Bangkok AIDS Conference


Randall Tobias, the United States' Global AIDS Coordinator,
speaks from the podium as activists sit protesting at the International
AIDS Conference in Bangkok on July 14, 2004

                          under construction

Bush administration's AIDS czar fails to win over critics
Sunday, July 11, 2004

By Mary Curtius, Los Angeles Times

WASHINGTON -- As the man in charge of the Bush administration's $15 billion plan to treat millions of HIV-infected people in underdeveloped nations, Randall Tobias might expect a hero's welcome at the International AIDS Conference opening today in Thailand.

Instead, the U.S. global AIDS coordinator was greeted by the protests of activists opposed both to the administration's policies and to Tobias.

Tobias, some activists said, could expect a reception similar to the one given Health and Human Services Secretary Tommy G. Thompson at the last conference. Thompson was booed off the stage at the 2002 conference in Spain.

Since then, the administration has launched the most expensive effort ever mounted by a government to fight AIDS internationally. Yet neither the financial commitment nor the power Bush has given Tobias to mobilize the U.S. bureaucracy has won over critics, who charge that the administration's efforts are hamstrung by political and ideological concerns.

"He's been worse than we thought," said Sharonann Lynch, of the AIDS organization Health Gap, of Tobias. "Tobias is the front man for Bush's ideology-driven policies on prevention and on treatment of AIDS."  Lynch said Tobias has given his critics fodder by emphasizing abstinence and faithfulness as effective ways of preventing AIDS while downplaying the role of condoms, and by failing to embrace generic drugs as substitutes for more expensive, patented brands.

Conservative supporters of the president's program argue that it is meeting with resistance because an entrenched international network of AIDS experts and activists doesn't like being told that their methods failed to defeat the epidemic.  Rep. Mark E. Souder, R-Ind., who strongly supports the president's efforts to combat AIDS internationally, said the criticism of the U.S. program was politically motivated. "Every action taken by President Bush to elevate the fight against AIDS, both domestically and globally, has been greeted with derision and whining by activists who can't bear to see the president's compassionate conservative agenda achieve the results that the previous administration failed to deliver," Souder said.

The U.S. program seeks to double the number of people with access to AIDS drugs in Africa in its first year, vastly expanding treatment and prevention efforts in hard-hit African nations, the Caribbean and Vietnam. In the five-year time frame of the program, it plans to treat 2 million HIV-infected people with antiretroviral drugs and provide palliative care for 10 million HIV-infected people and AIDS orphans.

Tobias says his critics' vehemence mystifies him.  "This program gets a lot of criticism," he acknowledged in an interview in his Washington office. Bush, he said, "is doing so much," yet "a lot of the critics are saying, 'You should do more.' "

Health Gap opposed Tobias' appointment from the outset last year, Lynch said. Her group feared that, as head of the pharmaceutical firm Eli Lilly & Co. in the 1990s, Tobias would protect drug company interests by preventing underdeveloped nations that accept U.S. money from using lower-cost generic drugs.


Health GAP (Global Access Project)
Doctors Without Borders/Medecins Sans Frontieres (MSF)
ACCESS Foundation


Thailand Among Countries Targeted for Agreements That Limit Access to Life-Saving Drugs


(Bangkok) – The United States is negotiating trade agreements with several countries, including Thailand, which will potentially reverse the hard-won gains of people living with HIV/AIDS. That word today from a coalition of activist groups attending the XV International AIDS Conference. Representatives from Thailand’s ACCESS Foundation, U.S.-based Health GAP (Global Access Project) and Doctors Without Borders /Medecins Sans Frontieres(MSF) spoke about the insidious nature of the agreements being negotiated by the United States.

“Here in Thailand, we have moved in the direction of universal health coverage for people living with HIV/AIDS,” said Nimit Tien-Udom, Director of Thailand’s ACCESS Foundation. “This has only been possible because of the access to generic drugs. The United States has begun negotiations with the Thai government that would reverse the gains we have made by restricting the access to those drugs.”

The U.S. government is currently negotiating Free Trade Agreements with Thailand, five nations in Southern Africa that account for approximately 33 percent of all HIV infections in Africa, countries in Latin America and the Caribbean and the Middle East.

