Global AIDS Policy Tiptoes Around Prevention
MICHELE NORRIS, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.
MELISSA BLOCK, host:
And I'm Melissa Block.
The General Assembly of the United Nations has concluded a special session on AIDS. More money than ever is being spent to fight AIDS, yet only a fraction of people with HIV in developing countries are being treated with life-saving drugs. Prevention efforts are falling behind, too, as NPR's Brenda Wilson reports.
BRENDA WILSON reporting:
By the end of last year, a little over half a million people in developing countries had begun to get access to anti-AIDS drugs. Still, the majority of people in developing countries--one out of nine, according to UNAIDS--are not getting treatment. But more money needs to go to prevention as well. There are five million new cases of HIV each year. UNAIDS director Peter Piot.
Mr. PETER PIOT (UNAIDS Director): It is true that in some countries, all the emphasis has gone out on providing treatment for people with HIV, and that the more difficult issues that come up when you deal with prevention--that's mostly dealing with sex and drugs. But it's an illusion to think that just providing treatment will stop this epidemic.
WILSON: But as the United States has begun to provide more than half of the funding to fight AIDS, roughly $3 billion a year at this point, prevention has been undercut by politics.
Mr. BERNARD RIVERS (Aidspan): In the war against AIDS, certainly the United States is an 800-pound gorilla.
WILSON: Bernard Rivers runs Aidspan, which monitors the activities of major AIDS donors such as the US, the Global Fund and the European Union. The hundreds of millions of dollars the US gives to countries and programs is important, he says, in determining international AIDS policy.
Mr. RIVERS: Eight-hundred-pound gorillas tend to have their own way. And people are hesitant to argue with them.
WILSON: As a consequence, Rivers says, donors in global health have shied away from controversial AIDS projects and AIDS-prevention projects in particular, and contributed instead to safer subjects.
Mr. RIVERS: Such as orphans and such as the need for clean water, particularly as the religious right becomes more influential in this country and becomes increasingly effective in pushing its own moral agenda with regard to sex and related topics.
WILSON: The most recent example, Rivers says, is the requirement that recipients of US funding condemn prostitution in writing, which would seem obvious, he says, except that prostitution is legal in some countries, and the requirement also interferes with work most likely to control the spread of HIV. Mark Dybul, the deputy director of the US Global AIDS office, says no one has turned a grant down because of the provision.
Mr. MARK DYBUL (Deputy Director, US Global AIDS Office): It goes on to say very quickly in the legislation that that does not mean we cannot provide services. There's a difference between providing services and compassion for those who are in such professions and being in favor of it.
WILSON: And Dybul says it's really paternalistic to say that the US sets the agenda for international AIDS policy.
Mr. DYBUL: The folks we deal with in countries and are privileged to work with know more about AIDS than most of us. I think it's insulting almost to the people working on the ground to say that we tell them what to do and that they would listen. That is definitely not the case. And we would never attempt to do so.
WILSON: But Aidspan's Bernard Rivers says he knows organizations and countries who were too small and dependent on the US to object, even if they will never say so.
Mr. RIVERS: They go into a closed room and they make a decision. And they may not come out of that room saying, `We made that decision because the US pushed us into it.' They will say, `We made that decision because we made that decision.' So it's rare that anyone will actually say, `Yes, we were maneuvered.'
WILSON: Some conservatives think the administration needs to tighten AIDS funding restrictions. As Philip Christensen, an administrator in the US Agency for International Development under former President George Herbert Walker Bush, puts it, `When you hire a painter to paint your house, he paints your house the color you want. You don't have everyone show up and do his own thing.'
Despite differences about the best approach for controlling the spread of HIV, there is agreement that there has not been nearly enough success in either treating or preventing AIDS. And the epidemic is not likely to reverse its course in the near future. Brenda Wilson, NPR News, Washington.