Bangkok AIDS Conference

1. $15 billion is the U.S. fair share for responding to the global HIV/AIDS pandemic and thus the U.S. should be congratulated for the boldness of its new initiatives.   The Truth: U.S. defunded foreign aid and decreased per capita spending on people living with HIV/AIDS in developing countries throughout the 1990s -- the time period when the pandemic exploded in intensity; the U.S. fair share over the next 5 years should be closer to $30 billion than $15 billion and its half measures (at best) must therefore be condemned.
   
   
2. The U.S. is committed to securing the best available medicines at the lowest cost so that poor people in developing countries get the same standard of care that is available in the U.S.   The Truth: 59,000 Americans are not getting consistent, lifesaving HIV treatment in the U.S., 1500 of which are on ADAP waiting lists (Institute of Medicine) and 5,600,000 are waiting for treatment in developing countries -- frankly the "U.S." standard of care is not nearly good enough; the U.S. is currently committed to procuring brand name drugs only at a cost two to four times higher than therapeutically equivalent generic products; in fact, many of the generic products are actually superior to U.S. brand name medicines because they are available as fixed-dose combinations, meaning that patients will find it easier to adhere to their one-pill-twice-a-day regime and thus that therapies will be more durable; the U.S.'s unilateral process for approving generic ARVs at the FDA can not be used for the newest medicines thus categorically barring purchase of cheaper medicines of assured quality.
   
   
3. U.S. is undertaking to ensure the long-term availability of affordable medicines having joined the international consensus on the proper balance between intellectual property rights and public health.   The Truth: The U.S. continues to seek higher intellectual property protections (bars on parallel importation, limitations on compulsory licenses, barred access to registration data, eased standards for patentability, and extended patent terms) in multiple bilateral and regional trade agreements including those with countries in Central and South America, southern Africa, and Southeast Asia; the U.S. does so at the bequest of the hugely profitable proprietary drug industry which consistently heads the Fortune 500 list as the world's most profitable industry.
   
   
4. If you provide people with comprehensive sex education and expand access to condoms you will encourage reckless sexuality -- instead you should use faith-based institutions to preach abstinence until marriage and faithfulness and thus the U.S. PEPFAR program is justified in requiring that one-third of prevention funds be used for abstinence-only programs.   The Truth: all the available scientific literature suggests that comprehensive sex education delays sexual activity and is more likely to result in safer sex; for many women in Africa, faithfulness in marriage is a death sentence because of their partners' pre-existing HIV infection; condoms are in fact not widely available in developing countries with as few as 20% of adults having adequate access to affordable condom, moreover, many countries supply only a handful of condoms a year, guaranteeing that condom use will not be widespread.
   
   
5. If you provide intravenous drug users with clean needles and other harm reduction systems, they are more likely to abuse drugs and HIV infection will accelerate -- thus, the U.S. PEPFAR program is justified in condemning and refusing to fund such interventions.   The Truth: studies of needle exchange programs have uniformly found that they reduce the incidence of HIV and that they do not encourage or expand drug use.
   
   
6. Private sector and NGO/mission sector health services are much more reliable than public health sectors in developing countries and thus to mount an emergency response the U.S. should bypass health ministries.   The Truth: HIV/AIDS presents a unique opportunity to rehabilitate public health sectors in Africa and other developing countries, many of which weakened during periods of fiscal discipline and privatization imposed as part of the neo-liberal/Washington Consensus; improving health sector capacity to prevent and treat HIV infection will strengthen capacity to respond to a broad range of other health care needs; a unified system of health care delivery is far superior and ultimately more sustainable than the stove-pipe HIV/AIDS programs championed by the U.S., many of which will rely on temporary foreign experts; although NGOs and mission hospitals should be used, they cannot be the central element.
   
   
7. Community-based initiatives for responding the HIV/AIDS pandemic are corrupt and inefficient and thus the U.S. is justified in refusing to fund these programs.   The Truth: community mobilization, treatment literacy, treatment support groups and other communal activities are critical to rollout and scale-up of programs for comprehensive treatment, prevention, and care.
   
   
8. The multilateral Global Fund to Fight AIDS, TB, and Malaria is cost-heavy and inefficient, thus the U.S. unilateral Global AIDS Initiative and PEPFAR programs are more cost effective and efficient.   The Truth: Typical overhead on U.S. aid programs is several times higher than comparable overhead costs at the Global Fund; moreover, many of the international NGOs and consultants chosen by the U.S. programs are more costly than their equivalents in U.N. and local institutions; the U.S. intends to procure branded antiretroviral medicines costing at a minimum two to four times as much as generic equivalents.
   
   
9. The slow pace of U.S. investment in global treatment is justified by the lack of "absorptive capacity."   The Truth: UNAIDS estimates that with moderate improvement medical capacity exists now to treat over 50% of people living with AIDS in developing countries; at the same time that it complains about capacity, the U.S. refuses to invest in building health sector capacity in developing countries; U.S. ignores that health sector capacity will grow in response to wider availability of treatment.
   
   
10. There's a terrible bottleneck in providing HIV/AIDS treatment because of the lack of health care professionals.   The Truth: U.S. still imports doctors and nurses from Africa and other developing countries; U.S., IMF, and World Bank still impose health sector spending limits on developing countries causing such paltry salaries that health workers go elsewhere and causing hiring freezes even for open positions; U.S. is doing too little to train the health workers that exist that can learn how to provide simplified ARV treatment regimens; and U.S. is doing virtually nothing to educate a new corps of health workers through PEPFAR or otherwise.
    
    
11. The health care and medicines delivery system in Africa is corrupt and thus we must delay investment until it becomes more accountable.   The Truth: although it is hard to believe that the U.S./Halliburton/Enron team could criticize corruption elsewhere, the U.S. has done little to strengthen medicines distribution systems in developing countries, having decimated the same with structural adjustment policies and wages freezes for public sector workers; many countries are strengthening their health care delivery systems with technical assistance from WHO and other partners, but the U.S. refuses to pay its fair share for this assistance.
    
    
12. You can address HIV/AIDS without addressing some of the structural issues that have intensified the pandemic, e.g., urban migration, migrant labor, women's inequality, debt etc.   The Truth: structural prevention requires structural reform including revitalization of rural economies by dismantling agricultural export subsidies that wreck subsistence farming in developing countries and close developing country access to lucrative Northern markets; fair trade and diversified economies are better for addressing the developing malaise that has resulted in negative development for many not-really-developing-countries during the past two decades; income inequality between racial groups and between men and women must be reduced and ultimately eradicated to reduce the structural flaws that make people more vulnerable to HIV/AIDS; the odious debt allegedly owed by developing countries must be written off so scarce resources can be devoted to health, education, and social services.

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