When George W. Bush announced a $15 billion Emergency Plan for AIDS Relief in his 2003 State of the Union address, he compared the fight against AIDS to the war on terrorism. Unfortunately, the analogy has proved apt. More than fourteen months and 3 million AIDS deaths later, the Administration’s “war on AIDS” has been characterized by unilateralism, disregard for international consensus and corporate cronyism.

Rather than support existing and proven international programs to prevent and treat HIV/AIDS, the Bush plan has undercut and circumvented them at nearly every turn. It has reduced funding for the Global Fund to Fight AIDS, TB and Malaria from $550 million appropriated by Congress for 2004 to $200 million for 2005, a 64 percent reduction at a time when the fund desperately needs resources to make its fourth round of grants.

Although Bush quoted prices for generic versions of AIDS drugs in his announcement, in fact the first round of US grants under its PEPFAR program does not authorize the use of generics, instead favoring drugs from Western pharmaceutical companies at prices at least four times higher than the lowest-cost generics. Indeed, the Administration took the unusual step of calling a meeting of international health officials in Botswana to “debate” the safety and efficacy of fixed-dose combinations–generic drugs that combine several drugs in one easy-to-take pill. Such “medical” concerns, however, are merely an attempt to use sham science to protect Big Pharma–following earlier, failed attempts to use patent law to accomplish the same thing. Fixed-dose combinations have been screened and approved by the WHO in a rigorous prequalification process similar to the one used by the FDA to license fixed-dose combinations in the United States.

Fixed-dose generics are a crucial component of almost all international AIDS plans. For example, Médecins Sans Frontières has just launched an anti-retroviral treatment program at Bulawayo Hospital in Zimbabwe that uses fixed-dose combinations that cost $244 per patient, per year and require only two pills a day, purchased from Indian generic manufacturers. At the very same hospital, using the same treatment protocols and pharmacy, the Centers for Disease Control will launch a parallel program that, following Administration guidelines, will use six brand-name pills a day from three separate drug companies at a cost of $562 per patient, per year. By simply switching to fixed-dose generics, the United States could double the number of patients in treatment and reduce the number of pills, making compliance easier.

The Administration’s latest move, however, may have generated an international backlash. The Botswana meeting was boycotted by European health experts and decried by nongovernmental agencies, including the Catholic Relief Services Consortium, one of the current PEPFAR grantees. Even Richard Holbrooke, who represents 140 multinationals on the Global Business Coalition on HIV/AIDS, scolded Bush officials, saying that US protection of Big Pharma was “tearing apart all the good work that people are doing.” The Clinton Foundation, UNICEF, the World Bank and the Global Fund have just announced a collaborative initiative to buy massive quantities of fixed-dose generics for as low as $140 per person, per year as part of the WHO’s plan to treat 3 million people with AIDS by 2005. The international community is behind it, but the success of this plan largely depends on the Bush Administration. Will it pony up the US fair share of funding and authorize the use of generic drugs, or will it continue its go-it-alone, pro-drug industry policies?