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Foreign Affairs
The Politics of AIDS: Engaging Conservative Activists
By Holly Burkhalter
Holly Burkhalter is Director of U.S. Policy and of the Health Action AIDS campaign at Physicians for Human Rights.
Twenty years into one of the worst health disasters in human history, the AIDS pandemic continues to grow exponentially, outstripping prevention efforts and treatment programs; every day it kills 8,000 people and infects 13,700 more. Although the United States provides fully half the foreign aid aimed at the pandemic, the total has been woefully inadequate to check its spread or stop the deaths — until now.
Thanks to recent activism by conservative political and religious groups, AIDS has finally started to gain foreign policy attention commensurate with its substantive importance. Prodded by its conservative evangelical base, the Bush administration has pushed AIDS to the forefront of its international agenda, backing record increases in U.S. assistance for AIDS treatment abroad and beginning to address issues such as sex trafficking and the dangers of HIV transmission from unsafe injections and blood transfusions.
The future of U.S. global AIDS policy will be complicated, however, because the conservative groups interested in the issue have different tactical priorities than their liberal counterparts and the broader medical establishment. They have traditionally been hostile to some important AIDS-prevention strategies such as comprehensive sex education and condom distribution, and they are much more enthusiastic than others about policies such as the promotion of abstinence.
Now that the United States is finally stepping up its efforts to tackle the crisis, it would be tragic if their impact were dissipated because of ideological differences between constituencies that are vital to the struggle against AIDS. The time has come, therefore, for all interested in AIDS policy to unite behind a comprehensive strategy to combat the pandemic, one based on the most effective practices in both prevention and treatment. The tens, possibly hundreds, of millions at risk deserve no less.
A Duty to Treat
Until recently, almost all foreign-funded AIDS programs in Africa, Asia, and Latin America have been directed toward prevention. Whatever justifications there might be for a prevention-only approach to the pandemic, the strategy has proved neither morally nor medically sustainable.
Ignoring AIDS treatment is tantamount to condemning to death the more than 30 million Africans, most of them in the prime of their lives, who have the disease. Moreover, an estimated 95 percent of Africans do not know their HIV status, partly because the stigma associated with AIDS discourages them from participating in counseling and testing programs. A better-informed population could move more effectively to control the spread of the disease, but absent the possibility of treatment, people have little incentive to learn whether they have the virus or not.
Jim Kim, a senior official at the World Health Organization (WHO) and one of the world's leading AIDS experts, has noted that making treatment available would actually help prevention. He testified before the U.S. Senate that even in Uganda, where prevention efforts have been among the most successful in Africa, prevalence seems resistant to reduction below eight percent when preventive approaches are used alone. Along with most other infectious disease experts, therefore, he advocates comprehensive programs that integrate prevention and treatment into a mutually supporting package.
Yet . . .