By Scott Tucker
Open Letter
Twenty three million dead, forty million living with AIDS
 Sen. Dick Durbin: Proposed more than $700 million in funding to fight the global AIDS epidemic |
Recent debates in Congress, and a recent Rose Garden speech by Bush, have put global AIDS in the news once more. But getting the real story means reading beyond headlines such as this one in The Philadelphia Inquirer (June 20, 2002): "Bush seeks $500 million for AIDS fight."
That kind of money is generous for a CEO's yearly salary, but does not give millions of people living with AIDS a fighting chance. Under the banner of global charity, politicians in Washington are beating a retreat from global responsibilities. |
HIV/AIDS has claimed an estimated 23 million lives over the past 20 years, and continues to kill some 8,000 people each day, mostly in poor countries with inadequate health care systems. Forty million more people living with HIV/AIDS are now endangered.
Upwards of 5 million new cases are reported for 2002, according to UNAIDS. Of that number, 3.4 million are in sub-Saharan Africa, with a prevalence rate of 8.4 percent. The next highest prevalence rate is 2.2 percent in the Caribbean, with new infections for 2002 listed at 60,000.
Roughly two thirds of all people with HIV/AIDS live in sub-Saharan Africa, and when the whole continent of Africa is considered that figure rises closer to the three quarters. Of 40 million people now living with HIV/AIDS round the world, 30 million are Africans.
So the new Bush plan, which targets women and children in Africa and the Caribbean, is not entirely remote from the planet Earth. It is a plan, however, which has been best designed as a public relations campaign. Who benefits most? Politicians protecting careers and pharmaceutical companies protecting their patents and profits.
North America, Western Europe, Japan and Australia have high percentages of people living long term with the disease because the general populations of the richer nations have better access to life extending drugs and care.
But that generalization must be broken down when we examine health care systems, country by country. Sex, race and class remain real fractures in the body politic of the United States, for example, where over 40 million people are medically uninsured. People of color remain high percentages of those last hired and first fired in this country, and of those who get medical care only in emergency rooms or in the most underfunded clinics.
Health charity vs. health solidarity
One more bipartisan shell game has been played in Congress with public money and with the lives of millions. After a factional struggle on Capitol Hill over two separate amendments on international medical aid, the final results are heartbreaking but not surprising.
To turn back the tide of global AIDS will take big bucks from the wealthier nations, and not just spare change. The United Nations and independent medical experts say the new Global Fund to Fight AIDS, Tuberculosis and Malaria needs at least between $7 billion to $10 billion a year to contain the disease. In recent decades, the United States has provided at least 25 percent of the budget for most major multilateral programs. But not this time. Why?
One answer is that politicians must plan ahead to stay in power. If this country takes the lead in an international effort for medical aid, then people may wonder why we can't spend money more wisely on health care within our borders.
The medical disparity between Canada and the United States is great enough that some elderly citizens of this country take regular bus rides to Canada to get certain medications at lower prices. Canada spends just over 9 percent of its Gross National Product on health care, and all Canadians are medically insured under a Single Payer Plan. Yes, this means some folks with less urgent medical needs must wait a little longer for some specialists. But no one in Canada goes without care.
In stark contrast, the United States spends almost 15 percent of the GNP on health care, yet 40 million people here are medically uninsured. We get less bang for every buck because our medical system puts profits before people.
This means more medical bureaucracy, not less--contrary to the usual mantra of politicians who oppose a Single Payer plan. Mountains of medical paperwork in this country are designed to put an obstacle course between millions of patients and proper health care, even as pharmaceutical companies push new (and not always better) products to upscale market segments.
No wonder health statistics among the bottom economic fifth of our population are so punishing. Beyond the poor, the unemployed and the working class, many more millions of middle class people are struggling to pay their medical bills.
Working harder than ever, many people are getting raw deals in education, public transportation and medical care. Public services of this kind cannot be run at a profit in all sectors all of the time. Yet our government has proven much more eager to privatize public schools than to make parochial schools pay a fair share of taxes; much more willing to bail out Chrysler than Amtrak; and much more content entertaining pharmaceutical lobbyists than listening to people with chronic diseases.
We have the best democracy money can buy, which means the bipartisan system is largely bought and paid for by the biggest corporate donors. In the field of health care, an Enronized economy takes a big toll on the quality and length of many lives. Since our national health care system is run for profit, it's not surprising that international medical aid is run on the lines of charity rather than solidarity.