“These Free Trade Agreements contain provisions that will kill people with HIV/AIDS,” said Asia Russell of Health GAP. “Drugs on patent are expensive. Most governments realize that in order to reach the greatest number of people in need, it is necessary to remove the patent restrictions and make generic drugs available. The United States through the stipulations included in the Free Trade Agreements, is putting patent rights over patient rights.”

Among the groups working to eliminate the restrictions on generic drugs in the FTAs is Doctors Without Borders/Medecins Sans Frontieres (MSF).

“As medical professionals, Doctors Without Borders/Medecins Sans Frontieres is in the forefront of any effort to make effective treatment available to those in need,” said Médecins Sans Frontières’ head of mission in Thailand, Paul Cawthorne. “The United States, by negotiating these bilateral agreements, and through the restrictive nature of President Bush’s AIDS emergency plan, obstructs access to generic drugs and weakens competition in places with proven records of success such as Thailand.”

The activist groups took part in a protest at the conference today targeting both drug companies and industry groups representing the pharmaceuticals.

Thai Treatment Action Group [TTAG], ACCESS Foundation, Health GAP [Global Access Project],
Thai Network of People Living with HIV/AIDS [TNP+], and ACT UP



(Bangkok) - AIDS activists made their collective voices heard at a protest and march on opening day of the XV International AIDS Conference in Bangkok. The activists, led by representatives of Thai and U.S. organizations, pushed for greater accountability on the part of heads of state, agencies and individuals in addressing gaps in access to HIV/AIDS treatment.

The groups’ demands were contained in a memorandum which was accepted by several leaders of the world AIDS community. One exception was U.S. Global AIDS Coordinator Randall Tobias. Tobias, when asked during a news conference to accept the memorandum from the thousands of persons taking part in today’s demonstration, refused to join his colleagues.

“Mr. Tobias’ refusal to meet with people affected by HIV/AIDS and hear their concerns once again demonstrates the arrogance of the United States in dealing with the pandemic,” said Asia Russell of Health GAP, one of the marches’ sponsoring the rally. “Along with drastically reducing the number of U.S. scientific presentations allowed here in Bangkok, the U.S. government’s senior AIDS official refused to share the same stage with people representing those who are dying of AIDS.”

Officials who did meet with the groups and address their concerns were Peter Piot, Executive Director of UNAIDS, Dr. Jim Kim, director of the HIV Department, World Health Organization, Dr. Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria and Joep Lange, the president of the International AIDS Society. Feachem and Lange thanked the protesters for their commitment, and for keeping the spotlight on greater access to treatment.

“That these leaders of global organizations engaged in the fight against HIV/AIDS chose to meet with and hear the concerns of those living with HIV/AIDS only serves to magnify the shame in Ambassador Tobias’ refusal to do so.” concluded Health GAP’s Asia Russell.

US criticised for cutting its own deals with makers of AIDS medicines

July 15, 2004   Business Reports  By Jack Barton

Bangkok - The US came in for sustained criticism at the 15th International Aids Conference yesterday in a growing row over cheap copycat drugs.

The head of the European delegation criticised US bilateral trade agreements, saying they threatened a deal already in place to provide affordable anti-HIV treatment to developing nations.

Lieve Fransen, the head of the EU delegation to the conference, said: "There is a danger that the US would go into major bilateral trade agreements that don't follow the agreements that we have all made in Doha."

Europe said the trade pacts posed a danger to the 2001 agreement struck in Doha to supply cheap drugs to the countries that most needed them.

The latest row follows complaints at the conference in the Thai capital over the US abstinence strategy to combat the disease, instead of aggressively promoting condom use.

UN secretary-general Kofi Annan has also led claims that the US should be contributing more to fight the disease.

US global Aids co-ordinator Randall Tobias sought to soothe tensions at the conference but walked out of the meeting after delivering his speech, following a noisy protest by 50 people.

Members of the protest group ACT UP, along with Thai activists, held up posters saying: "He's lying" and shouted "shame" as he left .

The US is the world's largest contributor to the fight, with President George W Bush pledging $15 billion (R92 billion) over five years.

However, activists have complained that the Bush administration had embarked on independent deals with developing countries instead of joining a multinational effort.

Critics say the deals have been used to beef up protection for western pharmaceutical firms, which complain that their drugs are being counterfeited.

The scale of the crisis was highlighted yesterday in a new UN report showing Aids had slashed life expectancy to 33 years in some African countries.

