AIDS: Another World War | The Nation


AIDS: Another World War

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Whether measured by numbers killed or nations wounded, by economies upended or families crushed, the AIDS pandemic is a deadlier global threat than that posed by terrorist groups. But almost no one draws the logical conclusion: The war on AIDS is more important than the war on terrorism. Those on the frontlines of this war--people living with AIDS, medical professionals and community activists, family and friends--are fighting back with the meager resources they have. Report after report documents what needs to be done. The price tag is modest compared with the sums quickly appropriated in response to September 11. Yet only a trickle of resources is reaching the AIDS battle fronts.

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Salih Booker
Salih Booker is executive director of Africa Action, the oldest US-based advocacy group on African affairs,...

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Africa Action has launched a petition, supported by the Congressional Black Caucus, that calls on Secretary of State Colin Powell to name the genocide in Darfur and to support immediate intervention to stop the killing.

The Africa trip of Treasury Secretary Paul O'Neill and Irish rock star
Bono produced a bumper harvest of photo ops and articles about aid to
Africa. Unfortunately, media coverage was mired in the perennial and
stale aid debate: Should we give more? Does it work?

If the O'Neill-Bono safari resulted in Washington finally paying more of
its proper share for global health, education and clean water, that
would be cause for applause. But any real change requires shifting the
terms of debate. Indeed, the term "aid" itself carries the patronizing
connotation of charity and a division of the world into "donors" and

At the late June meeting in Canada of the rich countries known as the
G8, aid to Africa will be high on the agenda. But behind the rhetoric,
there is little new money--as evidenced by the just-announced paltry sum
of US funding for AIDS--and even less new thinking. Despite the new
mantra of "partnership," the current aid system, in which agencies like
the World Bank and the US Treasury decide what is good for the poor,
reflects the system of global apartheid that is itself the problem.

There is an urgent need to pay for such global public needs as the
battles against AIDS and poverty by increasing the flow of real
resources from rich to poor. But the old rationales and the old aid
system will not do. Granted, some individuals and programs within that
system make real contributions. But they are undermined by the negative
effects of top-down aid and the policies imposed with it.

For a real partnership, the concept of "aid" should be replaced by a
common obligation to finance international public investment for common
needs. Rich countries should pay their fair share based on their
privileged place in the world economy. At the global level, just as
within societies, stacked economic rules unjustly reward some and punish
others, making compensatory public action essential. Reparations to
repair the damage from five centuries of exploitation, racism and
violence are long overdue. Even for those who dismiss such reasoning as
moralizing, the argument of self-interest should be enough. There will
be no security for the rich unless the fruits of the global economy are
shared more equitably.

As former World Bank official Joseph Stiglitz recently remarked in the
New York Review of Books, it is "a peculiar world, in which the
poor countries are in effect subsidizing the richest country, which
happens, at the same time, to be among the stingiest in giving
assistance in the world."

One prerequisite for new thinking about questions like "Does aid work?"
is a correct definition of the term itself. Funds from US Agency for
International Development, or the World Bank often go not for economic
development but to prop up clients, dispose of agricultural surpluses,
impose right-wing economic policies mislabeled "reform" or simply to
recycle old debts. Why should money transfers like these be counted as
aid? This kind of "aid" undermines development and promotes repression
and violence in poor countries.

Money aimed at reaching agreed development goals like health, education
and agricultural development could more accurately be called
"international public investment." Of course, such investment should be
monitored to make sure that it achieves results and is not mismanaged or
siphoned off by corrupt officials. But mechanisms to do this must break
with the vertical donor-recipient dichotomy. Monitoring should not be
monopolized by the US Treasury or the World Bank. Instead, the primary
responsibility should be lodged with vigilant elected representatives,
civil society and media in countries where the money is spent, aided by
greater transparency among the "development partners."

