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Now
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.
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