July 21, 2004
As the dust resettles on Bangkok after the International AIDS Conference, the question of U.S. leadership against AIDS looms larger than ever.
In January 2003, President Bush surprised the world by announcing a major initiative to combat AIDS. Calling it "a work of mercy beyond all current international efforts," he announced a $15 billion program for Africa and the Caribbean.
Yet there is more reason for skepticism than optimism about U.S. leadership in the global struggle against AIDS. A close look at the Bush initiative suggests the White House is more concerned with politics and ideology than with the most effective response to AIDS.
Right to information and condoms:
The president's approach to HIV prevention is to push "abstinence until marriage." This pleases social conservatives, who view sex outside marriage as promiscuous. But abstinence programs deny young people the critical information they need to protect themselves against HIV. The United States used to lead the world in providing low-income countries with condoms, which remain the only hope for HIV prevention for millions of people. Now the Bush administration is using taxpayer dollars to propagate messages exaggerating condom failure, remove information on condom use from federal web sites and appoint high-level AIDS advisers who deny the effectiveness of condoms.
Rights of women:
The Bush administration has also compromised programs targeting one of the groups most at risk of HIV: married women. The president's initiative supports education programs that preach fidelity for married people. But to women in most societies who have little control over the extramarital sex of their husbands, this message is a cruel joke. To make matters worse, Bush has cut off funding to the U.N. Population Fund, a key supporter of AIDS prevention and reproductive health services for women.
Generic medicines:
Meanwhile, the Bush administration has been shoring up the power of multinational drug companies to block the marketing of low-cost generic drugs. As Doctors Without Borders said recently, the United States is forcing countries to "trade away the health of their people" by pressuring them to implement patent laws that would take affordable medicines out of their markets. Administration officials have also waged a campaign of misinformation against generic drugs, calling into question the United Nation's process of certifying these drugs for use in AIDS programs. The administration seems more concerned with cementing its ties to the pharmaceutical industry than with bringing cheaper drugs to the greatest number of people with AIDS.
Needle exchanges:
Finally, the White House has hardened its opposition against needle-exchange and other effective HIV-prevention programs for people who inject drugs. Bush has called needle exchange an "abdication," referring to the myth that needle-exchange programs condone drug use -- even though they have been demonstrated repeatedly to reduce HIV transmission without promoting drug use. Bush supports an international war on drugs that in country after country has led to heavy-handed police tactics that drive drug users underground and away from HIV-prevention services.
Bush has placed politics above science, ideology above lives. He risks undermining the good his AIDS initiative could have done.
Joanne Csete is director of the HIV/AIDS Program at Human Rights Watch (www.hrw.org). She worked on AIDS and health programs in Africa for more than 10 years. She can be reached at pmproj@progressive.org.