AIDS Culprits.

The numbers beat out a dirge: Twenty-two million people to date worldwide have died from AIDS. Thirty-six million are infected. Twenty-five million of these live in Sub-Saharan Africa. Last year, the number of HIV positive people in Russia and Eastern Europe nearly doubled.

In the West, for those who can afford proper medication, AIDS is no longer a certain death sentence. In developing countries, it usually is.

"A fifteen-year-old in South Africa has a better than even chance of dying of AIDS," reported The New York Times Magazine on January 28. "One in five adults is infected with HIV. Hospitals are filled with babies so shriveled by AIDS that nurses must shave their heads to find veins for intravenous tubes."

In Africa, "fewer than 25,000--one-tenth of 1 percent--receive the therapy that could avert their deaths," reported The Washington Post in a remarkable four-part series in late December. "At current levels of intervention, the number of Africans dead of AIDS in ten years will probably surpass the population of France."

Precious little has been done about this plague, in part because multinational drug companies hold a patent on, and overprice, the antiretroviral medications that, when taken in triple combination, could keep millions alive.

The drug companies knew they could discount the drugs drastically for use in Africa, but they worried that a secondary market would develop, whereby people in Africa would buy the drugs cheaply and resell them at a mark-up in the West. The companies feared "killing the golden goose in the United States, Canada, Germany, France, Britain, Italy, and Japan," Post reporter Barton Gellman wrote on December 27.

"Corporate boards and regional operating companies weighed the costs and benefits of pricing AIDS medicines within reach of most of the dying," wrote Gellman. "With the tacit and sometimes explicit assent of public authorities, the companies decided the costs were too great."

Then, in counterpoint, comes the aggressively cheerful noise of P.R. In 1999 and 2000, Bristol-Myers Squibb--which calls itself "a $20 billion diversified, global health and personal care company whose mission is to extend and enhance human life"--and four other giant pharmaceutical companies announced a series of grants that were, among other things, supposed to make free or greatly discounted drugs available in Africa. For instance, the company announced a project in South Africa: "As active partners, Bristol-Myers Squibb and the government will make a significant impact on the lives of women and children affected by HIV/AIDS," said vice chairman Kenneth E. Weg, according to a company press release.

But the offer does much more to improve the reputations of the drug companies than it does to save lives. "Nothing fundamental has changed in the calculus of access to AIDS treatment," wrote Gellman.

"If it's relatively cheap to manufacture [AIDS] drugs, it makes no moral sense to let thirty-six million people die," says James Love, director of the Consumer Project on Technology, an organization started by Ralph Nader.

Love points to one positive development: the agreement whereby Cipla Ltd., a Bombay drug manufacturer, will make generic AIDS drugs that it will market for $350 per year per patient to the organization Doctors Without Borders, which will then distribute the medications for free. At Western prices, the brand-name versions of the drugs would sell for $10,000 to $15,000 per person per year.

Love's group, along with the Paris and Philadelphia chapters of the AIDS Coalition to Unleash Power and Doctors Without Borders, worked for six months to bring about the Cipla deal. They regard it as "the big breakthrough," says Love, who personally negotiated the price. "A dollar a day for a three-drug cocktail. That's a life-or-death issue in South Africa right now."

"We've been pursuing cheaper sources for medicines now since 1996, with the Vancouver AIDS conference, when it became clear that the triple combination therapy was helping people with AIDS live longer, more productive lives," says Eric Sawyer, a founding member of the New York chapter of the AIDS Coalition to Unleash Power. "We knew at that time that the costs being charged for those medications were beyond the reach of poorer people worldwide. We immediately sought a way to bring those prices down."

The Cipla deal works, says Love, because international trade law allows companies to produce generic drugs against the will of the parent company if they pay a small fee of around 5 percent, a process called compulsory licensing.

Love and Sawyer both say that compulsory licensing is one of several methods developing countries can use to obtain AIDS drugs legally without paying exorbitant prices. They have launched a campaign to draw attention to the availability of these legal remedies. "We're continuing to try to push the envelope every way we can," says Sawyer. "We'd like to see this type of process go worldwide."

Without these creative ways of bringing down drug prices, says Love, "We sit around and we beg and beg and beg the giant companies, `Please, please, please lower your prices.'"

But, as one current WTO case reveals, the loopholes may allow such freedoms only temporarily. By declaring a national emergency, Brazil has been able to manufacture generic versions of eight of the twelve antiretroviral AIDS drugs, which it then supplies free. And the program works. Contrary to the warnings of the drug companies that poor countries would not be able to administer the drugs properly, Brazil reports that the great majority of its patients stick to their drug regimens.

"One major reason that only Brazil offers free triple therapy is that, until now, there was no Brazil to show that it is possible," reported The New York Times Magazine. "A year and a half ago, practically nobody was talking about using triple therapy in poor countries. Today, it is rare to find a meeting of international leaders where this idea is not discussed."

