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.
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.