Bush's Broken AIDS Promise to Africa?
by Aaron
Sussman
"Moralistic provisions within U.S. policy have hampered
aid organizations and have cost countless lives."
While most discussion of President George W.
Bush's foreign policy centers around the much maligned invasion of Iraq, the
ongoing conflict in Afghanistan, and the escalating tension with Iran, only
slight attention is usually given by the media and the public to this
administration's policies in Africa concerning the HIV/AIDS crisis. Bush, in fact, is responsible for a "dramatic
increase in U.S. aid to Africa," boosting "direct development and
humanitarian aid...to more than $4 billion a year from $1.4 billion in 2001,"
thanks to the passage of the AIDS Leadership Act
in 2003. Behind these impressive
numbers, though, are underlying issues that have outraged some international
health and aid organizations, invigorating a debate over how aid should be
distributed and what the priorities should be.
One of the most controversial clauses in the AIDS Leadership Act states
that federal funding is unavailable "to any group or
organization that does not have a policy explicitly opposing prostitution
and sex trafficking."
Stipulations like this one, which is currently the subject of ongoing
litigation, have served to undermine the potential of foreign aid to curb the
epidemic of HIV/AIDS in Africa.
During his State of the Union address in 2003, Bush proposed
the AIDS Leadership Act, claiming that "this comprehensive plan will prevent 7 million new
AIDS infections, treat at least 2 million people with life-extending drugs
and provide humane care for millions of people suffering from AIDS and for
children orphaned by AIDS." He touted
the success of this five-year,
$15 billion initiative in his 2007
State of the Union speech when he said that "the number of people receiving
life-saving drugs has grown from 50,000 to more than 800,000 in three short
years." Many are unaware that these
efforts were largely spurred by Bush's "Christian supporters
[, who] seldom get the credit they deserve for their role in the global
fight against AIDS." While there has
been discernable progress stemming from Bush's policies, there has also been
serious criticism that moralistic provisions within the policy have hampered
aid organizations and have cost countless lives.
"The emphasis is more on countries that open up their
markets so American companies can go in and privatize things like water and
electrical service."
The manner in which wealthy countries like the
United States contribute foreign aid has drawn disapproval from those saying
that the amount is too little and is "primarily
designed to serve the strategic and economic interests of the donor
countries or to benefit powerful domestic interest groups." To serve these interests, there are often
strings attached, such as those requiring governments to "open
up to trade and foreign investors" and adhere to "enhanced patent
protections" that prevent access to affordable medications. According to Nii Akuetteh, the Executive
Director of Africa Action,
"there
are conditions that are attached where the emphasis is more on countries
that open up their markets so American companies can go in and privatize things
like water and electrical service or have access to certain resources." Some of the most damaging restrictions,
though, are the ones reflecting moral dogma, like the sex worker clause in the
AIDS Leadership Act. This clause,
however, is not without precedent.
Often, a
designated percentage of U.S. foreign aid for HIV/AIDS prevention must be
dedicated to abstinence programs, even though many experts assert that there
are more effective methods. The politicizing
of foreign aid in areas of health has its roots in the Mexico City Policy
initiated by Ronald Reagan in 1984; the policy prohibited recipients of U.S.
international family planning funds from having anything to do with abortion,
including mentioning
the procedure in counseling. This "global gag rule," retracted by Clinton
but resurrected
by Bush, is responsible for the closing of essential health clinics,
including five in Kenya, some of which "were
the only affordable reproductive health services in the area." The AIDS Leadership Act follows this
example, with devastating effects and questionable legality.
Many organizations have condemned the Act, resulting in two
ongoing lawsuits brought by the Alliance
for Open Society International, Inc., and DKT International, both of which
have been heavily involved in preventing the spread of HIV/AIDS in Africa. Last year, over 200
charities and organizations signed a letter to Bush protesting the sex
worker rule. Many of these
organizations, with support from the American Civil Liberties Union (ACLU), have attacked the Act for violating the
First Amendment rights of U.S. organizations.
According to DKT International, the Act constrains the organization's "speech
in other programs for which it does not receive
federal funds and...forces [it] to convey a message with which it does not
necessarily agree" (DKT
International, Inc v. USAID [2007] at
5). Though
two federal courts ruled that the Act's policy was in violation of the First
Amendment, the Court of Appeals of the District of Columbia Circuit reversed
the decision in the DKT International case on February 27, 2007.
"It is essential to involve members of the target
high-risk community, such as sex workers, in delivering the message of HIV/AIDS
prevention."
