No experience necessary: a profile of Bush's AIDS czar.

Randall Tobias, the U.S. Global AIDS Coordinator, as standing at the podium to address the fifteenth International AIDS Conference in Bangkok in July when about fifty activists burst into the hall chanting, "Bush lies, millions die." They also carried a giant check for $15 billion payable to "Big Pharma & Rightwing Extremists."

The disturbance lasted about ten minutes, and Tobias sat down to wait it out. Once it died down, he said, "At this time, perhaps the most critical mistake we can make is to allow this pandemic to divide us. We are striving toward the same goal: a world free of HIV/AIDS."

Being divisive, however, is not the most critical mistake. The real danger lies in following the retrograde policies of the Bush Administration, as implemented by Randall Tobias.

In his State of the Union Address in January 2003, President Bush announced a $15 billion, five-year initiative to fight HIV/AIDS in Africa and the Caribbean. It sounded like an impressive pledge attached to an extraordinary sum of money: the largest ever promised to address the global pandemic that has so far infected sixty-five million people worldwide.

But Bush's appointment of Tobias was a tip-off. Tobias, a former pharmaceutical executive and major Republican Party donor, had no training in public health administration, much less specialized expertise working with HIV/AIDS. And the pharmaceutical company he ran from 1993 to 1998, Eli Lilly & Co., didn't even make anti-retroviral drugs.

What recommended Tobias to the post, Bush claimed at his swearing-in ceremony in July 2003, was his "ability to manage complex organizations and to navigate government bureaucracies." More likely, it was the $2.65 million Tobias and his company donated to Republican Party candidates and political action committees in the 2000 and 2002 election cycles.

Instead of ensuring that the President's Emergency Plan For AIDS Relief (known as PEPFAR) is used to promote public health and save lives, Tobias has been protecting U.S. corporate pharmaceutical interests overseas while helping to export a far-right evangelical health agenda to the world's poorest nations.

"The policies that Tobias is promulgating and advocating for are dangerous to public health," says Dr. Paul Zeitz, executive director of the Global AIDS Alliance, a Washington-based nonprofit organization. "They are slowing down, if not undermining, the global response to AIDS. As a result, the Bush initiative is actually doing more harm than good."

In recent months, Tobias has become a leading broker of misinformation about prevention and treatment of HIV/AIDS. In public forums, he has argued that condoms don't work and he has suggested that life-saving generic drugs aren't as safe as brand-name medications.

At the same time, he has made disparaging remarks about the world's most important mechanism for financing the treatment of AIDS--a public-private partnership known as the Global Fund--just as President Bush attempts to drain some of that organization's vital funding. For fiscal year 2005, President Bush has proposed reducing support for the Global Fund to $200 million from $547 million and increasing AIDS money allocated through Tobias's office by 196 percent, to $1.45 billion.

Tobias, who declined to be interviewed for this article, began his business career right out of Indiana University at AT&T in 1964 and worked his way up to CEO of AT&T International Co. In 1993, Eli Lilly, the Indiana pharmaceutical manufacturer of Prozac and other medications, hired him as chairman and CEO, with a starting package of $922,000. During his last year at the company five years later, he earned $2.5 million.

Jodi Jacobson, executive director of the Center for Health and Gender Equity, says Tobias has "created a strategy that has no relationship to twenty-five years of public health data and information on prevention."

By raising questions about the effectiveness of condoms and generic drugs--two of the most powerful weapons developing countries have in their arsenal to fight AIDS--Tobias has not only undermined his own credibility, he has jeopardized the chances of preventing the spread of the disease.

During a Global Business Coalition on HIV/AIDS meeting in Berlin in April, Tobias told a news conference at the U.S. Embassy, "Statistics show that condoms really have not been very effective," according to Agence France-Presse. "It's been the principal prevention device for the last twenty years, and I think one needs only to look at what's happening with the infection rates in the world to recognize that it has not been working."

In May, speaking before a Senate Appropriations Committee, Tobias cited research he attributed to the London School of Hygiene and Tropical Medicine that concluded that "less than 50 percent of women used condoms with nonregular partners." In the hearing, he concluded, "This shows that condoms simply are not effective." He also mentioned an unnamed U.N. AIDS study, which he said made the point that "condoms are not effective in disease prevention in a generalized epidemic."

Unfortunately, neither study exists. The U.N. AIDS fact sheet about HIV prevention published in 2001, in fact, states: "Condoms are currently the only available means of preventing the sexual transmission of HIV." To correct the other mistake, Andy Haines, dean of the London School of Hygiene and Tropical Medicine, sent a letter to Tobias (obtained by The Progressive) requesting that he desist from using the school's name in connection to any such assertion. Haines wrote that the school has actually produced "a steady stream of publications ... attesting to the importance of condom promotion as part of any comprehensive HIV prevention strategy."