U.S. takes solo course in global AIDS fight
$15 billion program for list of countries -- 12 in Africa, 2 in Caribbean, Vietnam

Sabin Russell, San Francisco Chronicle Medical Writer  Thursday, July 15, 2004

Bangkok -- - President Bush's global AIDS czar delivered a vigorous defense Wednesday of the administration's $15 billion program to battle the epidemic in poor countries, a plan that critics say undermines a multinational effort to address the epidemic.

His speech came amid controversy over the Bush administration policy to direct most of the $15 billion to a chosen list of countries -- 12 in Africa, two in the Caribbean and Vietnam -- rather than expand support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, an agency created at the request of U.N. Secretary-General Kofi Annan that provides aid to 128 countries.

In an interview with The Chronicle after his speech, Tobias said that, in fact, "the United States is urging the Global Fund to slow down.'' Tobias said the Global Fund, which has raised $3.5 billion, already had "a large pipeline'' of approved grants.  "If we put more money into the Global Fund right now ... that money is going into an account at the World Bank,'' he said. "I believe they have adequate resources on hand.''

Angry reaction   Stephen Lewis, U.N. special envoy for HIV-AIDS in Africa, reacted angrily to Tobias' interview comments. "Slow down? It needs to speed up," he said. "It's the most effective instrument against the pandemic.''  Lewis said that Bush's program reflected the same "go it alone" approach that had gotten the United States into trouble in Iraq. He predicted that the United States would eventually embrace the Global Fund's multinational approach, just as it is now reaching out to other nations to work with it in Iraq.

The Bush administration is the largest single contributor to the Global Fund, but it is proposing to provide only $200 million next year, down from $540 million appropriated by Congress this year.  "I think the president's budget request for $200 million for next year is just fine,'' Tobias said.

Tobias also defended the program's reliance on "faith-based" institutions to distribute local AIDS assistance, noting that the "temples and the monasteries, the churches, the mosques and the synagogues are among those who have gone where no one else would go.''

Tobias' "slow down" comment was particularly irksome to AIDS activists, given that much of the conference is devoted to seminars on practical ways to increase treatment and prevention programs to a level commensurate with the scale of the epidemic.

Tobias contends that the Bush's program is the most effective way to do so with American dollars. AIDS protesters strenuously disagree.  "His global AIDS policy is an astounding patchwork of cynicism and pandering to special interests,'' said Health Gap Coalition activist Asia Russell, who was among those disrupting the start of Tobias' speech.

But Dr. Nils Daulaire, president of the Global Health Council, called Tobias' address "one of the most thoughtful and comprehensive statements of policy and commitment that we have heard.'' Daulaire said his group "deplores the extremists who tried to drown him out.''

Only last month, Daulaire denounced the Bush administration, which had funding cuts of the group's annual health conference after objecting to discussions of reproductive rights issues slated for the meeting. Daulaire said then that the Department of Health and Human Services had bowed to "a clique of right- wing extremists.''

On the deeply controversial question of whether the Bush administration will buy low-cost copies of AIDS drugs made by overseas generic pharmaceutical companies, Tobias reiterated that he would do so if the products can pass muster through an expedited Food and Drug Administration approval system.  He urged the companies making the generics "to file their applications as soon as possible so we can begin funding these drugs as soon as possible."  In the interview with The Chronicle, Tobias said he did not know of any applications for approval, but predicted that generic AIDS drugs would be approved by year's end.

Chanting “Bush lies, millions die”, protesters at the International AIDS Conference in Bangkok on July 14 shouted down Randall Tobias, the US global AIDS coordinator and the former CEO of pharmaceutical giant Eli Lilly & Co. The US has got a bad reputation all over the world as not defending the interest of vulnerable people and communities, but instead of big business.   read more

The focus of activist outrage is a deadly and hypocritical United States AIDS policy that promises help and delivers nothing.

Top Bush Administration Member on HIV/AIDS Policy Also Heads Drug Industry Front Group Opposing Generics

With the 15th International AIDS Conference underway in Bangkok, American policy watchdogs charged today that the Bush administration is implicated in a conflict of interest with the drug industry. The following analysts are available for interviews from Thailand and from the United States.