One well-established example of what is possible is the UN's Capital
Development Fund, which is highly rated for its effective support for
local public investment backed by participatory governance. Another is
the new Global Fund to Fight AIDS, Tuberculosis & Malaria, which has
already demonstrated the potential for opening up decision-making to
public scrutiny. Its governing board includes both "donor" and
"recipient" countries, as well as representatives of affected groups. A
lively online debate among activists feeds into the official

Funding for agencies like these is now by "voluntary" donor
contributions. This must change. Transfers from rich to poor should be
institutionalized within what should ultimately be a redistributive tax
system that functions across national boundaries, like payments within
the European Union.

There is no immediate prospect for applying such a system worldwide.
Activists can make a start, however, by setting up standards that rich
countries should meet. AIDS activists, for example, have calculated the
fair contribution each country should make to the Global AIDS Fund (see

Initiatives like the Global AIDS Fund show that alternatives are
possible. Procedures for defining objectives and reviewing results
should be built from the bottom up and opened up to democratic scrutiny.
Instead of abstract debates about whether "aid" works, rich countries
should come up with the money now for real needs. That's not "aid," it's
just a common-sense public investment.

Six months ago the world gathered in New York in a special session of the United Nations to adopt a global strategy to defeat AIDS, now acknowledged as the worst plague humankind has ever faced. The level of consensus offered hope that leaders might soon translate words into action. Kofi Annan won approval for a global fund with a target of $10 billion a year in additional resources. Yet on December 1, World Aids Day, the international community and the media gave only perfunctory notice to new UN estimates for 2001: 3 million more dead, 5 million more HIV infections, 40 million people now living with HIV/AIDS--28 million of them in Africa. The Global Fund has garnered only $1.6 billion in pledges, including multiyear commitments. George W. Bush set the bar low with a US pledge of only $200 million, and other countries followed his example.

Years from now people will ask about AIDS, as with the Holocaust or the Rwandan genocide, "How could they have known--and failed to act?" The reason isn't not knowing what to do. The main elements were clearly agreed on in New York: Prevention measures, like condoms and safe-sex education, are essential. Women, more vulnerable to infection, must have the right and power to control their sexual choices. Treatment, including access to antiretrovirals, must be available to provide hope for survival and an incentive to be tested. Health systems must be given the capacity to fight back by treating opportunistic and other diseases and by blocking HIV transmission from mothers to newborns.

What is lacking is the money to carry out these efforts, notes UN special envoy Stephen Lewis: "We have all over the [African] continent individual projects and programs that are successful, and the frustration lies in our inability to take them to scale." Lack of dollars is "the single most inhibiting factor."

Though AIDS activists have pointed out the connections between AIDS, poverty, African debt and the policies of international financial institutions, these realities have not penetrated US public discourse. Nor has the concept that paying for global public health is an obligation for those who have the means to pay. Most of the dying are in Africa and therefore invisible outside that continent. Even if moved by Africa's tragedy, the average American is programmed to assume it is someone else's responsibility.

Few slogans have been so often repeated as the need for "leadership" against AIDS. Notably, two leaders who could have taken decisive roles chose not even to attend the June UN session, Bush and South African President Thabo Mbeki. Together, they epitomize the two greatest impediments to the fight against AIDS: denial and disregard.

Mbeki represents deadly denial. South African activists have played leading roles in the struggle against AIDS. The South African government joined the struggle to force drug companies to back down on their court case putting patents before health. But Mbeki has balked at treatment for South Africans with HIV/AIDS. Instead of taking the clear connection between AIDS and poverty as a starting point for galvanizing the global campaign against both, he has veered into battle against his own medical community. Tragically, he has turned his eyes away from those dying for fear the sight might mar his vision of an African renaissance.

Bush, on the other hand, symbolizes outright disregard. Strong US leadership in funding the global war against AIDS would turn the tide, but Washington fails to appreciate the link between the spread of poverty, desperation and insecurity and the increase in such global threats as AIDS and terrorism. Bush refuses to give priority to the war on AIDS because the victims are mostly black, poor and female.

September 11, by bringing home the common vulnerability that Americans share with others on this planet, should serve as an impetus to a greater sense of solidarity. Instead, the reverse has happened: The world war against AIDS, less visible but more urgent than the war against terrorism, has not even been joined.

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