Wednesday, September 17, 2003

During his state of the union address in January, some people lauded President Bush for his promise to spend $15 billion over the next five years to fight AIDS in Africa. At the time, I said they were nice words, but that I'd withhold plaudits until they money was actually spent and programs actually implemented. Experience has shown me that state of the union addresses (like state of state) are about grand rhetoric, with few of the always numerous proposals truly followed through upon with the full weight of the White House. This has been the case regardless of who's president. Presidents want to get the spotlight of feel-good press and hope that people will forget about it once the shine of the moment is off. The AIDS promise was always going to have trouble sticking in the public's memory because they were followed by the more dramatic (to us) part on Iraq. The non-governmental organization Africa Action issued its assessment of the president's promises on AIDS-HIV and how that's translated, or not, into reality. Since there's been little media follow-up on the issue, it's useful to know how this has played out, lest the president get undue credit for his words rather than his actions.

From Africa Action

Since his State of the Union address in January 2003, President Bush has
reaped great public relations benefits by parading himself as a
compassionate conservative, committed to helping the people of Africa
defeat AIDS. But the reality is very different.

When he traveled to the continent in July 2003, Bush repeatedly emphasized
how much his Administration was doing to fight the AIDS crisis. And on the
domestic front, the President has said that his Administration remains
committed to confronting AIDS in the U.S. But President Bush's track
record on AIDS policy reveals a litany of broken promises and betrayals.

The President has misrepresented the actions of his Administration. He has
misled the American public, and he has failed the people of Africa. Bush's
broken promises are costing thousands of African lives every day.

The following talking points include quotes from the President, promising
leadership in the war on AIDS. These are followed by facts about the
reality of his Administration's policies.

Emergency Plan for AIDS Relief (2003)


"To meet a severe and urgent crisis abroad, tonight I propose the Emergency
Plan for AIDS Relief, a work of mercy beyond all current international
efforts to help the people of Africa...I ask the Congress to commit $15
billion over the next five years, including nearly $10 billion in new
money, to turn the tide against AIDS in the most afflicted nations of
Africa and the Caribbean." (State of the Union address, January 28, 2003)

"Next week, I will go to Africa to meet with leaders of African countries
and with some of the heroic men and women who are caring for the sick and
are saving lives...They deserve our help, without delay. And they will
have our help." (White House news conference, July 7, 2003)


* The AIDS plan announced in the State of the Union address in January
2003 was not an emergency plan. President Bush requested NO new money for
this initiative for the entire year of 2003.

* President Bush promised $15 billion over 5 years, or $3 billion a year,
for his new AIDS initiative. But in his budget request for 2004, unveiled
the week following his promises, Bush asked for less than half a million
dollars ($450 million) for next year for this initiative.

* Instead of the $3 billion per year over 5 years that was promised, most
of the money for the AIDS plan will not even be requested until 2005 and
beyond. This is after Bush's term in office will have ended, so there is
no guarantee this will be requested at all. Even more importantly, this
deadly delay will cost millions of African lives.

* The focus of the new AIDS initiative is not really on Africa and the
Caribbean. The White House has clarified that the $15 billion will include
all U.S. funding for AIDS globally. In July 2003, President Bush said the
initiative he announced in January was to fight AIDS abroad , breaking his
own promise that it would be for Africa and the Caribbean. This means that
whatever amount of money is appropriated for AIDS, Africa will get far less
than promised.

* In July 2003, the White House specifically asked Congress to limit AIDS
funding for next year. President Bush intervened during the budget process
to urge Congress not to spend the $3 billion that was being considered at
that time. This was after Bush had returned from Africa, where he had seen
first-hand the devastation caused by AIDS and where he had repeatedly
promised U.S. support for African efforts to fight AIDS.

