World Aids Day

Tommy Thompson may have been a bit too honest in pointing out that AIDS has caused "more casualties than any other war." He's right. About 3 million people have died this year. But the war analogy invites unavoidable comparisons, which Jeffrey Sachs made yesterday:

Speaking at the opening of the annual General Conference for the United Nations Industrial Development Organization (UNIDO), Sachs said the world was spending an astronomical amount of money on the instruments of war and a fraction of that on AIDS.

"This year, the world will spend $900 billion on armaments, $50 billion on development assistance, and perhaps one billion dollars on AIDS," he said in his speech coinciding with World AIDS Day.

"And my own country, the United States, will spend $450 billion on the military and $10 billion on development assistance -- a ratio of 45 to one," he added.

I've picked on George Bush's ostentatious but hollow AIDS relief plan enough times. Nothing I can do will scratch that hypocrisy. So on to what others are doing. The World Health Organization is focusing on how to get medicine to 3 million people in poor countries by 2005:

The World Health Organisation will on Monday announce a plan to train "barefoot doctors" to deliver Aids drugs in parts of Africa and other poor countries.

Under the new plan, the WHO will organise training programmes to teach people who do not have medical qualifications how to provide elements of Aids treatment in rural communities.

The training scheme is one of the central parts of the WHO's new plan to have 3m people in poor countries on Aids drugs by 2005. Other initiatives include establishing a list of recommended and simple Aids treatments and a system for acquiring cheap and safe drugs.

All important steps -- particularly training people to deliver medication. As the New York Times recently reported, one of the problems in dealing with the epidemic is the shortage of medical workers in developing countries, aggravated by the fact that some Third World professionals are being lured away to fill shortages in developed countries. Charles Arthur phrased it more bluntly in today's Independent:

Botswana's nurses, doctors, pharmacists and other health workers qualified to run such a programme are leaving. Britain, America and other European countries have poached them. Botswana recently lost 130 nurses to Britain and the country's 6,000-strong nursing workforce is not large enough to deal with the country's health needs. Only 9,000 out of a possible 110,000 patients have been enrolled on the antiretroviral programme.

Mompati Merafhe, the Foreign Minister, has raised the issue of poaching with the British Government. To the private agencies that recruit the staff, he said: "How heartless can you be? Why do you recruit medical personnel from countries which are so afflicted by Aids?" At Princess Marina Hospital in the capital, Gaborone, 3,000 patients are enrolled on a programme but there are only 30 nurses trained to run it.

I know. They can make far more money here, far more easily, than there. But I can't understand by what logic we need nurses more than they do. One more free market failure, which the WHO tries to work around.

But there are things the World Health Organization can't do. All the health care workers in the world won't make a difference if the drugs aren't available, or are too expensive. And American trade policy has a great deal to do with the cost and availability of those drugs. Nicholas Kristof, who rarely goes radical, recently wrote a fierce op-ed on the subject, and got it exactly right:

Even now, some governments in Central America choose to let their people die rather than distribute cheap generic AIDS drugs, which would save more lives but might irritate the U.S. And now America is trying to make it more difficult for these countries to use generic drugs.

That's why I decided to write about the Free Trade Area of the Americas, or F.T.A.A., not from Miami, where the negotiations were under way this week, but from rural Guatemala. Here it's easier to appreciate the stark choice that we Americans face: Do we want to maximize profits for U.S. pharmaceutical companies, or do we want to save lives?

American trade negotiators, in both the Clinton and Bush administrations, have pushed U.S. interests in a narrow economic sense by making it difficult for poor nations to use cheap generic medicines. In front of the television cameras, the U.S. has made some concessions to public health needs, but the compassion usually vanishes in trade negotiations.

They need money. They need drugs. They need the kind of honesty they aren't going to get from people who run and hide when they hear the word condom. Health GAP, an organization of AIDS activists in the US, has asked all the candidates running for president to endorse a nine-point plan to deal with the AIDS crisis. It isn't just about how much money to spend; it's about knocking down the barriers to getting treatment to people who need it. Today Wesley Clark planned a proposal to enormously increase American contributions to AIDS relief, and to channel it through international organizations. It will be interesting to see if other candidates use World AIDS Day as an opportunity to be more specific about how they would deal with the crisis. One way or another, it wouldn't hurt to give them a little push in the right direction.

Update: All nine Democratic candidates have agreed with the Health GAP plan.