DKT International, which receives roughly 16
percent of its budget from the United States Agency for International
Development (USAID), refused to sign the pledge because it would result in
"stigmatizing and alienating many of the people most vulnerable to HIV/AIDS -
the sex workers" (DKT International
at 4). This concern was echoed by the
25 organizations that signed the ACLU's friend-of-the-court brief, including
such varied voices as the American Foundation for AIDS Research, American
Jewish World Service, Physicians for Human Rights, and Dr. Jim Young Kim, Chair
of the Harvard Medical School Department of Social Medicine. According to the ACLU, "Many organizations
that work to prevent
the spread of HIV/AIDS often reach out to commercial sex workers to
distribute condoms and offer education on safer-sex measures."
This point was emphasized by Chris Beyrer,
the director and founder of the Center for Public Health and Human Rights at
the Johns Hopkins Bloomberg School of Hygiene and Public Health, in a Declaration
to the court in Alliance for Open
Society International, Inc. v. USAID (Judge's
decision ruling against USAID).
Beyrer cites USAID's own research to support his claims: "Providing sex
workers with access to education, condoms, and other prevention tools is very
effective in curbing the spread of the disease within this community and the
general population (UNAIDS, 2001, 2004).
It is essential to involve members of the target high-risk community,
such as sex workers, in delivering the message of HIV/AIDS prevention (USAID,
2001)."
It was USAID, in fact, that
released valuable information on the ways in which stigma and discrimination "push people in high-risk groups (e.g. sex workers,
injecting drug users) underground, making them difficult to reach through
prevention programs and thus creating more opportunities for HIV/AIDS to spread
to the general population." Though the
political aspects of this debate are highly controversial, there is a near
consensus among health experts that the pledge in the AIDS Leadership Act is
misguided and harmful.
Most experts agree with Paul Zeitz of the Global AIDS Alliance, who says
that the most rapidly growing HIV/AIDS epidemics "are happening among sex
workers in developing countries, yet the Bush administration policy would
create an even bigger crisis."
Organizations like DKT International do most of their work in these
vulnerable nations, such as Sudan and Ethiopia, which have some of the highest
rates of infection. According to
Beyrer, groups including the World Health Organization, UNAIDS, and the World
Bank have promoted working with commercial sex workers as an effective strategy
to fight the epidemic. Evidence of this
effectiveness is clear in nations like Brazil (which has refused to accept $40
million in American aid because of the restrictions) and Thailand; the latter
having seen rates of infection in
soldiers peak at over 12 percent in 1991, and then fall to under one percent
ten years later, due to programs involving outreach to sex workers. Not only have organizations seen success
with these tactics, but sex workers have formed their own coalitions to battle
the virus. Women in the Indian state of
Maharashtra created the organization
SANGRAM, "a collective of
female sex workers that grew to include thousands of members." SANGRAM has worked extensively against the
spread of HIV, leading to a number of international awards for their positive
results. Despite these proven
strategies, no organization receiving funding from the AIDS Leadership Act
could effectively work with a group like SANGRAM.
"The condom crisis in Uganda is being driven by US
policies."
The deleterious effects of attaching politically motivated
strings to foreign aid are evident. The
sex worker pledge in the AIDS Leadership Act could hurt states that were
previously on upwards paths, such as Uganda, one of the few African countries
that was reducing infection rates, but that has recently deteriorated, partly
as a result of U.S. policy. Stephen
Lewis, the UN Secretary General's Special Envoy for HIV/AIDS in Africa, says
that American cuts in funding for condoms and a focus on abstinence has
contributed to a critical shortage of condoms.
According to Lewis, "There is no doubt in my
mind that the condom crisis in Uganda is being driven by [US
policies]. To impose a dogma-driven
policy that is fundamentally flawed is doing damage to Africa."
The fact that this administration, despite these harmful
restrictions and the opting for political moralizing over saving lives, has
done more for victims of HIV/AIDS in Africa than any previous administration is
a testament to how poorly the United States, and other wealthy nations, have
done in addressing the problem. That
the AIDS Leadership Act rejects the advice of health experts in order to
appease those who morally object to prostitution, though, is unconscionable, if
not unconstitutional. For true progress
to be made against HIV/AIDS and other diseases that plague impoverished
populations in Africa and elsewhere, the United States and other nations must
cooperate with local coalitions and health experts, even if it is at the
expense of economic and political gain.
Aaron
Sussman is a freelance journalist, activist, and co-founder/Executive Editor of
InciteMagazine.org. Sussman is also a radio show host, stand-up
comedian, and will soon begin working for a legal advocacy and civil liberties
organization in New York City. For more
of Sussman's work, visit ACrowdedFire.com. He can be contacted at [email protected].
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