The Global Fund to fight HIV/AIDS, Tuberculosis & Malaria


"The devastation across the globe left by AIDS, malaria, tuberculosis, and
the sheer number of those infected and dying is almost beyond
comprehension...The United States is committed to working with other
nations to reduce suffering and to spare lives. And working together is the
key. Only through sustained and focused international cooperation can we
address problems so grave and suffering so great." (Rose Garden Ceremony,
with United Nations Secretary General Kofi Annan and Nigerian President
Olusegun Obasanjo, May 11, 2001)


* In 2001, President Bush supported the creation of the Global Fund to
fight HIV/AIDS, Tuberculosis and Malaria. But his Administration has
consistently undermined the effectiveness of this important vehicle by
refusing to pay the U.S. fair share, leaving it severely under-funded.

* The U.S. has contributed only an average of $200 million a year to the
Global Fund since it was created in 2001. An equitable contribution to the
Global Fund from the U.S., based on the U.S. share of the global economy,
would be $3.5 billion per year. In contrast, the U.S. is spending more
than $1 billion a week on the war and occupation in Iraq.

* President Bush said in January 2003 that the U.S. was committed to
leading the world in the fight against AIDS. But he continues to neglect
the best way to address the AIDS crisis -- the Global Fund to fight
HIV/AIDS. Bush has pledged only $200 million per year over the next 5
years to the Global Fund as part of his Emergency Plan for AIDS Relief .

* U.S. Secretary for Health and Human Services, Tommy Thompson, is chair
of the Board of Directors of the Global Fund. Yet the Global Fund is
running out of money because the U.S. is failing either to contribute its
share of resources or to act responsibly as Board chair and implement a
fundraising plan for this crucial vehicle.

* To coordinate his new AIDS initiative, President Bush is creating a new
U.S. government bureaucracy that will compete directly with the Global
Fund. This bilateral approach breaks Bush's earlier promise to support
multilateral efforts to fight AIDS. This new U.S. agency will take money
away from the Global Fund. It is also less efficient, with ten times as
much overhead , or administrative costs, as the Global Fund. It is to be
headed by a former Drug company executive, Randall Tobias, of Eli Lilly & Co.

* While President Bush's AIDS plan is unlikely to be up and running until
at least 2005, the Global Fund is already operational and it can save lives
NOW. U.S. contributions to the Global Fund will leverage billions of
dollars from other donors. By refusing to support the important work of
the Global Fund, President Bush is undermining international efforts to
defeat AIDS and betraying those on the frontlines fighting this pandemic in

HIV/AIDS Treatment


"Anti-retroviral drugs can extend life for many years. And the cost of
these drugs has dropped from $12,000 a year to under $300 a year -- which
places a tremendous possibility within our grasp." (State of the Union
address, January 28, 2003)

"We'll work quickly to get help to the people who need it most by
purchasing low-cost anti-retroviral medications and other drugs that are
needed to save lives." (White House Ceremony, announcing the appointment of
the new Global AIDS Coordinator, The Roosevelt Room, July 2, 2003)


* In 2001, the member countries of the World Trade Organization (WTO),
including the U.S., adopted the Doha Declaration, which declared that
patents on drugs should not be allowed to hinder poor countriesaccess to
essential medicines. But since this time, the U.S. has consistently
blocked efforts to relax patent rules and facilitate African
countries' access to anti-AIDS drugs and other essential medicines. The
agreement reached in Geneva in August 2003 still imposes extremely
complicated procedures designed to protect patent rights, which leave
enormous obstacles to overcome before affordable medicines are actually
made available in Africa.

* The Bush Administration's close ties to the pharmaceutical industry have
meant that U.S. policies continue to support the interests of the powerful
pharmaceutical lobby to keep their profits high. This betrays the efforts
of African countries to secure affordable access to essential HIV/AIDS
treatments for their people. The pharmaceutical industry is one of the
largest contributors to the Republican party.

* President Bush named a pharmaceutical executive, Randall Tobias, as the
Coordinator of the new AIDS initiative that was announced earlier this
year. Tobias has no experience in public health or international affairs
he represents the pharmaceutical industry, which has sought to deny
Africans access to essential drugs. One prominent example of such was the
lawsuit brought against Nelson Mandela by several major pharmaceutical
companies in the 1990s, which sought to prevent the South African
government gaining access to essential anti-AIDS treatment for its
people. This suit was only withdrawn in 2001 under international pressure.