ASIA RUSSELL, (267) 475-2645, 011-66-515-69-232,
SHARONANN LYNCH, (646) 645-5225,

Both Russell and Lynch are with the group Health GAP, and they are both currently in Bangkok attending the International AIDS Conference. Russell said today: "Abner Mason is a member of the Bush administration's Presidential Advisory Council on HIV/AIDS and chair of its International Subcommittee, as well as the president of a drug industry-funded front group named the 'AIDS Responsibility Project.' The main function of that organization, of which he is apparently the sole employee, has been lobbying against the use of cheap generic drugs. In Monday's Bangkok Post, Mason's group took out a full-page ad attacking generic drugs. It is hard to gauge whether the global AIDS treatment community is more shocked to learn that a drug industry stooge is at the highest advisory level of AIDS policy in the United States or to learn the lengths to which he and his paymasters would go to falsely undermine confidence in proven and effective treatment options."

Lynch said today: "Delegates sent by the Bush administration have been spending a lot of time trying to undermine scientifically proven HIV treatments and prevention interventions such as condom outreach, comprehensive and age-appropriate sex-education and treatment with generic medicines prequalified by the World Health Organization. Here we have heard even more scientific evidence coming out of clinical studies and field reports supporting such approaches while U.S. Global AIDS Coordinator Randall Tobias and his entourage continue to behave as if they have blinders on. Worse yet, the United States is using its economic muscle to help big pharmaceutical companies against generic competitors whenever it negotiates bilateral trade agreements, such as with Thailand, in spite of the fact these countries facing a health crisis are allowed the right to produce or import generic drugs under World Trade Organization rules. As a new Government Accountability Office report [click here] finds, the U.S. unilateral effort is reaching too few people as it is rife with administrative chaos and riddled with restrictions that have crippled service delivery. The U.S. needs to join the global community efforts that prioritize effective, well-coordinated treatment and relief rather than drug company profits."

Follow the money to fight AIDS in Africa


By all appearances, the Bush administration is finally providing real money to fight AIDS in Africa. Sure, the $15 billion "PEPFAR" program (President's Emergency Program For AIDS Relief) is under attack for buying expensive brand name drugs rather than cheap and equivalent generic drugs.

Moreover, President Bush is criticized for demanding that PEPFAR AIDS programs focus on abstinence and faithfulness in a context where such a focus might be ineffective. Nevertheless, the administration is credited by most critics as having provided an enormous amount of resources to fight AIDS, said to be more than double the sum of all other donor support worldwide in 2004.

The untold part of this story is where the money flows are going. Most of the PEPFAR money actually ends up in U.S. hands rather than going to Africans or their institutions. Worse still, over the past two decades, African governments have been paying $15 billion per year in debt installments to donors and banks in the rich countries of the north. The sum effect is that poor countries of Africa are subsidizing the rich countries while the rich country governments are putting aid money into their home- country organizations in the name of poor Africans.

Here's how it works. The U.S. government doesn't like to give money directly to African governments. Why? Part of it is political and philosophical. Ever since the Reagan era, the government officially has preferred supporting the private sector rather than governments. Another reason is that these governments are said to have inadequate "absorptive capacity," that is, the health ministries don't have adequate management and financial systems to account for the money; the health clinics don't have enough trained health care providers to provide the services; and their health clinics are lacking equipment and are poorly maintained. The public sector in Africa literally has been crumbling away for the past two decades.

Ironically enough, a big reason for the crumbling governments comes from U.S. policies -- debt repayment schemes called Structural Adjustment Programs. These programs are austerity measures imposed on nearly every African government to squeeze public money to pay their debts to foreign banks. Most people don't know that the debts came about mostly because of factors external to African governments. The big factors are enormously high interest rates (up to 22 percent) -- caused by U.S. financial policies -- that increased payments; and U.S. and European subsidies that decreased price of African exports.

So who gets the PEPFAR money? Most of the money goes to U.S.-based non- governmental organizations. We now know that a big chunk of the money lets them buy AIDS drugs from U.S. drug companies, who make a significant profit on PEPFAR by charging four to five times what it would cost to buy equivalent generic drugs. Most of the remaining money goes for expensive salaries and benefits to foreign (usually U.S.) staff, their very nice cars and offices, their operating expenses and overhead costs to support their home offices in the United States. Though the accounting is difficult, it is likely that less than 25 percent of PEPFAR aid value actually goes to recipient-country people or institutions. The money actually making it to an African country might be even less if profits to drug companies are counted as going back to the United States.

The result: Of the $15 billion of PEPFAR funds, African governments will be lucky to see $3 billion to $4 billion over five years. At the same time they will be paying $75 billion back to rich countries in debt repayments. The money that is being paid back is "real" money -- money that can be spent on local people and institutions.

