In a deeply depressing announcement, the United Nations has conceded that its much-touted initiative to provide anti-retroviral treatment to millions of Africans with AIDS is doomed, given the lack of financial commitment from the industrialized world, especially the United States.
Because of lack of money, infrastructure problems and local resistance, 90 percent of those needing treatment in Africa are still without hope. Perhaps it is time to finally give up on the fund and open the door to a more thoughtful global response on AIDS.
The UN effort has become a cloak of illusory compassion for politicians to hide behind and a salve for Western guilt about the relative privilege of those who have access to HIV treatment in the United States.
We should abandon this well-meaning effort, face the horror that most of those now infected in Africa will probably die due to the greed of the industrialized world and salvage the remaining funds for a more useful goal–development of an effective HIV vaccine.
Efforts by the Western world to provide HIV treatment in Africa have been troubled from the very beginning. The problem was not, as first suggested, patient compliance with complicated treatment regimens. It has been shown that AIDS patients in Africa have a 90 percent compliance rate, as opposed to 70 percent or below in the United States.
The real problems have originated in the United States.
The U.S. pharmaceutical industry has used its powerful lobby to restrict generic versions of anti-retroviral drugs. Also, the Bush administration has pandered to conservative Christian forces that have blocked African organizations offering abortion and family planning services from receiving funding. With cultural imperatives emphasizing profit, abstinence and monogamy, the Bush administration has managed to derail prevention and service programs in Africa almost as effectively as it has in the United States.
President Bush has employed his favored political strategy to deal with AIDS–mouthing conservative compassion but providing, at best, indifference. Although Bush has promised to be the leader in the global AIDS fight by spending $15 billion in Africa and the Caribbean, he has not requested even the modest levels of funding authorized by Congress.
Facing increasing criticism for his deficit spending, the president is unlikely to push for the amount of money originally promised. Even if he does, America’s involvement in the Global Fund to Fight AIDS, Tuberculosis and Malaria has already been so tainted by drug company meddling and conservative Christian moralizing that the United States cannot serve as an effective leader in the coalition of nations.
There is a destructive tendency to equalize the different AIDS epidemics that span the globe. This simplification avoids developing strategies that will maximize scarce funds while acknowledging differing needs.
It is time to develop a strategy that benefits the supposedly privileged gay men in America dying of the disease while still providing benefits to those infected in other parts of the world. Even though the American and African epidemics are strikingly dissimilar, everyone lacks the one tool that might eventually end the epidemic: a vaccine.
Every empty gesture toward the epidemic in Africa allows the U.S. government to ignore the unique needs of those infected with HIV at home. We have been so eager to remind the public that “AIDS is no longer a gay disease” that we ignore Centers for Disease Control and Prevention statistics showing that it remains a predominantly gay disease in America and presents particular challenges here because of that fact.
$16 billion pledge
Most people have already forgotten that, in 2003, the president also pledged to spend $16 billion fighting the domestic AIDS crisis. Yet if this funding were used to develop more abstinence campaigns focused on heterosexual teenagers or to support drug companies’ development of more intricate treatments, the money would be wasted.
Gay men simply are not going to practice abstinence until marriage, and new drugs will be out of reach for the poorer populations now experiencing the greatest infection rates in America. Closeted black gay men with fewer financial resources have replaced middle-class white gay men as the primary demographic of the U.S. epidemic. It is estimated that 1 in 10 black gay men in America is HIV positive–an infection rate equaling rates found in Africa.
The idea that gay men in the United States have access to workable, long-term treatments is also a fallacy. The treatments that we are so eager to share with the world are toxic and disfiguring. They may delay death, but they do so at a very high price, in terms of dollars and quality of life.
Because AIDS was, until recently, a fatal disease even in the West, it is unsurprising that advocates would push for the immediacy of treatment, however flawed, rather than the long-term promise of a vaccine. Yet a vaccine that showed effectiveness against multiple strains of the HIV virus would provide immeasurable benefit globally.
Consider a $31 billion pool of funding–the totality of what the administration has stated it is committed to spending over the next five years on AIDS treatment and education, with $15 billion to be spent internationally and $16 billion on the home front–however unlikely it might be.
Rather than separating those dollars on mutually exclusive efforts domestically and internationally, imagine the impact of that funding if used almost exclusively on the development of effective HIV vaccines. It is hard to imagine that science could not respond given such largess.
The non-profit International AIDS Vaccine Initiative is the largest non-governmental organization in the world working on development of an AIDS vaccine. Their innovative and vital work remains comparatively underfunded given the amounts of money being spent on other AIDS efforts. The Vaccine Initiative still needs to raise $460 million in support of its goal of $600 million for vaccine development by 2008.
Beyond the Vaccine Initiative’s internal goals, the organization recommends that $1.1 billion more be spent globally to reach effective levels of research. AIDS is supposedly one of the world’s most dire health emergencies, but AIDS vaccine efforts amount to less than 1 percent of the global funds spent on drug research and development.
Tackling drug issue
The organization is not waiting for a vaccine to be approved to tackle the difficult issues that have stymied efforts to provide access to anti-retroviral drugs. Corporate entities such as pharmaceutical or biotech companies receiving funding from the Vaccine Initiative must sign an agreement that allows them to retain rights for vaccines in the industrial world but commits the companies to controlled costs in developing countries.
The organization is also working to adapt traditional vaccine delivery systems that have focused on adolescents and the unique needs of adults in countries without health-care infrastructures.
There is also the hope that a vaccine might provide therapeutic benefits to patients already infected with the disease. Although there is no scientific precedent for a vaccine providing therapeutic benefit, several AIDS vaccines in development show some promise in this area.
Many feel that turning away from anti-retroviral treatment and prioritizing vaccine development means heartlessly watching millions infected with HIV die.
However, it is far crueler to know that these people will die anyway while billions of dollars are wasted or never committed, even as politicians pose behind feeble programs. And when those millions die, millions more will be infected because the global vaccine plan remains underfunded.