* The choice of Randall Tobias by Bush reveals his allegiance to the
pharmaceutical companies and breaks the promise he made that the U.S. would
promote low-cost anti-AIDS drugs.

* In June 2001, the Administrator of USAID, Andrew Natsios, said that AIDS
treatments would not work in Africa because Africans don't know what
Western time is. He used this racist and ignorant logic to oppose the
provision of essential treatments to people living with HIV/AIDS in
Africa. Africa Action wrote to Secretary of State Colin Powell
(Natsios' boss) to demand a retraction, and to call for
Natsios' dismissal. But the Bush Administration issued no retraction or

* The Bush Administration continues to stall on providing low-cost AIDS
treatments to African countries, claiming that inadequate infrastructure
means that funding for treatment must wait. But treatment programs
throughout Africa need money now. The solution to weak infrastructure is
urgent investments to improve capacity. These delays in extending
treatment access are costing thousands of African lives every day.

* The Bush Administration supports conservative measures that undermine a
comprehensive response to the AIDS crisis in Africa. These include
emphasizing abstinence-only measures, prioritizing prevention over
treatment, and opposing the use of condoms. This emphasis on
fundamentalist ideology over science and public health represents a
dangerous step backward in the fight against AIDS.

Domestic HIV/ AIDS Programs


"We have confronted, and will continue to confront, HIV/AIDS in our own
country." (State of the Union address, January 28, 2003)


* As the HIV/AIDS crisis in the U.S. continues to grow, the Bush
Administration is failing to show leadership to address this urgent
situation. For the past 3 years, the Bush Administration has essentially
flat-funded domestic HIV/AIDS prevention and treatment programs.

* The CDC has stated that there are more than 40,000 new HIV infections in
the U.S. each year, half of these under the age of 24. A 2003 study from
Emory University has said that failure to reduce HIV infections by 50% in
the next two years could cost this country more than $18
billion. President Bush's budget request for 2004 cut $4 million from
domestic HIV/AIDS prevention programs.

* The 2004 budget request flat-funded the Minority AIDS Initiative, which
provides essential funding to organizations addressing the HIV/AIDS crisis
in communities of color across the U.S. There is a growing demand for
funding for this initiative, but the Bush Administration continues to
ignore this reality. More than half of all new HIV infections in this
country are occurring among Black people.

* President Bush's budget request for 2004 proposed only a small ($5
million) increase in the Housing Opportunities for People with AIDS (HOPWA)
program, although the demand for this program has grown dramatically, and
more funding is needed urgently. The CDC estimates that there are
currently 900,000 people living with HIV/AIDS in the U.S. The total number
of people living with HIV domestically increased by 33% between 1996 and

* The 2004 budget request contained an inadequate increase (only $100
million) for the AIDS Drug Assistance Programs (ADAP), but this is far less
than what is needed. Already 13 of these programs around the country have
had to limit access to anti-retroviral treatments or close enrollment to
new clients altogether because of inadequate funding. Another 7 programs
have reported they are likely to have to undertake similar measures in the
next year.

* The Bush Administration remains committed to an abstinence only policy
when it comes to education about HIV/AIDS and STDs. Many AIDS advocacy and
AIDS service organizations have expressed grave concerns about an approach
that places political ideology over science and public health. Public
health experts emphasize that a comprehensive approach to HIV/AIDS
prevention must include education about condom use.

* The federal ban on funding for needle exchange programs denies thousands
of injecting drug users in the U.S. access to a lifesaving medical
intervention. Access to sterile needles can help prevent thousands of HIV
infections ever year. At present, injecting drug users account for more
than one-third of all new HIV infections in the U.S. Federal funding for
needle exchange programs is needed to expand these programs to control the
spread of HIV and save thousands of lives.


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