A whole generation into the AIDS pandemic, we now have significant (though still insufficient) knowledge of how to combat the disease. But while the world’s collective understanding is gradually advancing, U.S. AIDS policy remains mired in a right-wing economic and social vision that is curtailing progress and costing lives.
In fact, the politics that drive U.S. AIDS policy–and sexual and reproductive health policy in general–have swung so far to the right that many in the United States are no longer outraged by the truly outrageous. Something that once would have sounded utterly insane, like requiring health clinics around the world to sign a loyalty oath condemning prostitution, today passes for business as usual.
But as public debate shifts to the right, we should refuse to drift with it. Last month’s election of a Democratic Congress offers some hope, but only if we succeed in shifting public debate onto more reasonable ground. One place to begin is to recognize how financial greed, religious dogma, and hostility toward women’s rights are fueling AIDS policy. Then we can begin to address the gap between what AIDS policy is and what it should be.
Greed and Dogma
After another three million AIDS deaths this year around the world, the Bush administration is still prioritizing pharmaceutical industry profits over people’s access to medicine. Patents that allow drug companies based in the United States and Europe to control the manufacture and sale of AIDS medicines prevent countries in Asia, Africa, and Latin America from providing people with cheaper, generic AIDS drugs (even though 95% of AIDS patients are in those countries). Meanwhile, the nine largest US drug companies turned a profit of nearly $43 billion dollars last year–more than the gross national income of some of the worst AIDS-affected countries.
The latest trend, embodied by Bill Clinton, is to haggle with drug companies for reduced prices or donations. But charity is not what the countries of the Global South are asking for.
Nor are they asking for religious dogma. Today, a full one-third of international U.S. AIDS prevention funding is mandated for programs that promote either abstinence or fidelity as prevention strategies. Condoms are decried as a “last resort.” But moralizing about abstinence does not reduce the spread of HIV. On the contrary, in Uganda, it took only two years for HIV rates to double after U.S. missionaries-turned-policymakers effectively shifted the emphasis of the country’s AIDS prevention programs from condom use to abstinence.
Yet Bush continues to favor right-wing Christian organizations that preach abstinence in disbursing federal AIDS funding. He has stacked his Presidential Advisory Council on HIV/AIDS with religious fundamentalists and incompetent ideologues. This year’s notable appointment was of Herbert Lusk, a vocally anti-gay pastor with no HIV-related experience. And just last month, Bush picked Eric Keroack–who opposes birth control–to head the family planning programs at the Department of Health and Human Services. Keroack believes that publicly funded sexual education should consist almost entirely of abstinence promotion.
Contempt for Women’s Rights
Current U.S. AIDS policy gives drug companies control over treatment options and allows religious fundamentalists to dominate prevention strategies. This union of greed and dogma has produced an AIDS policy that undermines women’s human rights at a time when HIV infects more women than ever before.
The drug industry’s hostility towards generics is disproportionately harmful to women, who represent the majority of the world’s poor. Their health so often neglected within families and communities, women have the least access to costly AIDS medicines. The abstinence-and-fidelity mantra of the religious right endangers women by ignoring the fact that many women lack the power to refuse sex–especially from their husbands. In sub-Saharan Africa, where 65% of this year’s new HIV infections occurred, being married actually increased a woman’s chance of contracting the virus.
And the fundamentalist attack on abortion rights–which now permeates U.S. international health policy–continues to fuel the spread of AIDS. The “global gag rule” has pulled U.S. funding from any health organization that provides information about abortion. As a result, clinics that once offered a range of critical health services–including AIDS treatment and prevention programs for women in some of the poorest countries–have been forced to close.
Choice, Not Charity
Everything we know about combating the AIDS pandemic points to the need for a synthesis of prevention and treatment strategies within a human rights framework. It’s not Bono’s or Oprah’s job to develop and enact those strategies. Safeguarding public health and upholding human rights are the responsibility of government. Rather than a fundamentalist fantasy of stamping out sex, AIDS prevention strategies should be grounded in what we know works: education and access to condoms within a framework that promotes women’s and girls’ rights to negotiate sex and make the best choices for their well-being.
To realize those goals, federal AIDS programs should rely on generic AIDS medicines–which, at a fraction of the cost of patented brands, are the key to ensuring universal access to treatment. Reluctant corporate charity is no way to fight the worst epidemic in recorded history. Rather, like food and water, medicine should be excluded from World Trade Organization patent rules. The United States has already agreed to this demand in trade talks held in Doha in 2001.
We need to hold the administration to its promise. That means renegotiating recent trade deals, such as the Central American Free Trade Agreement (CAFTA), that skirt commitments made in Doha and prevent governments from providing generic drugs to people living with AIDS. And since CAFTA passed by such a slim margin last year, November’s victories may offer a real possibility for future trade deals that actually comply with U.S. obligations to allow the manufacture and sale of generic medicines.
Next fiscal year’s HIV/AIDS budget should reflect the U.S. commitment to fund its fair share of the UN Global Fund to Fight AIDS, TB, and Malaria. The Global Fund–which relies on generic medicines, operates within a human rights framework, and facilitates international cooperation–is the best-situated institution for combating the spread of AIDS worldwide.
Now that the Democrats control both houses of Congress, we should push for another vote to repeal the “global gag rule.” Last year, the Senate voted to rescind it, but the measure never made it past the House. Rep. Barbara Lee (D-CA) has also introduced a bill to repeal the requirement that one-third of U.S. HIV/AIDS prevention funding be dedicated to programs that prescribe abstinence. It calls on the president and the Global AIDS Coordinator to develop a comprehensive strategy to address the impact of HIV/AIDS on women and girls.
And U.S. policy should be brought into compliance with the action plan developed by public health and women’s rights advocates at the 1994 UN Conference on Population and Development.
You don’t need to memorize the latest UN AIDS report to know that corporate greed and religious dogma are no substitute for a human rights-based international AIDS policy. That should be our message to the new and improved Congress this World AIDS Day.
YIFAT SUSSKIND is communications director of MADRE, an international women’s human rights organization. She is the author of a book on US foreign policy and women’s human rights and a report on US culpability for violence against women in Iraq, both forthcoming.