It’s time to be even more generous on AIDS

Spending on HIV/AIDS has become a litmus test of the depth of international commitment to helping the developing world — and of the spirit of generosity in which is offered.

Former South African President Nelson Mandela was in apocalyptic mood last week when he addressed an international meeting in Paris on recent research into HIV/AIDS. Mandela complained bitterly that the world had failed to translate improved scientific research into action to combat the disease. And he described the number of sufferers, especially in the developing world — where 3.2 million died from the disease in 2002 alone, and 5 million become HIV positive in the same period — as a travesty of human rights.

If the numbers are vast — sometimes too vast to comprehend easily — so is the size of the war-chest required to fight the disease. Earlier this year, US President George W Bush made a bid for the moral high ground (and hoped to repair some of his county’s tarnished image in the developing world) when he committed the United States to providing US$15 billion over the next five years to combating AIDS in Africa and the Caribbean. Separately, the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was set up three years ago by the G8 industrial nations, wants to spend US$6 billion to meet on research and other projects to combat these diseases.

Not surprisingly, such figures have been difficult to swallow for some developed countries, particularly those currently facing difficult economic circumstances and tough restrictions on public spending. The German government, for example, has been struggling to find ways of making a commitment to the Global Fund that is comparable to that of the United States. So far, despite currently spending €300 million a year on AIDS, it has only provided €50 million to the Global Fund — placing Germany among other European countries that have failed to make a comparable commitment to the United States.

Yet however high the cost of fighting AIDS appears on paper, the total cost remains relatively small in terms of overall public spending. As economist Jeffrey Sachs, the director of Columbia University’s Earth Institute, points out, the contribution being asked of Europe towards this fight amounts to little more than US$3 a year from each individual — about the price of a glass of beer. Similarly the US$15 billion promised by George W Bush over five years needs to be compared to the US$3.9 billion a month that is being spent by the United States in maintaining their forces in Iraq. That is where Mandela’s travesty lies.

The need for political generosity

In such circumstances, all of the developed world — despite the apparently high level of its current commitments — can justifiably be criticised for still not doing enough. This becomes clear once the HIV/AIDS crisis is put in its true perspective. If the crisis is not contained, it threatens not only to undo the achievements of decades of development assistance, but also to sink vast parts of the developing world into a permanent mire of poverty and chronic underdevelopment.

Financial generosity is, admittedly, only part of the picture. It is also important that the money being provided to tackle the AIDS crisis is offered in a spirit of political generosity as well, and not merely one of political self-interest. This means a willingness to accept the need to respect the fact that AIDS will only be successfully tackled if it is done so within the frameworks offered by national — and even local — health and economic systems.

The challenge here is, in many ways, just as daunting as that of persuading Europeans to forego their single glass of beer. There have, for example, recently been reports from China that government officials have been using considerable levels of violence in suppressing protests by AIDS victims that they have not been receiving promised assistance. This has been despite the fact that the most prominent cause of the spread of AIDS has been the unsanitary conditions under which government-sponsored blood collection campaigns have been carried out.

It is not unreasonable to demand more enlightened treatment of AIDS sufferers by the Chinese authorities in return for external assistance in tackling the problem (China currently has a request for US$100 million being considered by the Global Fund). Achieving this, however, will required a delicate balance of carrot and stick — similar to that successfully used on the case of the SARS epidemic — as well as the sophisticated diplomatic skills required to avoid treading excessively on issues of national sovereignty.

Justifiable caution

There are similar challenges in ensuring that money allocated for AIDS prevention and treatment is properly spent. In Kenya, for example, several individuals responsible for organisations set up with Western funds to treat and care for AIDS patients are reported to have disappeared with the money they were given. The organisations concerned are not large, and their number is relatively small compared to those that work honestly and effectively. But they provide ammunition for those who argue that the AIDS problem is not going to be solved just by throwing money at it; equal attention must be paid to ensuring that the money is spent effectively.

Such events give legitimate cause for caution. Conventional demands for honest behaviour — or, for that matter, for respect for human dignity — must not be ignored in tackling the AIDS crisis. Ensuring that they are acknowledged, yet at the same time that the crisis is handled effectively, is a significant diplomatic challenge. And there may be times (as there were with the SARS epidemic) when external political pressure is necessary to achieve this.

But that does not mean that the ends justify the means. Considerable concern has been expressed by AIDS pressure groups that — in line with conventional US thinking about how aid money in general should be spent — much of the money being committed by President Bush for anti-retroviral drugs will go on purchasing the products of its major pharmaceutical companies, rather than cheaper, generic alternatives being produced in countries such as India and Brazil (US officials now say that the money they will provide can be used to purchase generics). And pressure from anti-abortion groups has led to a decision that at least one-third of the US money used on the prevention of HIV must be spent by on promoting abstinence rather than safe sex, despite the scepticism of most AIDS campaigners that this is an effective strategy.

The threat therefore remains that tackling the AIDS crisis will be exploited as an opportunity by certain groups to pursue agendas that have little to do with preventing the spread of the disease. That is where the need for political generosity — a willingness on the part of donors to accept projects based on concepts that they may disagree with comes in (for example, in a willingness to relax the restrictions on the use of intellectual property in order to achieve significant reductions in the price of anti-AIDS drugs).

At the end of the day, however, political generosity needs to be expressed in hard cash. A failure to deliver on commitments already made — the price of just one glass of beer from everyone in the developed world — will be the biggest travesty of all.