Today, December 1, is World AIDS Day,
a chance to take stock of how the world is doing at confronting
the worst pandemic of the last 500 years.
It is an unbearably grim situation.
The death toll and shattering of communities across Africa —
and increasingly other areas where the epidemic is skyrocketing
— defies description. And yet world leaders, in rich and poor
countries alike, are letting the problem worsen, as they let
corporate greed, ideology, homophobia and incompetence get in
the way of solutions.
The only good news is that
activism has stopped the situation from being worse than it is,
and holds out hope of making it a lot better.
Quick reminders of how bad
things are —
For those who relate to numbers:
Roughly 40 million people worldwide have HIV/AIDS, and the number
is rising fast. More than three million people are dying from
AIDS-related each year, and that number is rising fast, too.
The average life expectancy in many southern African countries,
the region worst hit so far, has plummeted to less than 40. In
St. Petersburg, Russia, infection levels rose 100 times between
1998 and 2002.
If the numbers don’t move you,
check out the heart-rending report in the Sunday New York Times
on how the HIV/AIDS epidemic is laying waste to Lavumisa, a village
in Swaziland. Here’s a short excerpt:
Madlopha wanted to be a police officer. Instead, next year she
will till her grandparents’ fields, filling in for her dead parents.
Her brother will herd livestock.
“Their grandmother, Vayillina
Madlopha, wanted a quiet old age. Instead, at 80, she is a new
mother. ‘I thought my daughters-in-law would be serving me food,
washing for me and cleaning the yard,’ she said. ‘Now I must
wanted to be a third grader. Instead, he lies on the floor of
his one-room hut, his knees swollen like baseballs and his mouth
pitted with sores. His mother, who died in May, infected him
with H.I.V., either during her pregnancy or later as he helped
tend her oozing sores. His sister, Nkululeko Masimula, 26, wanted
a job. ‘ I wanted to have my own business; to be a hairdresser
or a wholesaler,’ she said. Instead, she tends her brother and
their 61-year-old grandmother. She sells the family’s chickens
to raise money for food. Finding the $20 a month required to
take her brother to the nearest antiretroviral drug site, 60
miles away, is a pipe dream.”
And a review of the miserable
response of the world’s governments and institutions —
A few developing countries
have stepped up and instituted prevention and treatment programs
that are at least remotely commensurate with the scale of the
By and large, however, developing
country governments have failed to devote serious resources or
political capital to stopping the spread of the epidemic, reinvigorating
public health systems, providing life-saving treatment to people
living with HIV/AIDS, or stopping the violence against women
and redressing the power imbalances that are responsible in considerable
part for the epidemic’s deadly surge among women and girls.
The performance of rich countries
— who don’t have the same resource constraints to fall back
on as an excuse — is equally appalling.
In April 2001, UN Secretary
General Kofi Annan called for the creation of a global fund of
$7 billion to $10 billion annually to address HIV/AIDS. (To put
this number in perspective: the United States now spends $35
billion a year on pet supplies.) The fund was in fact established,
as the Global Fund to Fight Against AIDS, Tuberculosis and Malaria.
The Global Fund is an imperfect
institution. Among other problems, it has been slow to move the
money it has received.
But the Global Fund is among
the best things going in international aid. It doesn’t waste
money on a huge bureaucracy or overhead, and hasn’t let consulting
firms capture money intended to assist people in the developing
world, and it works to involve people living with HIV/AIDS and
nongovernmental groups in the process of developing project proposals.
The Global Fund’s big problem
is that it is criminally underfunded. It has committed $3 billion
in its three years of existence. In November, because of funding
shortfalls, the Fund decided to delay its next funding round
for two months, until September 2005. This was a victory over
those, led by the United States, who wanted to delay the next
grant round indefinitely.
The rich countries simply have
not been willing to pony up the monies needed to address the
epidemic, with more than enough blame to spread around among
Europe, Japan and the United States.
