President Bush has signed into law a measure that will allocate $15 billion to fight AIDS in the poorest countries of Africa and the Caribbean. This is a hopeful sign. It shows that the rich nations are finally taking concrete notice of a pandemic that is affecting ever greater numbers of people. Advocates, however, believe that a still greater commitment will be needed by the countries of the North to make the levels of infection fall instead of continuing to rise.
An estimated 13,000 new infections occur globally every day. Some 2,000 of these are among children under 15 years of age, most of whom had the virus transmitted to them by their infected mothers. Still more problematic, the parents of young children have themselves been dying so rapidly that in a few years the number of AIDS orphans may reach 29 million. Congress has earmarked part of the $15 billion, in fact, for the care of orphans, as well as for the care of those who have already become sick.
The funds will also be used to make anti-retroviral drugs more accessible. Through various state and federal programs here in the United States, these life-extending medications are generally available even to low-income people. Partly because of patent law and import restrictions, though, such drugs remain far beyond the reach of most people in the poorest countries. Some countries, like Brazil, have taken matters into their own hands by using World Trade Organization regulations to permit locally based private companies to manufacture generic drugs.
Especially in Africa, women have increasingly borne the brunt of the disease. In sub-Saharan regions, they now account for almost 60 percent of new infections, primarily as a result of sexual contact with infected men. Often these are monogamous married women whose husbands, working for long periods far from home, return with the virus and pass it on to their spouses. Cultural factors also work against women in Africa. Once ill, they tend to face blame and stigmatization to a greater degree than males, and yet bear the lion’s share of care for their spouses, children and even infected parents. To provide for their own and their loved ones’ needs, many marginalized and undereducated young women, unable to find employment, accept money in exchange for sex. The education and empowerment of women thus stands out as a primary goal, if they are to exert control over their lives in ways that can reduce their exposure to the infection [see this issue, p. 16].
In the absence of a vaccine, prevention remains the primary hope for stemming the epidemic’s increase. Part of the $15 billion is destined to be used for this purpose. Bolstered by aggressive political leadership, some African countries have already made impressive progress. Uganda’s rate of infection began to drop in the late 1980’s. Even among sexually active youth, a decline in infections has taken place, which suggests that it is possible to alter patterns of sexual behavior among the segments of the population that are most at risk.
The impact of AIDS extends far beyond the immediate realm of sickness and death. Because it has killed off so many in the younger age groups—people in their prime working years—the disease has emerged in some nations as a threat to their economies, to their military forces and consequently to local and regional security. Famine, too, represents part of the growing threat. Commentators point out that during times of planting and harvesting, a large labor force (largely women) is needed. But those who fall ill cannot assist in this physical work, and therefore harvests can fail. The accompanying hunger then hastens the illness of infected persons, who need extra nutrition to remain active.
One promising source of funding help lies in the newly established Global Fund to Fight AIDS, Tuberculosis and Malaria. An international umbrella group based in Geneva, the Global Fund was first proposed at the G-8 summit in Okinawa in 2000. President Bush has asked Congress to authorize $1 billion a year for the fund for five years as part of his $15 billion pledge. But again, given the United States’ resources even in these straitened economic times, we have the capability for greater generosity. The fund makes grants to worthy programs in dozens of countries. Money is not the only answer to the AIDS epidemic; free generic drugs and the empowerment of African women are also part of the answer. But without a greater infusion of money from the United States and other rich countries, progress will be slow. And as President Bush himself has said, “Time is not on our side.”