Originally published in the Online Journal, July 20, 2004.

Bush’s AIDS policy is a killer. AIDS took the lives of 3 million people since January of 2003, the majority of whom were in Africa. Nearly half were women. Yet Bush’s spending priorities to fight HIV infections and AIDS have allocated only $350 million of the highly publicized $15 billion he promised in his 2003 State of the Union speech. More interested in pushing a far-right agenda than in saving lives, Bush is presiding over one of the worst atrocities in human history. An assessment of the Bush administration’s AIDS policy shows that a far-right fundamentalist religious outlook subverts medical science for a racist, anti-gay, anti-woman agenda. Recently the administration has interwoven this dangerous worldview with the profit motive of large multinational pharmaceutical corporations. Finally, the administration has molded its general 'aid as imperialism' tactics to its AIDS policy. In other words, Bush uses anti-AIDS assistance to achieve certain foreign policy goals. As a result, this cynical president has overseen the deaths of millions and tens of millions more new infections.

Ideology Subverts Science

From its first day in office, an anti-condom policy has dominated many of the social policies of the Bush administration. In his 2000 campaign, Bush ran on an outspoken anti-choice, anti-gay platform in which he declared that he little in common politically with gays and lesbians and therefore they wouldn’t find a place in his administration. This thinking flowed from his Christian right-wing fundamentalism and was common to many of his religious backers in the Christian Coalition and other far-right think tanks like the American Family Association. Many of these groups blame lesbians and gays for the social ills of the country. So it wasn’t a shock when Bush adopted the 'global gag rule' on his first day in office.

The global gag rule, originally instituted by Reagan and removed by Clinton, is a funding condition that requires international programs that receive money from the US Agency for International Development (USAID) not to provide abortion-related services. This includes providing education about safe sex or contraception. The International Planned Parenthood Federation called it a signal of 'the Bush administration’s war against women and his overall contempt for their fundamental civil and human rights.'

While the 'global gag rule' is rightly seen as an attack on women’s reproductive rights, it also has dramatically affected social service organizations that educate local communities on preventing sexually transmitted diseases including HIV/AIDS. The administration used the rule to withdraw USAID funding from groups that provided abortion counseling, but it also used the rule to badger organizations that provided sex education into adding abstinence components to their programs. From the start, the administration, following a religious ideology that opposes reproductive choice and contraception instead of sound medicine, worked to supplant the accepted practice of promoting consistent condom use as the best defense against HIV and other STDs with faulty and dangerous abstinence indoctrination.

The religiously motivated abstinence doctrine has been universally condemned. Erica Smiley of Choice USA, a reproductive rights advocacy group for young women, described it as 'a huge disregard for democracy in other nations' because it imposes Bush’s religious views on people elsewhere. She also pointed out that it dramatically affects the ability to prevent HIV/AIDS as it froze millions in USAID funding that went directly into the distribution of condoms in countries hit hardest by HIV infections. Paul Nielson of the UN Commission for Development and Humanitarian Aid also blasted Bush’s abstinence policy as dangerous to women’s lives and as likely to result in 'weaken[ing] the battle against AIDS.' Dr. Peter Piot of UN AIDS asserted further that 'We are not in the business of morality.'

Right-wing Christian morality is the motor of the administration’s policy. Bush didn’t limit his agenda to the abstinence doctrine, however. In May of 2002 the administration, while attending the UN Children’s Summit, opposed the inclusion of language recommending condom use for the prevention of HIV/AIDS and demanded that this international summit promote abstinence programs. That summer Bush withdrew $34 million from the UN Population Fund asserting a similar argument as the 'global gag order.' As a result several AIDS prevention programs in African countries were forced to close. Weeks later, Bush withheld $200 million earmarked by Congress for programs in Afghanistan that included sex education and condom distribution as part of HIV/AIDS prevention.

At the UN Asian and Pacific Regional Population conference in December of 2003, the Bush administration exerted its abstinence ideology using its economic muscle. One participant at the conference is quoted as saying that between sessions of the conference 'we witnessed the US delegation threatening at least one high-level Asian delegate with his country’s loss of US foreign aid and the loss of his career' if he didn’t support the US agenda. The Bush administration delegation wanted to remove a recommendation of consistent condom use as an effective measure against HIV infections in favor of promoting abstinence.

This last week, the Bush administration provoked another controversy of the same brand at the 15th International Conference on AIDS in Bangkok, Thailand. First, the administration withdrew huge sums of money allocated to fund the participation of dozens of American experts at the conference in order to tighten the discipline on the pro-abstinence, anti-condom line. An international furor was sparked as a result. UN Secretary General Kofi Annan called on the world, with an implicit gesture to the Bush administration, to follow through on their pledges to fund the fight against AIDS fully. Rep. Barbara Lee (D-CA) accused the administration of undermining the fight against AIDS by pushing failed abstinence programs and drawing money away from condom distribution efforts.