Is there an alternative? Absolutely. The first thing to do is to forgive the debt, using the same arguments the administration is using to justify forgiving the debt in Iraq.

Debt forgiveness will liberate a huge sum of money that can go to training and hiring more Africans for public jobs; to pay living-wage salaries; to buy medicines and to improve conditions at hospitals, clinics and schools. In 2001, when Mozambique's debt was cut in half, the health budget doubled and health-worker salaries moved up to livable range. The second alternative is to provide external support through institutions that can provide money to local agencies in Africa, both government and civil society. Institutions already exist that can channel such money much more efficiently than PEPFAR. The Global Fund for AIDS, Tuberculosis and Malaria is one such example that is creating a new paradigm for international assistance. Sad to say, the administration is proposing cutting its contribution by 60 percent this year.

U.S. Trade Officials Seek To Strengthen Patent Protection for Brand Name Drugs, Including HIV/AIDS Treatments

July 6, 2004   Wall Street Journal Reports   (Chase/Lueck, Wall Street Journal)   

U.S. trade officials are negotiating a series of agreements to strengthen patent protection of brand name drugs, including antiretroviral drugs, the Wall Street Journal reports. In many countries, including the United States, generic drug makers often win approval for their drugs by proving that the products are equivalent to the brand name drug. However, new agreements sought by the United States would prevent countries trading with the United States from approving for five years generic drug applications if data submitted by the generic companies is based on data originally compiled by the brand name manufacturer. The agreements would in effect grant "temporary exclusivity" to brand name drug makers, the Journal reports. U.S. negotiators have reached agreements that include the new provisions with Jordan, Chile and Singapore. Agreements awaiting congressional approval with Australia, Morocco and the six Central American countries -- Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and the Dominican Republic -- that are part of the Central American Free Trade Agreement also include the provisions. In addition, U.S. negotiators late last month launched trade talks with Thailand seeking similar patent protections, the Journal reports.

Medecins Sans Frontieres study said that fixed dose combination antiretroviral drugs were as effective as brand-name regimens in treating HIV in developing countries (Maugh, Los Angeles Times, 7/17). The study, conducted in 21 developing countries, was the first large-scale study of the generic fixed dose drugs, which require two pills a day and cost about $140 per person per year. A regimen of the same three drugs purchased separately from patent holders GlaxoSmithKline, Bristol-Myers Squibb and Boehringer-Ingelheim requires six pills per day and costs about $562 per patient per year (Kaiser Daily HIV/AIDS Report, 7/15).

Doctors Say Pact Threatens AIDS Progress
A charity group urges Thailand to reject a U.S. trade deal that could end
an affordable-drugs program, which is seen as a model for Asia

By Thomas H. Maugh II   LA Times

July 13, 2004

BANGKOK, Thailand — A potential trade agreement between Thailand and the United States could derail this country's production of inexpensive AIDS drugs and imperil the future of an anti-HIV program that is widely considered a model for countries throughout Asia, the group Doctors Without Borders said Monday.

"If the Thais sign such an agreement, they will have to close down their generic drug production," Paul Cawthorne of the Belgium-based group told a news conference. "Trade rules are the biggest threat" to the fight against AIDS, he said.

Thailand is one of the few countries — others include India and Brazil — that manufacture generic versions of anti-HIV drugs developed by U.S. manufacturers.

The country began researching manufacturing techniques for the drugs in the early 1990s and was preparing to market a generic version of the drug didanosine when Bristol-Myers Squibb Co., the drug's manufacturer, served notice that it held a valid patent on the drug. The Thai government was ready to accede, but Doctors Without Borders urged it to fight the claim.

The following year, Thailand's Central Intellectual Property Court ruled the patent invalid in Thailand, paving the way for the country to begin large-scale drug production.

That decision was, in effect, reinforced last September when the World Trade Organization agreed that poor nations could ignore patents in times of national health crises.

A free-trade agreement — meant to greatly expand business exchanges between the United States and Thailand — would incorporate language reinstating the patents, in an effort to protect U.S. drug companies. The Bush administration has also argued that the generic versions of the drug are potentially unsafe and that they are not as effective as the branded versions, a claim most experts dispute.

The reinstatement of patents was part of a similar agreement signed last year by Singapore. Brazil has refused to sign an agreement because of the provision.

