The keys to the kingdom

The UN secretary-general Kofi Annan had a lot to say in Bangkok about the United States’ role in the fight against AIDS, much of it critical.

Such criticisms were hardly surprising, especially given the frosty relationship between the UN and the US on issues of power and responsibility.

It was Annan’s plea for the US to take the lead that proved shocking.

We really do need leadership. America has a natural leadership capacity because of its resources, because of its size, Annan said.

The UN secretary-general made his comments to the BBC this week, asking for more funds, allocated with greater intelligence, and was immediately criticised by Bush’s senior adviser on AIDS, Dr Anthony Fauci.

Fauci pointed out what everybody already knew: that the US had contributed more funds to the fight against AIDS than the rest of the world put together.

It’s an irony which frustrated many at the XV International AIDS Conference in Bangkok, as the USA’s use of precious medical and financial resources was denounced at the lectern and on the streets.

First up was cash. The US plans to spend US$15 billion to fight AIDS globally during the next five years, but only US$1 billion of that money will go to the UN’s Global Fund.

Kofi Annan said the Global Fund needs five times that amount from the US.

When individual governments begin to set up their own initiatives, they start from scratch, it takes longer, the money that they hold will not be spent for a long time, he told the BBC.

A panel of funding experts at the conference echoed this view saying the duplication of donors’ efforts was a major obstacle, The New York Times reported.

National AIDS Commission in Malawi executive director Dr Biziwick Mwale told the Times a lack of agreement on approaches and key issues among the donors themselves [had] also led to delays or problems in program implementation and coordination.

The issue it seems is ideological, not financial, a notion Fauci freely admitted when responding to Annan’s comments.

At the time the Global Fund was starting to get rolling, there was a concern on the part of the United States that if they put in this massive amount of money, $15 billion, they wanted to have much more of a direct say in how it was spent, he said.

Even Richard Gere found this ominous. Money without intelligence, without wisdom, is useless, he told Kaiser Daily. The Bush administration’s preference for abstinence rather than condom use in prevention campaigns has been widely denounced as unwise, and may explain the drop in American representation at the conference.

Only 50 experts from the United States are in Bangkok, compared with the 236 experts who visited the last conference in 2002, a fact conference co-chairman Joep Lange said sent a strange signal to the rest of the world.

Those not invited seem to concur. Many suspect that behind the action lies a rift between the US and AIDS activists who oppose its approach to the global pandemic, The Guardian reported, citing AIDS expert Catherine DeAngelis who said simply it is wrong.

Moving on from prevention to treatment: the battle for cheap antiretroviral drugs also proved a sticking point for the US. There are ongoing protests, condemnation of the US by the French government and equally defiant resistance from the Americans.

American drug companies hold the patents to many antiretroviral drugs, patents that when surrendered allow developing countries to make cheaper, generic versions.

French president Jacques Chirac denounced the United States for pressuring developing countries to give up making generic drugs in exchange for free trade agreements. Local protesters in Bangkok agreed and called for an end to free trade negotiations between the US and Thailand.

Why should Australia care? Because something similar might happen here.

The proposed free trade agreement between Australia and the US has already prompted concerns from NSW health organisations that new drugs will take longer to reach our shores and may be more expensive.

Ideologically too, Australia’s newly released international AIDS strategy bears some resemblance to the US ideology, The Sydney Morning Herald reported. Condoms, it seems, are to be used within an education campaign that includes abstinence and reducing the number of sexual partners, the Herald reported.

Much may change in November. In a press statement to the conference, Democrats candidate John Kerry promised the rapid distribution of generic, affordable, safe and effective drugs and accused the Bush administration of putting ideology before science.

Electionspeak, certainly. But Kerry also said he would lift the immigration ban on HIV-positive people, a potentially unpopular promise.

A -˜go it alone’ approach to the war on AIDS is not how we will succeed; only in partnership can we have a chance of defeating the deadly disease, Kerry wrote.

For Jim Kim the question is moot, citing the six million lives lost to AIDS since the 2002 conference in Barcelona. Kim is the director of the World Health Organisation’s AIDS department.

By these measures of human life, the ones that really matter, we have failed, he said.