Bush’s prioritization of ideology over medical science has been the major influence on his choice of political appointees. Among his first appointees in 2001 was Jerry Thacker, a former employee of Bob Jones University who described AIDS as a 'gay plague' and homosexuality as a 'deathstyle.' Bush withdrew Thacker after a heated controversy, but the anti-gay ideological component remained. In the summer of 2003, Bush appointed pharmaceutical executive and Republican Party booster Randall Tobias to head the President’s Emergency Plan for AIDS (the promised $15 billion fund). While Tobias seems most concerned with pressing a corporate agenda, he has done nothing to reverse the administration’s anti-science trend.

The preference for appointing anti-science ideologues sparked the Union of Concerned Scientists to circulate a petition with the support of over 4,000 scientists calling for 'the restoration of scientific integrity in federal policymaking.' Scientists have accused the administration of systematically, in many fields of scientific work, interfering with research and distorting science to serve its ideological ends. None of this culture of interference has had more impact than on the question of the prevention of HIV/AIDS.

Most recently Bush appointees in the Center for Disease Control, under the direction of the Department of Health and Human Services, altered federal regulations regarding funding for HIV/AIDS prevention education programs in the US. The goal, according to Doug Ireland, is to eliminate funding for community and school-based programs that promote condom use as the best method of HIV/AIDS prevention in favor of 'failed programs that denounce condom use, while teaching abstinence as the only way to prevent the spread of AIDS.' Additionally, the administration wants political appointees to screen all educational materials generated by programs that receive federal funding for 3 main things. First, they must advocate abstinence as the best method of prevention; second, they must inaccurately characterize condoms as less effective than abstinence education; and finally, they must adhere to moralistic guidelines about 'obscenity' and be void of 'sexual suggestiveness.' Main targets of these guidelines are programs that teach proper and consistent use of condoms. Since, in the view of the Bush administration, teaching condom use is the same as promoting sexual activity, we can expect the administration arbitrarily to force sex education programs to either emphasize abstinence and downplay or demonize condom use in order to keep funding or search for limited private sources. If Bush’s preference for shifting federal resources toward private, religious charities is any sign, more and more money will continue to be shifted away from sex education and prevention programs that work to abstinence-oriented and abstinence-only programs.

The main problem with abstinence programs, like other areas of Bush administration politicized science, is that they don’t work. At least three major studies have shown abstinence programs – especially abstinence-only programs – fail to convince youth to avoid sex until they are married. Some 88 percent of youth who made a pledge to avoid sex until marriage as part of an abstinence program, according to a Columbia University study, broke the pledge. Sexual activity among abstinence students actually increased dramatically. Because they weren’t taught condom use, youth who went through such programs were one-third more times as likely to have unprotected sex, reported a study published in the American Journal of Sociology. But the CDC rules elevate abstinence above the medically sound principle of condom use as the best preventative measure against HIV infection and the spread of AIDS.

Corporate Agenda is Job One

Despite research completed in June by Doctors Without borders and the University of Montpellier's Research Institute for Development in France showing generic so-called 3-in-1 anti-AIDS drugs to be as effective in fighting the disease as costlier brand name drugs, a group aligned with the Bush administration attacked makers of generic AIDS drugs at the recent international conference in Bangkok, Thailand. Agence France-Presse reported that an advisor of Bush heads this group which took out a full-page ad in the Bangkok Post. The Bush-affiliated group, in an effort to influence the outcome of the conference – numerous international conferences have in recent years usually have pitted the Bush people against the world and the international scientific community – attacked Cipla, an India-based company that made the 3-in-1 drugs. Bush’s people described the drug as ineffective and unsafe. What is most disturbing to the Bush administration is that Cipla and other generic producers may reduce the annual cost of anti-AIDS drugs from around $10,000 to just several hundred dollars per person.

The administration’s response to its critics has been to demand that the world look at its financial 'generosity' in contributing to the fight against AIDS. Indeed in his 2003 promise to deliver $15 billion over the next five years, Bush seemed to make a break from the slow-moving, underfunded policies of previous presidents. Closer scrutiny of the reality behind the public relations promise shows a return to the dangerous Reagan days.

