Global Epidemic, U.S. Response: A Winning Strategy, What You Can Do.

How to change the lack of political will now blocking worldwide AIDS control.

World consciousness on the HIV epidemic in developing countries -- about 90% of the global epidemic -- has changed greatly in the last three years. In 1998 the World AIDS Conference in Geneva took the theme "Bridging the Gap" -- meaning the gap between access to treatment in rich and poor countries. But outside the conference there was no institutional support for saving lives in poor countries; once the speeches were done, that was it. And we all knew it.

Now it is no longer OK to let tens of millions of people die without treatment when treatment is available. And especially since the XIII International AIDS Conference last summer in Durban, South Africa, real changes have begun. Prices of antiretrovirals have been reduced up to 90% in some poor countries -- either by generic manufacturers, or by major pharmaceutical companies trying to head them off. Treatment is now widely recognized as an important part of HIV prevention and control, especially since it gives people incentive to get tested and work with the public-health system. (With no chance of treatment, they have the opposite incentives.)

The big problem now is funding. Even with the price reductions many countries cannot pay for the necessary prevention and treatment programs without help. United Nations Secretary General Kofi Annan proposed a global fund of $7 to $10 billion per year to control HIV, tuberculosis, and malaria; economists agree that the money is available, and health experts agree that if well spent, it could do the job. Yet the Global AIDS and Health Fund is going to start with only a fraction of the amount required -- and even that includes one-time contributions, multiyear contributions all counted in a single year, and money already being spent on AIDS that has been redirected or renamed to make the Fund look bigger. (For current pledge totals to the Global AIDS and Health Fund, see http://www.un.org/News/ossg/aids.htm.)

The problem is not lack of money -- many institutions and some individuals could write a check for the entire amount required from all countries in the world -- but lack of political will. In the U.S., we are hearing from political experts that the biggest problem is not policy disagreements about what to do about global AIDS, but rather that global AIDS is not a priority for either political party -- simply because Congress is not hearing from constituents that this is a problem for them. These experts tell us that if Congress received 10,000 calls or letters per month expressing concern about the global AIDS epidemic and other infections diseases, the entire situation would be transformed.

That's about one call or letter per month for every 25,000 people in the United States -- to entirely change our country's response to the greatest epidemic of modern times. And it would change much of the world's response as well. If the world's only superpower takes global AIDS seriously, many other countries will also.

So why hasn't it happened already?

A big part of the problem has been the lack of good legislative vehicles (such as bills or amendments) for expressing concern -- or rather, the lack of knowledge about how to use the vehicles that do exist. With the way Congress works, letters and phone calls should target actual legislation or other decisions in front of Congress at the time; otherwise they may never be counted, because the office staff will probably not categorize, total, and report them, among the many thousands of communications that come in to each Congressional office.

To overcome this problem, advocates and the public alike must understand that what is most important is that Congress knows the public it represents does care about AIDS and other epidemics in developing countries. So even if specific legislation fails, or is flawed, or was not introduced in a politically astute way, your call or letter is still important because it adds up to the 10,000 communications per month that Congress needs to get from throughout the U.S. -- to know that people in their district care about the global epidemic (and therefore they need to care about it as well, and act accordingly).

When you write or call it helps to know that you are not trying to change anyone's position (the Senator or Representative and their advisers and office staff probably agree with you already), but to let them know you care about the issue, and want them to give it the priority it deserves. You don't need to debate or make technical arguments.

Political organizers can miss this reality because they are used to controversial issues where the most important part of a call or letter is where it makes clear which side the writer takes. Here it's not an question of sides, but of priority. Political organizations can also miss the point because usually their main goal is to pass or block specific legislation or other policies -- while the main goal here is cumulative impact on prioritizing the issue.

Also, lobbyists may find it hard to work on both domestic and international AIDS; but for the public, calls or letters to Congress or the White House on each of these add to the total momentum on AIDS, infectious diseases, and health, increasing the priority (the political will) on both U.S. and international AIDS.

Next Steps

In August, September, and October of this year international AIDS will come before Congress many times, as the new Global AIDS and Health Fund begins. Many AIDS organizations will put out action alerts when calls or letters are needed. Remember that what often counts most is letting Congress know you care about international AIDS, rather than the particulars of the legislation or amendment at issue.

We believe that a winning strategy is to use each appropriate piece of legislation to build cumulative momentum on this issue. Can we organize friendly contests on who can get the most communications from constituents to Congress (and/or to the White House)?

Every U.S. citizen can contribute substantially to better worldwide control of AIDS and other infectious diseases -- saving millions of lives, contributing to the safety of our country, and improving the quality of life for everyone. A few hundred committed, determined activists -- with the widespread community support they already have -- would be more than enough to do it.

Better political mobilization would help. We see action alerts with no date, with misspellings, or with no indication of whether they are still current. Or the action alerts are hard to find on a Web site. Some of them direct users only to an automated email response, without justifying whether emails to Congress are effective (despite widespread doubt that Congress listens to email).

Some give little guidance -- for example, urging readers to write the Treasury Department with no further details. None seems to have benefited from simple focus groups that ask supporters not familiar with writing Congress, etc. to relate what questions and obstacles come up as they try to respond to the alert. And many apparently lack a winning legislative strategy -- or if they do have one, they conceal it well from readers.

Years ago we noted the bad state of AIDS action alerts and grassroots organizing. Much of the problem stemmed from the ambivalence of inside-the-Beltway organizations toward grassroots action: they needed it to be effective, but were threatened by it as well. The community still urgently need organizers who define grassroots as their mission, and learn do it well.

The epidemic will not wait for perfect organization, and neither can we. Determined individuals throughout the country can use the information available (and insist on better information when necessary) to make sure the U.S. and other governments respond seriously to the worldwide epidemic -- not only in rhetoric, but in resources as well.