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Mayflower Hotel, Rose Garden and Other Summits of Folly
Sen. Richard Durbin (D-IL) and Sen. Arlen Specter (R-PA) co-sponsored an amendment to provide $700 million in immediate aid to the Global Fund to Fight AIDS, Tuberculosis and Malaria. That amount would cover the cost of one military jet plane, but is not adequate to fight a global disease. Even that measure was defeated on June 6 by a Senate vote of 46 to 49. It had been undercut by a competing amendment co-sponsored by Sen. Jesse Helms (R-NC) and Sen. Bill Frist (R-TN). |
 An amendment by Sen. Bill Frist helped defeat Sen. Durbin's bill to fight AIDS |
The Helms / Frist amendment originally set aside $500 million targeted primarily on mother-to-child transmission of HIV. The White House resident, George W. Bush, leaned on Frist to reduce those funds to $100 million. (Bush, junior member of a family with dynastic ambitions, cannot fairly be called president since that election was merely decided by a 5 to 4 majority of the Supreme Court, and not by we, the people).
Frist showed just enough face-saving resistance to double the sum. This was indeed spare change, and was attached as a kind of afterthought to a big bucks War on Terrorism bill. Frist is rumored to be Bush's favored running mate in 2004 if Dick Cheney decides to bow out. Cheney has health troubles of his own (and the best health care money can buy).
On June 19 George W. Bush dined with top pharmaceutical company executives at the Mayflower Hotel in Washington, D.C. The next day, Bush made a Rose Garden announcement of a $500 million dollar plan to prevent mother-to-infant transmission of HIV.
This was a savvy political move to make before the Group of Eight summit meeting in Western Canada, where AIDS is on the official agenda. (The rural site of this conference was chosen to discourage protesters, who have turned out in droves against previous economic summits, most often held in major cities.)
As Salih Booker, director of Africa Action, said, "Obviously, the timing of the announcement was designed to preempt criticism at the Summit by announcing something in advance that makes it look like Bush is serious about poverty and AIDS." Moreover, the Bush plan allocates no funds directly to the Global Fund. Instead, it is a bilateral program.
As Booker explained, "That means most of the money will wind up being spent on American goods and services and patented drugs." In contrast, the Global Fund is free to "spend the money on goods and services and generic drugs that may be obtained more cheaply and efficiently from somewhere else… The pharmaceutical companies at the Mayflower would not like that."
Of the current official sum, much will not be spent until future funding cycles. Meanwhile millions of lives will be wasted. Nevertheless, even this stingy charity can be put to good use. Targeting mother-to-child transmission is not irrational. Indeed, close to 2,000 babies are infected worldwide every day through pregnancy, birth or breast-feeding. One drug, Nevirapine, can cut this rate by roughly half.
Yet the narrow vision of this plan is very much in line with the familiar search for "innocent victims" of AIDS, and with "abstinence only" programs for the young. It is also consistent with the cultivation of good relations with the Christian Right, a key constituency of Republicans.
Unless health activists cut the strings that are attached to such underfunded programs, we will become unwitting puppets of the right wing. In both the short and the long run, independent political action is necessary to gain health care justice within and beyond our borders.
Queers, whores and junkies are being pushed once again to the moral and medical margins, both nationally and internationally. Beyond these heavily stigmatized groups, a much greater number of people who wish to have sex outside marriage and the family are still addressed from religious and political podiums in the usual commanding tones. The politics of health care cannot be disconnected from sexual politics.
Until the world is made safer for non-monogamy, we can expect this epidemic to continue. There will be no global sexual revolution for women until they gain the social power and freedom to have sex outside of marriage, and to have sex for reasons other than reproduction. A world that is safer for women will often mean a world which is safer for queers. Folks who get fucked (many women and queers) do not deserve to get fucked over.
Critical research and development of vaccines and microbicides must continue. So must support for harm reduction strategies such as needle exchange programs for injection drug users. Harm reduction must become an integral element of national health care plans.
Players and rules of the game
Among some health activists, hopes had been raised that the United States would take serious global leadership in getting urgent medical aid across borders. Unfortunately, those hopes were based on some political illusions.
A minority of politicians in Congress have the decency to put this issue on the public agenda. But they face obstacles built into the foundations of the bipartisan and corporate system, as recent Congressional maneuvers proved. The real key to understanding the Congressional impasse on health care, both within and beyond our borders, is to pay less attention to individual players and more to the institutional rules of the game.
