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World: Could Divisions Derail Global Efforts To Control HIV/AIDS?

Reports from this week's International AIDS Conference in Bangkok say serious ideological differences divide the participants and that future anti-AIDS efforts could suffer. Whether the issue is morality, condoms, funding or drugs, the debate seems to follow a familiar pattern -- the United States is on one side and much of the rest of the world is on the other.

Prague, 14 July 2004 (RFE/RL) -- U.S. global AIDS coordinator Randall Tobias -- speaking today at the International AIDS Conference in Bangkok -- sought to heal serious rifts that have opened on how best to confront HIV/AIDS.

"Let me say this as directly as I can: HIV/AIDS is the 'real' enemy. The denial and stigma and complacency that fuel HIV/AIDS, these, too, are the real enemies, and it is morally imperative that we direct our energies at these enemies and not at one another," Tobias said.

Tobias was trying to bridge differences that have surfaced at the 15th International AIDS Conference over how best to reduce and treat HIV/AIDS infections.

On the one side is the United States, with its policy of promoting sexual abstinence and fidelity within marriage, along with condom use, to reduce HIV/AIDS. On the other side are international anti-AIDS groups and some national governments who place greater emphasis on condoms and safe-sex techniques. They argue that programs based on abstinence are unrealistic and add an unnecessary moral dimension to the fight against AIDS.

Tobias sought to defend U.S. policies favoring anti-AIDS groups that promote moral or religious approaches, such as abstinence and fidelity.

"If we were to try to work in developing countries, but refused to work with [religious] organizations, we would be harming and inhibiting our ability to save lives -- and that is just incomprehensible," he said.

Some AIDS activists in the audience responded derisively to Tobias's comments with shouts of "Liar!"

The United States has taken a lead role in confronting the HIV/AIDS epidemic, which has killed an estimated 20 million people around the world since it emerged as a public health threat in the early 1980s. Another 38 million people are believed to be infected with the HIV virus that causes AIDS.

In 2003, U.S. President George W. Bush called for spending $15 billion over five years to combat AIDS -- an unprecedented effort by a single country.

"We must act decisively to meet the humanitarian crises of our time," Bush told the UN General Assembly in 2003. "The United States has begun to carry out the emergency plan for AIDS relief, aimed at preventing AIDS on a massive scale and treating millions who have the disease already. We have pledged $15 billion over five years to fight AIDS around the world."

The U.S. program was initially welcomed by AIDS groups, but it has come under increasing criticism. Those opposed say that, in addition to promoting a hidden religious agenda, the U.S. effort is hampering the development of cheaper generic drugs used to treat patients with HIV/AIDS. Anti-AIDS money provided by the United States can only be used to purchase more expensive brand-name drugs. A UN-run global fund on AIDS allows for countries to buy generic drugs.

The United States has countered its critics by saying that faith-based anti-AIDS programs can work in practice. Washington has cited Uganda as at least one African country that has reduced HIV/AIDS by promoting abstinence and sexual fidelity, in addition to condom use.

Nonetheless, U.S. administrators are said to be working hard to modify the Bush proposal to fit better with existing international anti-AIDS efforts. The U.S. initiative was aimed initially at 15 mostly African states, and early results in Mozambique are reportedly positive.

Still, the United States will have a hard time winning over its critics.

Simon Wright, a worker for the British charity group ActionAid, spoke to Reuters today, saying, "The Americans are having a terrible conference. There's an incredible amount of anger, and it's basically because the way they are approaching HIV and AIDS clearly is driven by their economic, religious and political interests, rather than actually listening to the voices of people who are affected and evidence of what works."

The fear remains that unless these divisions are bridged, global efforts to control the pandemic could suffer.
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    Mark Baker

    Mark Baker is a freelance journalist and travel writer based in Prague. He has written guidebooks and articles for Lonely Planet, Frommer’s, and Fodor’s, and his articles have also appeared in National Geographic Traveler and The Wall Street Journal, among other publications.