Data supporting the efficacy of condoms in preventing the spread of sexually transmitted diseases isn't hard to come by. As long ago as March 1988, the U.S. Centers for Disease Control and Prevention issued a Morbidity and Mortality Weekly Report stating that while condom use cannot completely eliminate the risk of transmission, epidemiological and laboratory studies showed that latex condoms blocked passage of HIV. Failure of condoms to protect against STD "is probably explained by user failure more often than by product failure," the report said.

One thing that is clear is that condoms don't work when they are not used consistently or correctly, and if people can't get them. And groups receiving funding from PEPFAR are barred from distributing them to the general population. Instead, PEPFAR allows condoms to be distributed only among people designated as "high-risk." High-risk categories include openly gay men, self-identified prostitutes, and people in monogamous relationships where one partner has been tested as HIV positive and the other is negative.

For almost everyone else, the Bush Administration is suggesting abstinence. Under the PEPFAR legislation, a minimum of 33 percent of U.S. prevention money must be devoted to abstinence-only education. But Tobias hasn't stuck to the minimums. An analysis of PEPFAR funding from February through July conducted by the Center for Health and Gender Equity determined that 50 to 80 percent of prevention monies were siphoned of to abstinence programs.

That approach poses a threat. There are at least eleven million nonmarried adolescents in thirteen targeted nations in Africa who are already sexually active, according to Advocates for Youth, a Washington-based nonprofit that works on AIDS prevention in the U.S. and Africa. "In the PEPFAR policy document, there's a statement that speaks of 'secondary virginity,' as a strategy aimed at sexually active youth," says James Wagner, president of Advocates for Youth. "That's not a public health term. That's where the U.S. government is going to wave its magic ideological wand."

In Africa, the abstinence-only agenda has also resulted in confusion among young women, who believe that if they don't have sex until marriage, they'll be safe, says Asia Russell, coordinator of international advocacy at Health GAP, a nonprofit that attempts to eliminate global trade barriers to treatment for AIDS.

Research conducted in two towns in Zambia and Kenya cited by Health GAP revealed that HIV prevalence rates among young brides were, in fact, higher than those among young women with multiple sexual partners. "The likely reason is because of the message that gets communicated: You shouldn't use condoms with your married partners; only use condoms if you're having risky sex," says Russell. "It's possible that women who were having more 'risky' sex were using condoms more often, and that's why they were less likely to become infected."

Tobias has also used his enormous influence to mislead the public on the question of generic versus brand-name medications. Currently, PEPFAR grantees are not allowed to use federal funds to purchase any generic combination anti-retrovirals, even those that have been certified by the World Health Organization's Prequalification Program, which is administered by an international panel of experts.

Only drugs that have been preapproved by the U.S. Food and Drug Administration are distributed with PEPFAR money, and so far, only brand-name drugs from American pharmaceuticals have qualified for that distinction.

To justify this rather unusual policy, Tobias has repeatedly asserted that the United States is trying to protect people in the fifteen target countries from untested and potentially unsafe generics.

In April, when Tobias was visiting South Africa, he defended the U.S. policy saying, "Patients ... in Africa deserve to have assurances about the safety and effectiveness of drugs in the same way that people in the United States do." He raised suspicions about the efficacy of fixed-dose combination anti-retroviral drugs produced by generic manufacturers. "Maybe these drugs are safe and effective," he said. "Maybe these drugs are, in fact, exact duplicates of research-based drugs. Maybe they aren't. Nobody really knows."

Of course, someone did know. The World Health Organization prequalification project had already approved the drugs, and many groups that were financed by the Global Fund were already distributing them. Medicins Sans Frontieres, the international relief organization, has treated 13,000 people with fixed-dose anti-retrovirals, using generics in about half the cases, says Rachel Cohen, U.S. director of the group's Campaign for Access to Essential Medicines.

"We know that they're prolonging lives," she says. "We know that excuses and justifications for not using these is resulting in people not getting access to treatment, and that really does mean that some lives are lost needlessly for ideological rather than scientific concerns about the validity of the medications."

The biggest difference between the brand-name drugs and the generics is price: While generic anti-retroviral medications from Indian pharmaceutical manufacturer Cipla, Ltd. cost about $250 per person annually, U.S. pharmaceutical brands go for $562, according to both Medicins Sans Frontieres and Health GAP.

"The U.S. government is willfully electing to treat one person when they could be treating three," says Cohen.

Tobias is "dangerous," says generic drug advocate William Haddad, who has traveled through Botswana, Nigeria, Ghana, Madagascar, Tanzania, and many other developing nations distributing generic AIDS drugs. "When you follow these policies to the end, you see dead children. And I'm not kidding. This is not some theoretical policy discussion in Washington. This has consequences: 8,000 lives a day."

Nina Siegel is a freelance journalist based in Brooklyn and Iowa City.