Losing a battle
The Bush administration's "war on terror" may also include a war on many of the gains made by AIDS activists, writes Negar Azimi
President George W Bush's pledge of $15 billion to combat the AIDS epidemic in Africa and the Caribbean is being hailed in some circles as an historic one. A closer look, however, reveals that the initiative represents a step backwards in several realms, rendering insignificant many of the prevention gains of the last decade and a veritable extension of the Bush administration's stifling of reproductive health care rights at large.
While the new legislation will triple the amount the United States currently earmarks for AIDS, one third of the money designated for prevention in the Bush package is designed to promote abstinence rather than safe sex. Countless prevention experts have branded this move as decidedly outdated and ineffective.
As further testament to its neo-conservative bent, the legislation bars funding any groups who work with prostitutes and allows medical providers and non-profit groups to refuse to endorse, utilise or participate in any AIDS treatment or prevention method to which they may have a moral or religious objection -- a clear nod to the Bush constituency.
Family planning experts argue that the package's stipulations surrounding abstinence are archaic. As a family planning method, they argue, abstinence has not proven effective the world over, while those who think that teaching children about sex serves to encourage it should be advised to examine the extensive literature surrounding the benefits of reproductive health education.
Terri Bartlett, vice-president for public policy of the Washington DC-based Population Action International, is among the concerned. "The bill focusses on abstinence-until-marriage programmes instead of balanced approaches that are proven effective in preventing the spread of AIDS," she told Al-Ahram Weekly. "With 14,000 people becoming newly infected each day, this bill simply falls short of arming those most vulnerable with every possible resource to protect themselves from HIV."
Others offer that the AIDS package makes little sense given the trends of sexual politics in the developing world. Espousing abstinence ignores the mass of women, in low-income countries in particular, who are effectively disempowered when it comes to sex. Without access to the language and means of safe sex, they are left completely vulnerable.
Besides being rooted in outdated prevention strategies, the new AIDS package is additionally problematic because of its weak commitment to the international Global Fund to Fight AIDS, Tuberculosis and Malaria -- an initiative launched by the G-8 at the 2001 Genoa Summit. The legislation allows, but does not require, the administration to contribute up to $1 billion in 2004 to the fund.
Such a figure is a mere drop in the bucket when measured against raw need, and particularly significant considering that US Secretary of Health and Human Services Tommy Thompson chairs the fund in question.
According to Paul Davis of New York-based HIV/ AIDS advocacy group, Health GAP (Global Access Project), the US has turned its back on the Fund in light of this bill, deciding instead to go at it alone in the fight against AIDS.
"The Global Fund is already operating and is producing impressive results after only two grant rounds, but now faces near total bankruptcy," Davis said. "A new round of applications are due this week, and at least $1.4 billion in new donor contributions is needed by the fund before the year is out to cover these rants."
Davis stresses that the US cannot afford to ignore the fund: "To succeed, the new US initiative will require the Global Fund to be successfully operating in order to build necessary infrastructure, treatment literacy and demand for medicine in the 14 countries President Bush has targeted."
The Bush administration's commitment to international public health has been unremarkable from day one. Earlier versions of the AIDS bill were decidedly non-progressive, bogged down in abortion politics and marked by the amendment of the so- called Mexico City policy (named for the city in which former President Ronald Reagan first announced it) or "gag rule".
Bush reinstated the law on his first business day as president, prohibiting US assistance for family planning from being provided to foreign non- governmental organisations that use funding from any other source to perform abortion in cases other than a threat to the life of the woman, rape, or incest. Groups are also barred from providing counselling and referral for abortion. Restrictions on groups receiving US aid continue to be severe.
And this is only the beginning. At last year's UN Conference on the child, the US joined a host of countries pushing to roll back international agreements stipulating that adolescents should have access to sexual and reproductive health programmes. The US opposed the provision of comprehensive information about sexual abuse, birth control, HIV/ AIDS, condoms and reproductive health services to young people under the age of 18. In the end, the event fell devastatingly short of its potential, backtracking in several crucial realms and culminating with the production of weak, watered-down resolutions.
In July of 2002, the Bush administration signed into law a $34 million contribution to the United Nations Population Fund (UNFPA). In signing the foreign operations bill, the president blocked release of these funds, based on the claim that the UNFPA supported coerced abortion and sterilisation in China. Despite the fact that a State Department team subsequently found no evidence of such activity, all funding for the UNFPA was subsequently eliminated.
The US has also pushed for tightening intellectual property laws surrounding HIV/AIDS drug patents to serve the pharmaceutical lobby. Commercial interests have been prioritised at the expense of the less than five per cent of persons affected by AIDS worldwide who lack access to life-extending medicines and therapies.
Meanwhile, this administration has recommended cuts in the Ryan White CARE Act, and cuts in federal programmes that subsidise access to expensive AIDS therapies.
President Bush has dubbed the $15 billion initiative a "moral duty", ambitiously likening it to the Marshall Plan following the Second World War, the Berlin Air Lift and the creation of the Peace Corps in the 1960s. His gesture will presumably target moderate swing voters for the 2004 elections, putting a progressive face on his administration.
However, the bill signed by Bush only authorises funds. In fact, the amount to be actually spent on AIDS has yet to be determined, while there is not enough money in the 2004 foreign aid budget to fund the AIDS bill as the moment.
Despite the controversies within, the Bush team's announcement may be timely, with the G-8 summit following on its heels. At the request of French President Jacques Chirac, global AIDS is on the agenda at Evian.
It is hoped that the gathered industrialised nations will re-evaluate their commitments to the global HIV/AIDS scourge. As it stands today, time is running out -- particularly as the AIDS epidemic threatens to wipe out a substantive portion of the world's population.
In 2002 alone, AIDS claimed more than three million lives, while an estimated five million people were infected with HIV, the virus that causes AIDS, bringing to 42 million the number of HIV positive people around the world.
Two decades into the epidemic, HIV/AIDS is by no means an exclusively humanitarian issue limited to the developing world. AIDS unchecked in the South will doubtless affect Northern economies, while the epidemic as a whole continues to threaten global development and stability at large.