The Bush administration has
worked hard to subvert the Global Fund. Although the relevant
Senate committees had agreed in 2004 to spend $550 million on
the Global Fund, in the final appropriations process the administration
maneuvered, pressured its Congressional allies, and succeeded
in slashing the final Global Fund commitment to $350 million.
(To prevent a re-occurrence
of this fiasco, activists are mobilizing today to demand that
Congress next year appropriate $1.5 billion to the Global Fund
and provide $330 million to the Fund as part of an emergency
spending bill expected this winter. To join this effort, simply
call Senator Majority Leader Bill Frist at 202-224-3344 and tell
him how important it is to fund the Fund.)
The administration dislikes
the Global Fund in part because it is multilateral, in part because
it supports the use of low-cost, quality generic drugs, and in
part because of its readiness to fund condom programs.
So instead of supporting the
global initiative, the administration has invested billions in
a bilateral program. The program will hopefully deliver results
eventually, but it has been slow to get off the ground, duplicates
work already accomplished by the Global Fund and other bodies,
and is reluctant to support use of generics.
Indeed, the United States is
actively working to undermine the prospect of generic production
of AIDS and other drugs. In a host of free trade agreements,
the United States is demanding on behalf of Big Pharma that countries
agree to rules that will delay introduction of generic competition
for years or even a decade or more. Given that the generic price
of first-line AIDS drugs is now less than 2 percent of the price
of brand-name drugs just five years ago, this is a big deal.
Meanwhile, although they are
reluctant to put new monies into developing countries, rich nations
are quite happy to suck resources out.
The sub-Saharan African countries
hardest hit by HIV/AIDS happen to be the poorest and most indebted.
Together, they owe $300 billion to the World Bank, the International
Monetary Fund and rich country creditors. There is no prospect
of them ever paying off this debt. But they do send billions
in interest payments to rich country financial institutions.
The bottom line of this collective
global failure: The World Health Organization estimates that
6 million people in the developing world need AIDS drug therapy
immediately — and face certain death if they do not get it.
WHO set a target of 3 million to get treatment by 2005 (“3
by 5”). Less than 8 percent of the 6 million are getting
treatment, nearly a third of them in a single country, Brazil.
And the epidemic continues
to spread, and intensify.
As bad as things are, they
could be worse. Activism and generic competition has dropped
the price of lifesaving treatment drugs dramatically — from
$10,000 a year per person to $140. The resulting lowered costs
made it possible to talk about provision of treatment in developing
countries, and created the conditions in which billions of dollars
could be mobilized in aid.
The list of things that need
to be done to improve the situation is very long. But the top
priorities in rich countries are clear, and achievable, if enough
people demand they be met:
* Getting sufficient funding
to the Global Fund;
* Stopping trade agreement
provisions that extend drug company monopolies and delay generic
* Canceling the debt of the
poorest countries — something that is now actually on the agenda
of the G7 group of rich countries.
Concludes Brook Baker of Health
“People with AIDS and
their allies have moved from the outrage of nothing being done
to the miasma of things being done far too slowly and poorly
to boot. Whatever specific campaigns that activists mount to
expand and improve the global response, we must not do so without
referencing the larger picture. The paucity and ineptitude of
the global response is an indictment of a world order where businesses
set global policy, where governments neglect social obligations,
and where multilaterals and international NGOs curry favor from
stingy, domestic-policy-crazed donors. The message on World AIDS
Day 2005 is one of shame and of determination — shame at our
collective inability to raise the world from its lethargy and
determination to show more pragmatic solidarity with the individuals,
communities and nations wracked by this lethal plague.”
Russell Mokhiberis editor of the Washington, D.C.-based
Robert Weissman is editor of the Washington, D.C.-based
Monitor, and co-director of Essential Action, a corporate
accountability group. They are co-authors of Corporate Predators:
The Hunt for MegaProfits and the Attack on Democracy (Monroe,
Maine: Common Courage Press; http://www.corporatepredators.org).
(c) Russell Mokhiber and Robert