Cawthorne, head of Doctors Without Borders in Thailand, urged the Thai government on Monday to follow Brazil's example lest it upset its thriving generic drug industry.

In March 2002, the Thai Government Pharmaceutical Organization began producing a single pill that contains the three drugs recommended by UNAIDS for first-line treatment of HIV infection: stavudine, lamivudine and nevirapine. The pill reduced the monthly cost of treatment for an individual from an estimated $750 to $30. The government now plans to provide it free to 50,000 Thai citizens.

Thai Prime Minister Thaksin Shinawatra said Sunday at the opening of the 15th International AIDS Conference here that the government would spend $20 million to provide about 40,000 of those patients with drugs and that the rest of the money would come from the Global Fund to Fight AIDS, Tuberculosis and Malaria. He also said Thailand would soon begin exporting the drugs to neighboring Cambodia, Laos and Myanmar.     
* see LIES

Thaksin said Thailand would also offer its manufacturing technology to Africa in the near future.

The high cost of AIDS drugs has been a continuing theme at the meeting, whose title this year is "Access for All."

On Monday, activists shut down the large booth operated by GlaxoSmithKline at the conference center exposition, ringing it in a black band and waving signs reading, "Greed = Death."

This is a pretty unbelievable story even by U.S. standards. Since the U.S.
has literally brought U.S. drug companies into the negotiations at the WTO
and elsewhere, boycotting negotiations when developing countries contract
with their own experts is truly outrageous.

30 July 2004

As most of you know, there is a process of negotiation of a Free Trade Agreement between Colombia, Equatro and Peru, and of course, it includes an especial chapter on Intellectual property rights. A lot of organizations had expressed their concerns about the TRIPS Plus provisions in this kind of agreements. He have a lot of messages on this matter in our network.

Andean's Countries had contracted (by UNDP) an adviser, expert on IP, in order to make the best possible negotiation. Ministries of Health of the three countries were in a seminary a month ago, to discuss this topics from a human rights and public health perspective. And then, they asked UNDP to support the contract of Mr Carlos Correa, a well known expert in this issues.

But the USA delegation reject to initiate the negotiations if the Andean countries were going to have this adviser. They imposed a veto. I know it is unbelievable, but it is true.

One of the arguments was that they are not interested on negotiations with people defending public health issues and generics........

So, negotiations are broken, and restart in September, but not with the advice of this expert. At least not in the table. Maybe in the parallel room.

I promise to maintain you in touch, but I think is important to inform as much people as possible. And to get some response and action. Thanks

Francisco A. Rossi. B.   <>
IPR and access to drugs project.
International Poverty Center.
SBS. Ed BNDES, 10 andar.
70076-900 Brasilia D.F. Brazil.
(55 61) 2105 -5005

see also information on Generics and Fixed Dose Medications

    Bush's Global AIDS Coordinator, Randall Tobias, Denigrates Condoms  
April 21, 2004

Size of U.S. Delegation at AIDS Conference Draws Fire
.  Voice of America News   reported by Steve Baragona

13 Jul 2004

While top AIDS researchers are meeting in Bangkok this week, some scientists from U.S. government agencies are absent.

This year's U.S. delegation numbers 50 people, far fewer than the 236 who attended the international AIDS conference two years ago in Barcelona.

Anthony Fauci, of the U.S. National Institutes of Health, said that the reason is allocation of resources.

"The decision was made that the money would be spent better by just funding research," he said.

But Democratic Congresswoman Barbara Lee says money is not the issue.

"I am not sure what the rationale is, but the funding is there. And I know that and they should be here. This is an important conference," she added.

Some speculate the delegation was cut back because the conference does not focus enough on abstinence, the Bush administration's preferred HIV prevention method. Others trace the cut to the Barcelona conference, where AIDS activists disrupted a speech by Health and Human Services Secretary Tommy Thompson.

Joep Lange, one of the organizers of the conference, supports free speech at the conference, but he said that the treatment Mr. Thompson received in Barcelona was out of order.

"Some things that happen at this conference are totally counter-productive," he noted. "The shouting down of Secretary Thompson has done a lot of harm."

Chief editor Cathy DeAngelis of the prestigious Journal of the American Medical Association says cutting the delegation is petty. And she said that the Bush administration is getting in the way of free scientific expression.

