TCS Daily


The Other Bush War

By Abner Mason - March 24, 2003 12:00 AM

The volume of commentary on the Bush administration's policy to lead the effort to disarm Iraq has overshadowed the other global fight President Bush has decided to lead, the war against HIV.

President Bush's Emergency Plan for AIDS Relief is a humanitarian relief effort of a scale never before attempted by any leader, of any nation, to benefit people of other nations. Given the magnitude of the devastation this epidemic has caused, and the continued threat it poses, a commensurate response is required.

But no matter how desperate the need is for a relief program of the scale Bush has proposed, there is no inexorable law that guarantees the existence of a nation with the resources and political leadership to provide it. This is a time when some people are anxious about the worldwide dominance of US power and wealth, particularly as exercised by the Bush Administration. But for those of us who understand the importance of waging a real war against HIV, and the risk associated with continued delay, we are grateful for America's wealth, generosity and political leadership.

AIDS is a monumental human tragedy. More than 60 million people have been infected with the deadly AIDS virus - 20 million are already dead. More than half of the 40 million people infected with HIV live in sub-Saharan Africa. If effective action is not taken soon in India and China, we could see a repeat of the African tragedy. Worldwide, if current rates of infection continue, 45 million more people will become infected by 2010. In the hardest hit regions of the world, decades of economic progress have been reversed, 14 million children have been orphaned and food production has plummeted causing famine. In addition to the human suffering involved, destabilization of this magnitude is a threat to the national security of nations around the world.

The AIDS epidemic is an international crisis that demands an effective response. President Bush's Emergency Plan for AIDS Relief is such a response. Bush proposes to spend $15 billion over five years to fight the epidemic in 14 countries in Africa and the Caribbean. Fifty percent of people infected worldwide live in these countries. The major focus of the plan is to provide life saving anti-retroviral treatment to people who need it. The Plan aims to provide this treatment to 2 million HIV infected people, prevent 7 million new infections and to care for 10 million infected people and AIDS orphans. In addition, $1 billion would go to the recently created Global Fund for AIDS, Malaria, and Tuberculosis. Bush's Secretary of Health and Human Services has recently accepted the Chairmanship of the Fund - signaling renewed U.S. commitment to its success.

Bush's decision to provide anti-retroviral treatment to some of the poorest people in the world is particularly significant. There has been much debate about whether treatment in poor countries was possible and, if so, was it worth the enormous cost. The Bush Plan has once and for all resolved the treatment question while simultaneously making available a significant portion of the funds necessary to provide it. Years from now we will look back at the treatment debate and wonder how we could ever have found it acceptable to withhold life saving drugs from so many in need. Thankfully, Bush's decision has almost overnight made such thinking a thing of the past. In the fight against AIDS, leadership truly does matter.

The focus on treatment also highlights one of the few bright spots in the fight against AIDS, the extraordinary success of drug treatment. Advances in the development of effective drugs have brought hope where there was once only despair. Many of us have seen friends on the verge of death from AIDS, seeming snatched from its clutches by anti-retroviral drugs. And thousands more have been spared the sickness that comes with AIDS because they began treatment early. With this progress comes the threat of increasing drug resistance, which is why it is so important for policy makers to ensure that pharmaceutical manufacturers get the support they need to develop more and better drugs to treat HIV.

Although treatment is the appropriate strategy, getting it to the people who need it will not be easy. In Africa today, fewer than 50,000 infected people are receiving anti-retroviral treatment. None with U.S. taxpayer funds. The barriers to treatment in such poor countries are complex, and not easily overcome. They include; uncooperative governments, a lack of clean water, little healthcare infrastructure, few trained healthcare workers, drug costs, few secure drug distribution channels, rampant fraud and cultural barriers. In addition, we have very little experience providing this kind of relatively complex treatment in such environments. Unlike other successful vaccine programs which required giving one shot one time, HIV treatment requires testing to determine HIV status and, if positive, a drug regimen of many pills that must be taken once and sometimes twice day, until a cure is found. For healthcare planners and providers, these are uncharted waters and there will no doubt be unforeseen problems and setbacks. That is why the President's leadership is just as important as the resources he seeks to provide. The global fight against AIDS is not a battle; it is a war that, in addition to resources, requires a focused and continued commitment to achieve results. As he has shown with the effort to disarm Iraq, this is the kind of persistence this President possesses in abundance.

A policy proposal of this magnitude will have political ramifications. Here at home, the anti-Bush left is still struggling to fit the President's AIDS plan into their worldview. Many of them simply cannot believe that during a time of sluggish economic growth, rising federal deficits, imminent war abroad and the threat of terrorism here at home, a conservative President would lead an unprecedented effort to help the poorest people of Africa.

On the international front, Bush's proposal has dramatically raised the bar for other wealthy nations. After years of too much talk and too little action, it is now time for those who can to match their words with deeds. As for the growing multi-lateralist crowd here and abroad, we should all be glad the President didn't heed their advice and wait for the French and the Germans to do their share before deciding to lead this war. People who suffer from AIDS in Africa certainly are.

So the decision has been made. America will lead the global fight against HIV. As we begin what some have called the new period of American "empire", it is not only non-Americans who are concerned about the unprecedented extent to which America dominates the world militarily, financially and culturally. Many Americans are also conflicted about our new role. History will be the ultimate judge of how justly we exercised our power. But we won't have to wait that long to be certain of one thing: When it comes to the global fight against AIDS, Americans have good reason to be proud of our nation's commitment to fighting and winning this war.

Abner Mason is Executive Director of the AIDS Responsibility Project. He also Chairs the International Committee for the Presidential Advisory Council on HIV/AIDS.
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