PEPFAR, BUSH'S PLAN TO COMBAT GLOBAL AIDS, DOES MORE HARM THAN GOOD

In 2003, President Bush abandoned his commitment to the Global Fund for AIDS, Tuberculosis and Malaria, in favor of a new plan, the President's Emergency Plan for AIDS Relief, PEPFAR, which calls for funding of AIDS treatment and awareness in fourteen African countries and Vietnam. The Bush administration's decision, in adopting PEPFAR, to act unilaterally in the face of a global epidemic is troubling. Global problems, such as the AIDS pandemic, require global solutions. The Global Fund, an effective multilateral approach to combating AIDS initiated by UN Secretary General Kofi Annan, is just such a solution. PEPFAR, in contrast, has been widely criticized for its unilateralism, its insistence on expensive brand name drugs, and its abstinence-centered approach to AIDS prevention.

PEPFAR not only ignores the Global Fund's potential for fighting global AIDS, it actively undermines it. Without the promised funds provided by the United States, the Global Fund's ability to fight AIDS is significantly diminished. President Bush has consistently tried to reduce allocations to the Global Fund despite Congressional refusals. In fact, Congress tripled the administration's request to $2.4 billion in 2004, which some still saw as inadequate. According to the New York Times, " Several members of Congress complained that $2.4 billion was not a lot of money for a global health emergency, especially compared with more than $100 billion spent on military operations in Iraq."

However, PEPFAR's negative impact is more than simply financial. PEPFAR would establish programs independently, creating confusion on the ground, and competition for scarce resources such as transportation and medical staff. The Global Fund seeks to avoid such waste by pooling countries' resources and streamlining its operations. The higher salaries that the American program provides might draw medical workers away from local public healthcare systems, reducing rather than enhancing their capacity in the long-term. The Global Fund, in contrast, emphasizes the development of local healthcare systems, ensuring that care continues after aid workers and NGO's have withdrawn.

It seems irrational for the U.S. to abandon the Global Fund, which assists eight times as many countries as PEPFAR, including the countries with the fastest rising infection rates, China, Russia, and India. The Global Fund is also not exclusively committed to fighting AIDS. It also combats tuberculosis and malaria, the greatest killer of children in Africa. Its detailed selection process ensures that the countries receiving funds are those most in need of help. In contrast, it is unclear what criteria were used to select PEPFAR's list of fourteen countries, which excludes many countries hardest hit by the pandemic. The Bush administration has claimed that the infrastructure of Africa is not developed enough to absorb large amounts of monetary aid. Yet, by requiring governments seeking funding to develop detailed action plans for AIDS prevention and treatment, the Global Fund increases the likelihood that its grants will be effectively absorbed, a safeguard PEPFAR lacks.

The Global Fund has supported the use of generic drugs because of their cost efficiency and their simplicity. PEPFAR, on the other hand insists that only brand name drugs be used in treatment. Generic drugs offer several advantages besides the obvious cost-benefit. They are available in fixed-dose combinations, which combine many drugs in one tablet, making it easier for patients and staff to manage treatments. Also, their cost means larger number of people may be treated. Most clinics in Africa are already using fixed-dose generic medication and want to continue with them. Substituting brand name drugs would encourage pill-sharing and missed dosages as well as reducing the number of patients who could be treated. Many critics see PEPFAR's emphasis on brand name drugs as catering to pharmaceutical companies.

The Bush administration's abstinence-centered approach to aids prevention has been widely criticized. According to critics, the president's "ABC" program - stressing abstinence, being faithful to your spouse, and the use of condoms - often places less emphasis on C than it does on A & B. They also contend that the program's reliance on "faith-based" institutions is unrealistic. Abstinence-centered programs also ignore issues such as rape and child marriage, which increase rates of AIDS infection.

The Bush administration's policy on the global AIDS crisis is flawed. Its unilateralism undermines the Global Fund, causing confusion and delaying the prevention and treatment of AIDS in Africa. Its ideological emphasis on abstinence costs lives because of its ineffectiveness. Its insistence on brand name drugs increases the profit margins of pharmaceutical companies at the expense of millions of lives. It is estimated that by the end of 2004, nearly 12 million people living in poor countries will have died from AIDS with only a few thousand having received medical assistance from the United States. It is too late to save those 12 million, but millions more can still be saved. Whoever occupies the White House come January must adopt a more effective, multilateral policy to fight the AIDS pandemic.

Updated October 27, 2004