How to Waste a $15Bn Opportunity: George Bush and Tony Blair Have a Lot of Money to Spend on Aids in the Developing World-But Don't Expect Them to Take Advice from the Experts

Article excerpt

Pity the ministers and officials who have to sustain Tony Blair's rosy vision of the special relationship. First there was climate change. Then came the war and British detainees in Guantanamo. Now there is an issue where hundreds of thousands of lives are at stake--Aids in the developing world.

The United States and Britain are the world's biggest Aids donors. George W Bush has committed $15bn over five years, and Gordon Brown has just come up with [pounds sterling]1.5bn over the next three. These are huge sums, and there is big influence to match. When Bush and Blair sat down in Downing Street last November and gave some time to the Aids issue, they also agreed on a joint task force to co-ordinate their approach. Since then, both the US and the UK have come out with strategies for how to spend the money. They certainly appear to be discussing the same epidemic and they agree on the statistics. But there the meeting of minds ends. Their Aids policy-makers inhabit different planets.

The first thing to note about the two strategy documents is the pictures. In the president's Emergency Plan for Aids Relief there are 13. Nine are of George and Laura Bush and two are of Randall Tobias, the former pharmaceutical industry boss who is running America's Aids programme. This leaves two pictures for people out there in the real Aids world.

The British document, Taking Action, has a foreword by Blair, but no photographs of him. The illustrations have a documentary feel--an Aids funeral in Zambia; a home for destitute women in India. Some would not meet with Washington's approval. There is one of a needle exchange in Kiev and two of condoms being handed out in India. The cover picture is of an Indian health volunteer demonstrating how a condom works to a female labourer in Tamil Nadu. This would outrage the Bush people.

After promoting condoms around the developing world for decades in response to population worries, the Americans under Bush have taken against them just as they are most needed. Under the influence of the Christian right and its congressional allies, the Bush document spells out the new policy. Condoms are to be distributed only to so-called high-risk groups--prostitutes, drug users and couples where one partner is HIV-positive--while others must either abstain from sex, in the case of young unmarrieds, or remain faithful, in the case of marrieds. As an approach to Aids, it is untested and unrealistic, and it will lead to confusion and possibly disaster in the 15 countries, 12 of them African, where the US is spending its $15bn.

Taking Action, by contrast, points out that Britain once had a good record in containing Aids at home through awareness campaigns and initiatives such as clean-needle exchanges. US policy prohibits needle exchange. According to the latest figures, the US has an Aids prevalence rate six times that of our own. Attitudes towards prostitution further divide the British and Americans. The British support programmes among developing world sex workers, a disadvantaged group at immediate risk both of infection and of spreading HIV. Specifically, they encourage women to insist that clients use condoms. The Americans say they want to increase condom distribution around brothels, but also stipulate they will fund only organisations that explicitly oppose prostitution. Excellent charities in poor countries are having to revise principles if they want US dollars.

Such moralising towards sex would be bad enough. But the Bush administration approach to the Aids disaster is flawed in other ways. The US pharmaceutical industry breathed easy when President Bush appointed one of its own, Randall Tobias, former head of Eli Lilly, as his global Aids co-ordinator. To be fair, Tobias has shown some inclination to balance the interests of US pharmaceutical giants with those of the developing world, particularly over the question of cheap copies of expensive American drugs. …