AIDS activists have cautiously welcomed last week’s surprise announcement that the United States will almost triple spending on programs to fight HIV/AIDS in the developing world.

In his annual State of the Union address on January 29, US President George W. Bush, who has long been criticised for doing too little to combat the global HIV epidemic, announced an increase in the US commitment to US$15 billion (A$25.5bn) over five years.

But there is no clear indication of where the money will be spent, with just US$1 billion (A$1.7bn) of the promised funds to go to the Global Fund to Fight AIDS, TB and Malaria.

Created in 2001 in response to an appeal by UN Secretary-General Kofi Annan, the Fund’s purpose is to ensure that aid money is distributed directly to those projects which most need it, bypassing often corrupt government channels. Anil Soni, an adviser to the Fund, told the Washington Post that Bush was “taking a unilateral approach” that could hamper the Fund’s efforts.

The Fund has raised just A$3.6 billion of the A$12 to 17 billion a year it says it needs to fight disease in the world’s poorest countries.

In a scathing attack on January 8 in New York, Annan’s Special Envoy for HIV/AIDS in Africa, Stephen Lewis, told a press briefing that the Fund had almost run out of money and was facing its “moment of truth.” The world’s richest nations would be guilty of “mass murder by complacency,” he said, unless immediate action was taken to provide the money needed.

“What’s wrong with this world?” Lewis asked. “What’s wrong with the rich countries? Why are they willing to jeopardise the integrity of the most hopeful financial instrument we have to combat the cruellest disease the world has ever seen?”

Lewis’s comments came after a tour of Lesotho, Zimbabwe, Malawi and Zambia, four of the most severely HIV-affected countries in Africa, where he said hunger and AIDS combine to form a “Hecate’s brew of horror.”

While remaining optimistic that the global epidemic can be defeated, Lewis expressed his exasperation at the failure of wealthy countries to come to the aid of the developing world.

“We could prolong and save millions of lives if we had the resources,” he said. “We don’t have the resources.”

The Special Envoy’s remarks reflect an increasingly desperate situation in Africa, where the toll of HIV/AIDS on workers in the agriculture and education sectors threatens to trigger massive political and social instability in large parts of the continent.

“The incessant, irreversible, cumulative death of so many productive members of society means, ultimately, that things fall apart,” he said.
Generic drugs

Meanwhile, trade negotiators reported some progress in talks in Davos, Switzerland on access to generic HIV medicines. Negotiations on the issue collapsed last year after the United States refused to sign on to an agreement that would have allowed poor countries to import low-cost generic HIV drugs from countries such as Brazil and India.

Despite a November 2001 agreement made in Doha, Qatar, that public health needs should override WTO rules, the discussions remain stalled after the US insisted in Sydney and Geneva last year that the agreement must be limited to HIV/AIDS, tuberculosis and malaria.

WTO Director-General Supachai Panitchpakdi declined to discuss the content of discussions in Davos last week, but was upbeat about the prospects for agreement when talks resume this week in Geneva.

‘Dramatic signal’

In Johannesburg, South Africa, Stephen Lewis told a press conference that President Bush’s announcement was a “dramatic signal” that the US is finally ready to respond to AIDS, and a means for activists to press other developed countries to increase their commitment to fighting the global epidemic.

“It gives leverage to activists everywhere to keep the pressure on,” he said. “It opens the floodgates of hope.”

Australia has yet to contribute to the Global Fund, but has not ruled out doing so.

South Africa’s Treatment Action Campaign (TAC) said the US pledge was a “paltry” amount compared to the money being spent on the imminent war with Iraq.

“What’s being spent on war preparations shows that there are substantial amounts of money floating around in the world that could be targeted at the world’s real problems,” TAC spokesman Mark Heywood said.

Stephen Lewis also expressed his fear that a war in Iraq would be a disaster for the effort against HIV/AIDS in the developing world. “War will eclipse every other human priority, HIV/AIDS included,” he said in New York. “Wars divert attention, wars consume resources, wars ride roughshod over external calamities.”

“The time for polite, even agitated entreaties is over,” Lewis said. “This pandemic cannot be allowed to continue, and those who watch it unfold with a kind of pathological equanimity must be called to account.”

“There may yet come a day,” he warned, “when we have peacetime tribunals to deal with this particular version of crimes against humanity.”