As the most recent Congressional debacle played out, responses came fast and furious in the press and by email. In a widely posted email, Paul Davis of ACT UP Philly and Health Gap Coalition, wrote that the Helms / Frist amendment undercut the Specter / Durbin amendment, but that it was "a positive development" in itself. Davis noted, "Reams of positive headlines and editorials were generated, as well as a great deal of applause from AIDS activists.
But it seems we were lied to. At the eleventh hour, Senator Frist was reportedly told by President Bush personally to withdraw the amendment, and to reduce the bill to $100 million…" This allowed Bush himself to step into the Rose Garden limelight with his own proposal shortly after, and to blunt any criticism of the United States at the Group of Eight conference which followed in Canada.
After the Durbin / Specter amendment was voted down, Sen. Durbin was also forthright: "Despite the fact that the AIDS problem will grow dramatically next year, the President's plan doesn't propose any new money for 2003.
It is all held in reserve until 2004-by which time nearly six million more men, women and children will have died of the disease." Durbin quite rightly called the Bush plan a "shell game," saying it "provides no funding beyond that already provided by the Senate until the year 2004."
This year's total budget for global AIDS projects is roughly $1 billion, not including the new funding. That is still well below the sum AIDS and health care activists are demanding as a yearly contribution from the United States to the Global Fund.
Asia Russell of ACT UP Philadelphia and the Health Gap Coalition stated, "The bodies won't stop piling up until Bush commits $2.5 billion in new money for HIV that prioritizes getting medicine into the hands of people living with AIDS." This means not only expectant mothers with HIV but everyone else living with the disease as well. If the United States does not take such a lead, other nations are under less pressure to spend according to their own ability and according to global need.
Health care between and beyond borders
AIDS is likely to hit southern Africa most heavily for several years to come. Epidemics are like the weather, however; they change, they don't stay still. A rounded view of this epidemic can't be limited to one nation or even one continent. A recent World Health Organization report predicted a sharp climb in HIV rates in Afghanistan, given the awful nexus of war, habitual injection drug use and unsafe transfusions in that country.
This is a subject some AIDS activists have been tracking for quite some time; even before September 11. Soviet era soldiers returned from war in Afghanistan with established injection drug habits, and this had been one factor in the continuing spread of HIV in Russia and former Soviet bloc countries.
India's right wing regime is not tackling AIDS as seriously as it has the military escalation with Pakistan. Not surprising, then, that India's leaders cherish certain notions about national purity and pollution. As if HIV, for example, could only be smuggled across India's borders. The Indian visa requires that anyone intending to stay one year must be tested for HIV within the first month of residency, and must leave the country if the test is positive.
And the news from China is not good. According to United Nations Wire (as transcribed on June 7 Progressive Review / UnderNews):
"China could soon have more HIV cases than any country in the world, according to an advance copy of a United Nations Joint Program on HIV/AIDS report obtained by Agence France Presse. According to that report (AIDS in China: New Millennium, Titanic Challenge), an 'HIV/AIDS disaster of unimaginable proportions now lies in wait to rattle the country, and it can be feared that in just a couple of years, China might count more HIV infections than any other country in the world... Despite official estimates that only 850,000 Chinese have HIV, the United Nations believes-owing to evidence such as 80% HIV rates among drug users in some areas-that more than 1 million may be carrying the virus."
One million may seem relatively containable (the figure is judged conservative by some health experts) but the future statistical curve of the epidemic may be very sharp, given the decades of denial and official evasions from the Chinese government. Despite great obstacles, some Chinese health workers are already doing brave and steady work.
Among health care activists in this country, the few remaining ACT UP chapters are among the genuine beacons of health care internationalism, and have paid particular attention to the devastation in sub-Saharan Africa.
Small groups of this kind can help save lives. But as we learned from the recent Congressional debacle, politicians feel the most pain when voters inflict it directly and consistently. A politically independent campaign for national health care would, of course, end many of the worst careers in Washington.
Beyond that goal, a serious campaign for national health care would give much greater power and political leverage to any long term campaign for international medical solidarity. As we study the statistics on global AIDS, tuberculosis and malaria, we might also study ways to go over, under and around the bipartisan corporate system.
Electoral reforms such as Instant Run Off Voting (IRV), for example, are critical
for health care reform. San Francisco has now joined other towns
and cities which now practice IRV. For more information on electoral
reforms, check the Center for Voting and Democracy at www.fairvote.org
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Twilight and dawn of democracy
Health care will be on the political agenda in the presidential race of 2004, mostly because middle class Americans of all races are getting hurt by the privatized health care inherited from the Reagan, Bush (senior) and Clinton years. The unemployed and working poor are not yet a serious threat in national elections.
