 who are HIV carriers has dropped to 8 percent from 38 percent in 1990. In Addis Ababa, Ethiopia, 15 percent of pregnant women aged 15-24 are seropositive now, against 24 percent previously. Statistics like these prove one thing: AIDS can be rolled back when nations and the world are willing to make the effort. Now it’s time for one more push—a big one!