A whole generation into the AIDS pandemic, we now have significant (though still insufficient) knowledge of how to combat the disease. But while the world’s collective understanding is gradually advancing, US AIDS policy remains mired in a right-wing economic and social vision that is curtailing progress and costing lives.

In fact, the politics that drive US AIDS policy-and sexual and reproductive health policy in general-have swung so far to the right that many in the US are no longer outraged by the truly outrageous. Something that would have once sounded utterly insane-like requiring health clinics to sign a loyalty oath condemning prostitution-today passes for business as usual.

But as public debate shifts to the right, we should refuse to drift with it.

We need to hold our ground and continue to insist on policies that reflect our convictions. Last month’s election of a Democratic Congress offers some hope, but only if we succeed in shifting public debate onto more reasonable ground. One place to begin is to help people recognize the ways that AIDS policy is fueled by financial greed, religious dogma, and hostility towards women’s rights. Then we can begin to address the gap between what AIDS policy is and what it should be.

Financial Greed

What the policy is: After another three million AIDS deaths this year, the Bush Administration is still prioritizing pharmaceutical industry profits over ensuring people’s access to medicine. Patents that allow drug companies based in the US and Europe to control the manufacture and sale of AIDS medicines prevent countries in Asia, Africa, and Latin America from providing people with cheaper, generic AIDS drugs (even though 95% of AIDS patients are in those countries). Meanwhile, the nine largest US drug companies turned a profit of nearly $43 billion dollars last year-more than the gross national income of some of the worst AIDS-affected countries. The latest trend, embodied by Bill Clinton, is to haggle with drug companies for reduced prices or donations. But charity is not what the countries of the Global South are asking for.

What the policy should be: Reluctant corporate charity is no way to fight the worst epidemic in recorded history. Rather, like food and water, medicine should be excluded from World Trade Organization patent rules. Not only is this a viable demand, the US already agreed to it in trade talks held in Doha in 2001. We need to push the Administration to make good on that promise. That means renegotiating recent trade deals, such as the Central American Free Trade Agreement, that skirt commitments made in Doha and prevent governments from providing generic drugs to people living with AIDS.

Religious Dogma

What the policy is: Today, a full one-third of international US AIDS prevention funding is mandated for programs that promote either abstinence or fidelity as prevention strategies (condoms are decried as a “last resort”). This is ludicrous. There is no evidence that moralizing about abstinence reduces the spread of HIV. On the contrary, in Uganda, it took only two years for HIV rates to double after US missionaries-turned-policymakers effectively shifted the emphasis of the country’s AIDS prevention programs from condom use to abstinence.

Yet, Bush continues to favor right-wing Christian organizations that preach abstinence in disbursing federal AIDS funding. He has stacked his Presidential Advisory Council on HIV/AIDS with religious fundamentalists and incompetent ideologues: this year’s outstanding appointment was of Herbert Lusk, a vocally anti-gay pastor with no HIV-related experience. And just last month, Bush picked Eric Keroack-who opposes birth control-to head the family planning programs at the Department of Health and Human Services.

Keroack believes that publicly funded sexual education should consist almost entirely of abstinence promotion.

What the policy should be: Remember when public health policy was based on public health? It’s not too late. Rather than a fundamentalist fantasy of stamping out sex, AIDS prevention strategies should be grounded in what we know works: education and access to condoms within a framework that promotes women’s and girls’ rights to negotiate sex and make the best choices for their well-being.

Contempt for Women’s Rights

Current US AIDS policy gives drug companies control over treatment options and allows religious fundamentalists to dominate prevention strategies. This union of greed and dogma has produced an AIDS policy that undermines women’s human rights at a time when more women than ever before are being infected with HIV.

The drug industry’s hostility towards generics is disproportionately harmful to women: as the majority of the world’s poor and those whose health is often most neglected within families and communities, women have the least access to costly AIDS medicines. Women are also endangered by the abstinence-and-fidelity mantra of the religious right because it ignores the fact that many women lack the power to refuse sex-especially from their husbands. In sub-Saharan Africa, where 65 percent of this year’s new HIV infections occurred, being married actually increases a woman’s chance of contracting the virus. And the fundamentalist attack on abortion rights-which now permeates US international health policy-continues to fuel the spread of AIDS. The “global gag rule” has pulled US funding from any health organization that provides information about abortion. As a result, clinics that once offered a range of critical health services-including AIDS treatment and prevention programs for women in some of the poorest countries-have been forced to close.

Everything we know about combating the AIDS pandemic points to the need for a synthesis of prevention and treatment strategies within a human rights framework. And it’s not Bono’s or Oprah’s job to develop and enact those strategies. Safeguarding public health and upholding human rights are the responsibility of government. To realize those goals, federal AIDS programs should rely on generic AIDS medicines-which, at a fraction of the cost of patented brands, are the key to ensuring universal access to treatment. The global gag rule and Bush’s anti-prostitution oath should be repealed. And US policy should be brought into compliance with the plan of action developed by public health and women’s rights advocates at the 1994 UN Conference on Population and Development.

You don’t need to have memorized the latest UNAIDS report to know that corporate greed and religious dogma are no substitute for a human rights-based international AIDS policy. That should be our message to the new and improved Congress this World AIDS Day.

*A few places to start*

Call on your representatives to endorse Barbara Lee’s bill seeking to repeal the requirement that one-third of US HIV/AIDS prevention funding be dedicated to programs that prescribe abstinence, and calling on the President and the Global AIDS Coordinator to develop a comprehensive strategy to address the impact of HIV/AIDS on women and girls.

Now that the Democrats control both Houses of Congress, we should push for another vote to repeal the “global gag rule.” Last year, the Senate voted to rescind it, but the measure never made it past the House.

The next fiscal year’s HIV/AIDS budget should reflect the US commitment to fund its fair share of the United Nations Global Fund to Fight AIDS, TB, and Malaria. The Global Fund-which relies on generic medicines, operates within a human rights framework, and facilitates international cooperation-is the single best situated institution for combating the spread of AIDS worldwide.

The Central America Free Trade Agreement was passed by such a slim margin last year that November’s victories may offer a real possibility for future trade deals that actually comply with US obligations to allow the manufacture and sale of generic medicines. Let your representatives know that such provisions matter to you.

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Yifat Susskind is the Communications Director of MADRE, an international women’s human rights organization. Her critical analysis of US foreign policy, economic justice, and women’s human rights has appeared in online and print publications such as TomPaine.com, Foreign Policy in Focus, Common Dreams, and The W Effect: Bush’s War on Women, published by the Feminist Press in 2004. Ms. Susskind has also been featured as a commentator on CNN, National Public Radio, and BBC Radio. She is the author of a book on US foreign policy and women’s human rights and a report on US culpability for violence against women in Iraq, both forthcoming.

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