"Our nation is supposedly the leader in research," she said. "To deprive many of our scientists who are doing this research from coming here and sharing their knowledge and learning from others, I just think that that is wrong."

Experts say the impact of the smaller U.S. delegation on the conference will not be devastating, but the presence of more U.S. researchers would have been helpful.

U.S. Cuts Number of Delegates to World AIDS Meeting Administration Cites Need For Savings; Critics Say Move Will Hurt Conference

By David Brown, Washington Post Staff Writer
Friday, July 9, 2004; Page A17


HHS officials tried to cancel a $250,000 CDC grant to the conference for scholarships for Third World AIDS researchers, said a person familiar with agency. When told the money could not be reclaimed, Thompson's office stipulated it go only to scientists in the countries getting aid under the PEPFAR program.

The NIH, which in the past gave grants to AIDS conferences, is not this year because "it chose not to," said Pierce, Thompson's spokesman.

A CDC official labeled as "bull" the HHS explanation that the cutbacks were primarily to save money.

"This is clearly the result of the booing of Secretary Thompson in Barcelona, which he took quite personally," this person said.

Two years ago, about 30 activists heckled the secretary with shouts of "Shame, shame!" "No more lies" and "Lies, lies!" -- making his 15-minute speech inaudible. Neither of the two speakers who followed -- Richard G.A. Feachem, director of the Global Fund, and Gro Harlem Brundtland, director general of the World Health Organization -- came to Thompson's defense or criticized the protesters.

Later that day, some of the hecklers met with Thompson, told him of their concerns and urged him not to take the catcalls personally. Several insiders said, however, that some people high in the HHS viewed the jeering as a serious affront to civility, U.S. generosity and the Bush administration.

Within weeks of the conference's end, word circulated that HHS participation might be different the next time.

Anger at US ban on AIDS scientists
Bangkok conference forced to cancel meetings and retract papers after authors stopped from attending

Monday July 12, 2004    The Guardian

The US government came under scathing attack from senior members of the medical establishment yesterday for blocking scientists from attending the International Aids conference which opened in Bangkok. The biennial conference, with 17,000 delegates, is more political rally than scientific meeting and bears huge significance for those involved in the fight against HIV/Aids.

The US government has sent only a fraction of its usual contingent of scientists, pleading cost - 50 instead of the 236 who attended the last event in Barcelona in 2002.

The Department of Health and Human Services, headed by the health secretary, Tommy Thompson, was yesterday accused of actively preventing certain US scientists and doctors who had a contribution to make from travelling to Bangkok.

Many suspect that behind the action lies a rift between the US and Aids activists who oppose America's approach to the global pandemic.

Joep Lange, president of the Sweden-based International Aids Society, which organises the conference, said it had been forced to retract papers that had been accepted for conference sessions after the US scientist authors had been refused permission to come. Many meetings, some to train developing world researchers, have had to be cancelled.

"I really think it is shameful that they restricted the US government participation, particularly when you think they are putting so much money into the fight and people in the field who have to do the job are directly prevented from coming here," said Dr Lange.

Earlier, the editor of the Journal of the American Medical Association (Jama) had also unexpectedly spoken out. Catherine DeAngelis said that Marc Bulterys, the co-author of a Jama paper who worked for the government's Atlanta-based Centres for Disease Control (CDC), had not been allowed to accept an invitation to fly to Bangkok to talk about it.

"It stymies the ability of scientists to discuss and learn from each other," said Dr DeAngelis. "It is wrong."

She pointed out that the trip would have been paid for by the American Medical Association, not the US government. "It is an incredible example of political pettiness. It is anti-intellectual and it is interfering with scientists and the scientific process and means American government-employed scientists are not allowed to be here to share their knowledge," she said.

Behind the fracas lies the gulf between the US policies on tackling HIV/Aids in the developing world and those of Aids activists who tend to dominate the big international event. Two years ago, Mr Thompson tried to give a speech at the conference in Barcelona but was rendered inaudible by noisy protests. This year the organisers have asked activists to be more civil and allow those with whom they disagree to be heard.

Although the US has put more money into the fight against HIV/Aids than the rest of the world put together, including $15bn (£8.5bn) pledged by President Bush in January last year, activists are unhappy with the way the money is to be spent and the "morality" and "corporate" strings attached. Most of it will go to American-instigated programmes in 15 selected countries which stress the so-called ABC philosophy - abstinence, be faithful and condoms "where appropriate".

