Problems with Current U.S. Policy.

Key Problems

* The U.S. has not provided global leadership on access to AIDS drugs for Africa and has not supported Africa's demand to purchase or produce generic drugs.

* The U.S. 2001 budget for fighting AIDS in Africa is about $460 million, but much more is needed.

* The U.S. has yet to assert its influence at the World Bank and the IMF to put more resources in Africa and to cancel external debts. Whether someone lives or dies of AIDS depends largely on where she or he lives. Despite the availability of drugs to treat AIDS, millions of Africans will die because they do not have access to AIDS drugs. In the U.S. and other Western nations, such drugs have helped AIDS to become a disease that can be managed and for which effective care is available.

Confronting the AIDS emergency, African governments are demanding that pharmaceutical companies directly provide AIDS drugs at deep discounts, or at the very least not oppose compulsory licensing and parallel import arrangements. Compulsory licensing is an international trade mechanism by which countries can instruct a patent holder to license the right to use this patent to any national company or government agency. Parallel importing describes a practice whereby a country imports goods for resale without authorization from the original seller. (See Facilitating Access to Essential Medicines by Robert Weissman, FPIF, March 2001.) This struggle became heated with the court battle between the government of South Africa and 39 drug companies. The companies contended that a new law would allow the South African government to ignore international patent law.

Under mounting international pressure, the pharmaceutical industry dropped its suit, and has promised to facilitate the flow of low-priced AIDS-treatment pharmaceuticals. But this issue will not go away, because even lower priced drugs will still be out of reach for most Africans, and the pharmaceutical industry remains committed to strong international patent protection and to staving off the production of generic medicines for the treatment of AIDS and other illnesses.

The U.S and its Western allies have failed to provide significant funds to fight AIDS in Africa. In 2001, the wealthiest nation on earth is spending only $460 million dollars to fight the biggest medical and humanitarian emergency of our time. The United Nations estimates that at least $10 billion will be needed to fight AIDS in Africa. A group of Harvard researchers, economists, and scientists recommended that, at bare minimum, the U.S. should spend $1.5 billion a year to fight AIDS in Africa.

Fortunately, U.S. policymakers are responding to such public pressure with increased allocations. The U.S. Senate, for example, recently approved a $700 million increase in proposed spending over the next two years to fight AIDS in poor countries. However, much more needs to be done.

In another major issue confronting Africa, U.S policymakers have not squared up to their responsibility. Africa owes foreign banks and governments about $350 billion. These debts are controversial and a major hindrance to an adequate African response to AIDS. Every year, Africa spends roughly $20 billion on debt repayment--more than the combined continental outlay for healthcare and education. At least 23 African countries spend more money on debt repayment than they spend for healthcare. The International Monetary Fund (IMF) and the World Bank have yet to effect significant debt cancellation for African nations despite widespread pressure from international citizen movements and from the G8, the forum of the world's wealthiest nations. The U.S., which is the largest shareholder in these two international financial institutions, has yet to demand debt cancellation for Africa.

The policy problems that contribute to the AIDS crisis in Africa extend beyond Washington and other international donors. Until recently, African leaders have largely ignored the pandemic. Even today, very few African nations match their AIDS rhetoric with commensurate budget allocations. Uganda and Senegal are prominent exceptions.

Senegal, through a combination of political will, prudent budget allocations, and massive mobilization has kept its rate of infection to less than one percent. Ugandan President Yoweri Musuveni, recognizing the gravity of the AIDS pandemic, mobilized his people to modify risky behaviors and to come forward for testing and counseling. The rate of AIDS in Uganda is down to about 8%, from a high of 16% in the early 1990s.

Despite the laudable efforts of Uganda and Senegal, corruption and the squandering of scarce national resources continue. Government spending on wars, white elephant projects, and persecution of political and economic opponents is still rife across the continent.

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Melvin Foote is President/CEO of the Constituency for Africa (CFA), a Washington, DC advocacy organization. CFA is promoting an AIDS Marshall Plan for Africa. Chinua Akukwe <[e-mail]> is a board member of Constituency for Africa, and Adjunct Professor at George Washington University School of Public Health.