Only $350 million in new money of the $15 billion had been disbursed in the year and a half since the promise even though Congress made $2.4 billion available. A $500 million payment to the Global Fund to Fight AIDS, the acclaimed UN-related multilaterally controlled fund organized in the 1990s to deliver large scale treatment and prevention resources to hardest hit regions, in June was 'late money,' according to Salih Booker of Africa Action. This money had been promised in 2003 and allocated in the 2004 budget. Bush seemed to wait for a useful photo opportunity to make a delivery of the payment, which coincidentally took place just about 15 days before the 15th International Conference on AIDS. The late delivery was an attempt to stifle criticism from the international community over controversial aspects of the Bush AIDS policy.

Meanwhile, the amount contributed to the Global Fund to Fight AIDS will shrink by 64 percent next year, prompting some anti-AIDS activists to predict the funds impending bankruptcy. Bush’s $15 billion promise, says Paul Davis of Health GAP, is far short of what is needed. '[H]is five-year plan to treat 2 million people,' insists Davis, 'means that 13 to 15 million people with AIDS will die during that same time period.' Health GAP argues that the US needs to chip in about $30 billion over the same period to fight the disease adequately.

Delaying delivery of resources, drugs, treatments, and research has been the hallmark of the Bush policy on AIDS since 2003. First, the administration’s grants made through the $15 billion fund provided no money to purchase generic drugs. When that proved to be unpopular, the administration developed a 'let’s research and hold conferences about generic drugs' approach, meanwhile AIDS patients died. Then, last May, the administration promised to speed up the approval of generic drugs by asking the US Food and Drug Administration (FDA) to oversee the approval process. The problem is that the World Health Organization (WHO) had already undertaken most of the work Bush planned to hand over to the FDA. This proposal to duplicate WHO’s work delayed the delivery process further and paralleled the administration’s unilateralist approach to most major international issues; more AIDS patients died. According to Jim Lobe, writing for Foreign Policy in Focus, Bush’s struggle over unilateral control of the global AIDS policy costs the lives of 8,000 people a day. According to UN estimates, 25 million of the 38 million infected with HIV worldwide live in southern Africa, while 7.6 million people living in Asia are infected.

The delay of resources cost lives, but in the Bush administration’s view it serves a useful corporate purpose. Jen Cohn of Health GAP was quoted as pointing out that 'By creating a parallel process, they’re making it much more expensive and time-consuming…. By forcing the generic manufacturers to go through more hoops, they’re ensuring Big Pharma…will get market share before generics get on the scene.' The Tobias appointment was crucial in the development of these tactics.

By the time the administration’s delegation arrived in Bangkok last weekend (July 11), the delay strategy was scrapped for an all out assault on generic manufacturers. Perhaps, the administration plans simply to wield its large financial stick to force the international community to do what it wants. Or perhaps it has deployed the anti-generic movement as a means of giving its more 'moderate' delay tactics and anti-science ideology time to appear as a rational alternative and gain acceptance from sections of the international community.

To the present moment, religion and corporate profits have served as the ideological and economic bases for the Bush policy on AIDS. The main barrier to maximizing the effect of the policy is the international community. To sidestep the world, Bush has adopted a program of trying to bankrupt the multilateral organizations developed over the last two decades in the UN. He is fighting to replace multilateral oversight over sex education, prevention of infection, and treatment of AIDS with his unilateralist approach akin, in his words, to the 'war on terror,' which The Nation editors recently noted has having failed so miserably. Far from an emergency plan, the Bush AIDS plan is another tool to promote a foreign policy of providing aid to his friends and forcing his enemies into greater carnage.

Two years ago prominent economist Jeffrey Sachs, now a special adviser to UN Secretary General Kofi Annan, called on African countries to unilaterally cancel their debt and redirect the resources used for debt servicing to fight AIDS among other pressing domestic needs. Sachs’ call needs to be revisited. The call for funding generics with oversight and approval through existing UN organizations should be supported. Most of all, we need an administration that will fully fund the Global Fund and will value people’s lives over corporate profits and religious ideology.

We need an administration that isn’t racist and homophobic and will follow scientific guidelines for the prevention and treatment of the disease. We need an administration that will regard the AIDS pandemic as a crisis not a source of profits, which currently afflicts nearly 40 million people – 4 of 5 of whom live in Asia or Africa. We need an administration that will allocate the $30 billion most anti-AIDS activists and scientists believe will be necessary to fight the disease adequately over the next 5 years. We need an administration that will fight for cheaper generic drugs that have already been proven to work against the disease and are already saving lives. We need an administration that will promote effective preventative measures like condom use. We need an administration willing to work with, not against, the international community to move the most resources to hardest hit regions and not use AIDS money as a cynical and deadly foreign policy tactic. We need to dump Bush in order to move forward against AIDS.



--Joel Wendland is managing editor of Political Affairs and can be reached at jwendland@politialaffairs.net.



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