Trade, aid and AIDS are three interrelated concepts that are hard enough to pronounce together in the same phrase, leave alone form cohesive policy around, as recent U.S. government efforts so clearly show. But perhaps they’re not trying enough: Last Tuesday, in his State of the Union address, Bush announced a long-awaited and much-needed $15 billion to aid global efforts against HIV and AIDS. Discounting previous commitments, that is $10 billion in new money to be spent over the next five years. The announcement was a vindication of the considerable efforts of activists around the world. It was also recognition by this administration that AIDS is a global humanitarian disaster it has the power — and a duty — to help resolve.
But no one’s clapping too loudly. Not yet, anyway.
First, we can welcome the money without being na•ve about, or agreeing with, the geopolitical work that Bush wants this announcement to do. The timing of the plan, coming as it did while the United States prepares for war, puts an ugly face on the mercy-talk Bush wrapped it in. A recent New York Times article claimed that “if the United States is going to present itself as having a moral imperative to stop terrorism, it must also take up the cause of morality in a manner that that does not involve dropping bombs.” Others are less thrilled to note that the global AIDS crisis may have been kidnapped to become the humanitarian distraction that helps justify a war with Iraq. South African activist Zackie Achmat, speaking for the pioneering Treatment Action Campaign, voiced the uneasiness of a large global community: “Although this increased commitment is welcome, we note with anger that the administration is dramatically increasing its military expenditure — The TAC and our allies oppose the militarism displayed by the Bush Administration.”
And then, people want to know how this money will be spent. While fourteen countries from Africa and the Caribbean have been identified as primary recipients, the selection logic is unclear and there is concern that the plan has left out equally critical countries elsewhere in the world. Bush’s plan calls for the aid to be channeled bilaterally: only $1 billion is to add to the coffers of the Global Fund for AIDS, Tuberculosis and Malaria. The United Nations has been crying itself hoarse that the fund needs $6.3 billion — in the next two years — to be effective; Bush’s announcement commits only $400 million from the US in that time frame. The Global Fund is a program that is up and running, and its multilateral nature ensures a broad consensus in policy. It’s the only institution that has the capacity and the (relative) independence to do the job well. Bush’s own secretary for health and human services just became chairman of the fund. Why then, is it being bypassed?
Why quibble over who distributes the money: aid, after all, is aid, right? One of the potential concerns is in evidence in the state of Texas, where the only sex education in schools is no-sex education. According to a recent article in the Christian Science Monitor, high school counselors tell students that using condoms will lead them to be known as “sluts,” and teenage mothers think that their “spit-babies” were born from oral sex, thanks to a 1995 law that Bush signed when he was governor of Texas limiting schools to an abstinence-only sex education curriculum. This, of course, serves the agenda of the conservative Christian coalition, a key component of Bush’s electoral base.
Dr. Fauci, a leading government scientist and senior official of the National Institutes of Health, allayed some of these concerns: He said that Bush’s new commitment includes access to generic drugs and condom distribution. He emphasized a 12-point WHO-approved prevention program that lists both abstinence and condoms among other strategies. While activists hope he is right, they point to a trail of broken promises — including an earlier Bush commitment of $500 million to prevent mother-to-child transmission that seems to have been merged into the new package — and await both the details and the rollout.
There is also concern that the $10 billion is something that this administration has come to be associated with: accounting sleight-of-hand, shrewdly calculated to deliver more political bang than its bucks are worth. A recent Wall Street Journal report calls the president’s new budget a throwback to the “old days of tradeoffs and tough choices.” This is what they mean: “Mr. Bush in his State of the Union speech proposed new spending to fight AIDS and HIV in Africa and the Caribbean. But his budget for 2004 would reduce by about the same amount the funding that aides had said would be sought for a separate development-aid initiative for poor nations.” Tough choices? Tough luck.
But by far the most perplexing section in Bush’s speech was his reference to generic antiretroviral drugs (“And the cost of those drugs has dropped from $12,000 a year to under $300 a year — which places a tremendous possibility within our grasp — “). This administration — and to give credit where its due, the one before this — has stridently used the WTO to try to deny developing countries the right to use exactly the kind of generic drugs that Bush lauded. Either the administration has changed its trade policy without telling its trade negotiators, or they are engaged in stunning hypocrisy.
So while Bush sings the praises of generic antiretroviral medicine, his trade representative, Robert Zoellick, fights against allowing developing countries to import generically manufactured essential medicines. At a teach-in organized by the Yale AIDS Network yesterday, a wide cross-section of students discussed the nature of current trade rules, and what the U.S. negotiating position means for health in developing countries. This Saturday, Yale students will join a host of other universities and organizations at a protest outside the U.S. Trade Representative’s office in Washington, D.C. Join up: there hasn’t been a more important time to demand fair trade.
Achal Prabhala is a first-year student at the School of Management. He is a member of the Yale AIDS Network.