Randall Tobias, the former head of the pharmaceutical firm Eli Lilly, who runs the president's plan for Aids relief, heads the US team in Bangkok. Yesterday he said he had "a very large delegation" with him.

Regarding the Tobias Speech and U.S. AIDS Funding:

Interview with Science reporter Jon Cohen Bangkok Notebook
(excerpts) from Kaisernetwork  7/13/04 and 7/14/04

JACKIE JUDD: The Tobias speech, you and I both watched
it. I came away hearing something slightly different than what
stuck you to you. What I heard was a forceful defense of the
President’s PEPFAR Program, the Emergency Funding for AIDS
Program; what did you hear?

JOHN COHEN: I heard what you heard, but in addition to
that I heard the loudest apology I have heard from the Bush
Administration about the behavior of the past of the United
States Government. And I have a copy of the text of his speech
here. And he said, I believe any fair-minded person looking at
history of the response over the last 20 years would conclude
that the world was far to slow to take up this fight with the
focus it deserves. But then he turns the corner and says, when
I say the world I mean in particular the developed world
including the United States; that’s an apology. And he goes on
to say we in the developed world displayed ignorance or even
apathy about the global dimensions and intricacies of the AIDS
crisis. I haven’t heard an apology like that before about the
past behavior of the United States.

JACKIE JUDD: And what do you think the political
calculus of that was?

JOHN COHEN: Well to turn to the next sentence which
is, but we are doing the right thing now, you know. That’s the
political calculus, and the other obvious thing to me is, you
know here we are in the land of elephants. There were big
elephants in the corner; there were things that didn’t come out
in his speech that are political hot potatoes.

JACKIE JUDD: Which is why they weren’t in his speech –

JOHN COHEN: Which is why they weren’t in his speech.
Well he discussed Viet Nam which is a new PEPFAR country, and
he didn’t say that they were going to offer needle exchange.

JACKIE JUDD: Because the Administration is on the
record opposed to it.

JOHN COHEN: The Administration is on the record
opposed to it, well that’s an elephant in the corner. It would
be, I think, more forthright to say, we opposed needle exchange
for these reasons and we don’t think that’s the way to help
Viet Nam. Say it, you know. There’s also another huge
elephant in the corner which is the big debate at this
conference of why is the U.S. spending so much more on PEPFAR
than it is devoting to the Global Fund and what’s the logic
that says that is the best way to use all that money. And they
really didn’t address why that is the best way to spend all
that money.


JACKIE JUDD: A lot of the frustration that’s felt here
about what you’ve just described is directed directly at the
United States. Why is that?

JON COHEN: It’s curious because the US spends more on
HIV and AIDS than any country in the world. And it’s also
understandable why the anger exists, I think. Most of the
leaders here, public health leaders, political leaders have
pointed out that the global fund to treat AIDS, Tuberculosis,
and Malaria is the vehicle to deliver drugs and prevention to
countries. Why? Why is it the vehicle? It’s a new thing, why
put faith in that?

It’s because of its organization. It’s a ground up
grass roots structure that says the countries have to come
with a proposal with all the stakeholders and say what they’re
gonna do and how much money they want. And, it actually is a
very clever way to distribute public health money to get
something done. And they have to be accountable as well. The
anger is because the US government has contributed to the
global fund but it has committed fifteen times as much money to
its own bilateral program which means money that it’s going to
decide where it goes and how it goes there and negotiate with
the government as it sees fit.

JACKIE JUDD: That’s PEPFAR. President Bush’s program.

JON COHEN: That’s PEPFAR. That’s right and that’s $15
billion over five years as compared to commitment to the global
fund from the US of $200 million for five years. So it’s
fifteen times more for PEPFAR which serves fifteen countries as
opposed to the global fund which takes on the world. And
that’s where the anger stems from and there’s a political
component that angers and scares people as well

JACKIE JUDD: What’s that?

JON COHEN: Well, when bilateral donation goes on
that’s kind of code for I’m gonna slip in my political agenda
here. If I don’t like condoms as the message, you’re not
getting my money. The US for example doesn’t like needle
exchange. The administration doesn’t. Well, they’re giving
money to Vietnam as one of those fifteen countries. Sixty
percent of the people who are infected in Vietnam are injecting
drug users. That’s the very group where you need needle
exchange, but with the US money that can’t happen. So, there
is an illogic that is clashing with the rhetoric.

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