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The Honolulu Advertiser

Posted on: Friday, July 16, 2004

Bush's war on AIDS: Early results mixed

Perhaps the biggest question at the the 15th International AIDS Conference, held this week in Bangkok, was what compassionate conservatism might mean for the worldwide fight against HIV/AIDS.

Seventeen months after President Bush announced his five-year, $15 billion emergency AIDS initiative, the program is belatedly coming on line in ways that have bemused and occasionally alarmed many veterans of what for so long has been a lonely, losing battle.

Bush's goal for the program, which is restricted to 13 sub-Saharan African countries plus Haiti and Vietnam, is to treat 2 million people in five years. There's a long way to go, with an estimated 6,000 to 10,000 people started on retroviral drugs so far.

The complications of the Bush administration's approach are myriad:

• Existing health delivery systems were simply unprepared to ramp up for the sudden onslaught of American billions, although substantial money has already been directed to health clinics, laboratories, testing centers, hospices and care of orphans.

• The program is Washington-dominated, clearly striped by the administration's political ideology, often unwilling to collaborate with — and to learn from — experienced programs already on the ground.

• This unilateral program operates independently of the multilateral Global Fund, relying on American universities, faith-based and other nongovernmental organizations that can afford to pay well enough to drain workers from local public health systems. Bush plans to cut 2005 funding for the Global Fund, which assists 130 countries including China, India and Russia, by 60 percent.

• The program is building clinics that turn away patients with broken arms or malaria because they specialize in AIDS.

• Congress requires at least one-third of the prevention money to be used to promote sexual abstinence. Experience has shown that such an approach does not work — at least not without an equal or greater emphasis on the use of condoms. Tragically, men have the freedom to choose abstinence, while millions of women lack the power either to say no or demand the use of a condom.

• Generic retroviral drugs, such as those manufactured in India, are shown to work as well as the far more expensive American brand-name drugs. The Bush administration insists that its aid be used to purchase the more expensive American drugs, going so far as to dangle free-trade agreements to developing countries that agree not to make generics.

These retroviral drugs are palliatives, not cures. AIDS victims must take them for life, which implies long-term international commitment in a world with short political attention spans. Until a cure is found (and experts reported in Bangkok that a cure is no closer than it was 20 years ago), the world's anti-AIDS programs in effect create a huge population that is totally and permanently dependent on the taxpayers of the rich world.

It's clear that to maximize its effectiveness, the American program must be integrated with existing programs, commit to proven instead of ideological approaches, spend more on finding a cure for AIDS, and face up to the likelihood that this battle will last a generation or more.

Much of this, no doubt, will come to pass. But how many lives will the delay cost?