But on February 2, The Wall Street Journal reported that the World Trade Organization had "set up a dispute panel to examine a U.S. complaint that Brazilian patent law discriminates against imports." The dispute could bring Brazil's drug program, widely praised as a success, to an end.

"We've already seen companies like Bristol-Myers Squibb challenging generic production," says Sawyer, adding that sometimes companies threaten, to sue even in countries where they don't hold patent rights. The activists, he says, are fighting back with demonstrations "to call attention to the outright inhumane and genocidal practice of putting patent protections ahead of human lives."

"I just don't see why we as a people tolerate a system where drug company profits are placed ahead of suffering people in developing countries," says Peter Lurie, deputy director of Public Citizen's Health Research Group. "But we are tolerating it."

In the context of millions of deaths, the companies' rationale sounds unpardonably cynical. They claim that they should not have to pick up the tab for Africa and other poor countries, that reducing prices for poor countries will lower prices in wealthier ones, and that developing countries lack adequate medical facilities and will be inclined to misuse the medications--leading to drug resistance.

"There's sort of a naysaying in the pharmaceutical industry and among certain researchers, a resignation about people in Africa," says Lurie. "They are willing to write off the developing world with facile comments." Lurie says that it is important to establish effective programs, "not use the lack of them as an excuse to deny people life-prolonging drugs."

"We can do this," says Lurie. "How incredible it is that a society that can put a man on the moon throws up its hands at a problem for which we have multiple possible solutions. It suddenly becomes impossible when it's in Africa."

The U.S. government has nothing to be proud of. The Clinton Administration threatened to bring trade sanctions against South Africa for manufacturing generic versions of AIDS medications. Only after activists raised a stink and picketed Al Gore's appearances on the campaign trail did the Administration change course. "We embarrassed the Clinton Administration" into issuing an Executive Order that it would not use trade sanctions to prevent developing countries from obtaining affordable medications, Sawyer says.

But the Clinton Administration has bulldogged other countries on patent rights. And it has done some of its own deceptive advertising. Last year, it announced $1 billion in funding for access to AIDS medicines. But that money "turned out be Export-Import Bank loans, at commercial interest rates, to buy American drugs at market prices. There were no takers," Gellman noted.

The World Bank, for its part, "still regards antiretroviral drugs as `cost-ineffective' in the Third World, and discourages borrowers from buying them," wrote Gellman in the Post.

Now with George W. Bush, things may get worse. "There is a danger that a more conservative, more corporate-friendly administration like the Bush Administration--which did receive both hard and soft money contributions, including contributions to some of the inaugural festivities, from pharmaceutical companies--may rescind that Executive Order or may again engage in the genocidal practice of using the power of U.S. trade sanctions to protect patents," says Sawyer.

The White House did not return repeated calls requesting its policy on distribution of AIDS drugs worldwide. But the Republican Party has some expensive favors to return. In 2000, the pharmaceutical industry gave $24 million in contributions to both parties, according to the Center for Responsive Politics. Most of that--nearly $17 million--went to the Republicans.

The Bush Administration's clumsy act of announcing that it was closing both the office on AIDS policy and the office on race relations on February 7, then hastily rescinding that decision on the same day, does not bode well--particularly since the Administration made those announcements the day after newspapers revealed that the AIDS rate was surging among black and Latino gay men in the United States.

According to Sawyer, the activists' hope lies in Colin Powell, who sees AIDS as a global security threat and wants at least to continue the Clinton Administration policy.

But something more dramatic is needed. "The amounts of money necessary to make an enormous difference for AIDS in Africa are tiny fractions of what a B-2 bomber would cost," Lurie says. "If you put it in that context, what we've been doing for AIDS in Africa has been pitiful for years. A couple of billion dollars would make an enormous difference in AIDS prevention there. The last thing we need are loans with the same contingencies that drove Africa into an enormous debt crisis in the first place."

Combating AIDS also requires liberating women from the bonds of inferior status and power. Until women can control their bodies and until sex becomes something they choose freely, the AIDS rate will continue to explode. In many countries, women do not feel they can refuse their husbands or boyfriends or ask them to wear condoms. And many turn to prostitution out of economic desperation. AIDS is, for this reason, directly connected to economic and social freedom for women. It is also connected to debt relief, since many countries pay more toward debt service than toward public health.

What is our moral obligation? It is to assist our neighbors and our fellow human beings.

To attack the AIDS plague will mean debt forgiveness, massive public funding for public health education, condom distribution, needle exchanges, and widespread, cheap distribution of drugs to those who are infected with HIV.

It is unthinkably cruel to consign those who already have the virus to an early death. The drug companies should not have the power to determine that people with AIDS in wealthy countries will be able to live longer, more productive lives, while poorer people in Africa, Asia, and South America have their lives drastically shortened.

A real, working solution to the global AIDS crisis will require U.S. and European governments to put lives ahead of patent law. It will require companies to choose human interests over financial ones.

"In this day and age, we really have to redefine what we mean by public health care, and we have to make sure that everyone on the planet has access to it," says Sawyer.