Given the fact that up to 50% of eligible voters reliably do not vote for either Republicans or Democrats, there is a wide open political space for serious change. If we are serious enough to make a move. How? By direct action and civil disobedience. By electoral reforms and challenges. Without short cuts and without illusions.
We can fill buses with protesters and lobby in the halls of Congress, but if the protesters don't hold politicians accountable at elections then they have wasted a day they might have spent at the beach, making love or caring for sick friends and lovers.
If we can't look politicians in the eye and say, "Vote with us or we'll vote against you," then they can tell us whatever we most want to hear and go on with business as usual. If protest doesn't add up to electoral muscle on issues of health care, then the politicians can go on saying "I feel your pain." (Remember that Clinton line once upon a time?)
If the Democrats can be moved to shoplift some good ideas from Greens (check www.gpus.org or www.greenpartyus.org ) and other independents, so much the better. But they have no reason to do so until they get tough electoral competition. Liberals remain liberals only when radicals remain radicals. That's why a critical percentage of the public has a right and duty to work outside and against the bipartisan system.
Irrelevant to AIDS in Africa or closer to home in Alabama? No, on the contrary. National and international health care are intimately and inextricably linked with political democracy. As long the Republicans undermine the republic and as long as Democrats subvert democracy, that's how long and how hard we will have to fight against corporate politics.
When the bottom fifth of the American public joins a much greater number of the decent middle classes of all colors, then the professional politicians will feel some pain. In the meantime, expect more factional fights among people such as Frist, Helms, Durbin, Specter, the Bushes, the Clintons, the Kennedys...
If it's truly billions we want for health care beyond our borders, why not begin connecting the dots for radical reform of health care within our borders? Health care internationalism begins at home.
Scale down the vastly inflated budgets for Congressionally protected CEO salaries and military hardware, and we could all make wiser and more democratic decisions with public funds. You won't take no for an answer on health care? Then don't take no for answer when politicians demand that you play on one of two teams or you don't play in the game at all.
Blame Bush and Reagan for the long twilight of New Deal democracy? That's a Sunday school lesson from the Democratic Leadership Council, from New Democrats such as the Clintons, Gore and Lieberman.
In many important respects, Clinton continued the social and economic "Reagan Revolution," far from reversing it or even putting up a brave fight. (I recommend the economic analysis of the Clinton years made by Michael Meeropol. Find and read his book Surrender: How the Clinton Administration Completed the Reagan Revolution, University of Michigan Press. Meeropol is Chair and Professor of Economics at Western State College, and staff economist at the Center for Popular Economics).
Walter Tsou was once Commissioner of Public Health in Philadelphia. He encountered obstacles from the Democrats in City Hall. After resigning he said, "I believe health care reform is going to be the civil rights movement of the next millennium." Tsou is a member of the Labor Party (check www.thelaborparty.org ), which supports the Just Health Care initiative, and he also works with Physicians for a National Health Program. Tsou underscores the fact that many local health care problems can only be solved at the national level:
"If we took the $1.4 trillion the U.S. spends on health care and divided it by the 280 million people who live in the U.S.-giving proportionately more to the elderly and sick and less to the young and healthy-we would easily provide Cadillac care for everyone. It's just outrageous that we don't. The system is not even working for people who have insurance. My own daughter was 6 months and it was time for her vaccinations, and we had to struggle to get the insurance to cover it. It took nine months before the payment came through for our pediatrician. And I was the Commissioner of Health at that time. I thought, if they treat me this way how are they going to treat the average Philadelphian?"
I have heard some AIDS activists make the claim that they are above ideology. Oh, really? If you think you can fight a corporate Congress without independent votes and a strong national campaign for health care, you are very much under the spell of ideology. It takes ideas to challenge ideas, and that much is irreducibly ideological.
The best ideas don't come from thin air but from the ground of history and unrestricted debate. AIDS activism can only be strengthened by a wider public campaign for health care reform. Likewise, health care reform means politicians must fear our votes, rather than take our votes for granted.
We can lobby and lean on the politicians already in power. When they throw spare change at problems that require big bucks, by all means take that money and try to spend it wisely. But we don't have to play by the rules of their game. We deserve real choices not only on election days, but on all the days and years of our lives in between.
Scott Tucker is editor of Open Letter,
an online journal of culture and politics at www.openletteronline.com
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