At the fifteenth international conference on HIV/Aids in Bangkok from 11-16 July 2004, the George W Bush administration secured its latest victory in its relentless campaign against multilateralism and international cooperation. It is one whose consequences for many people around the world are likely to be fatal.
To its scuttling of the Kyoto greenhouse treaty, refusal to recognise the International Criminal Court, abandonment of the nuclear test-ban treaty and emasculation of the Security Council over Iraq can now be added its sabotage of the international effort to contain the spread of HIV/Aids.
America proposes
The United States delegation arrived in Bangkok proclaiming its commitment to spend $15 billion on global HIV/Aids programmes over the next five years. It was less explicit in acknowledging that this money came with a large, indigestible obstacle. The United States wished it to be spent in two ways - promoting abstinence from sexual activity and drug taking as the primary method of HIV control; and purchasing HIV drugs from American drug companies, not from generic low-cost producers.
The drug companies see the $15 billion HIV/Aids programme as a lucrative, back-door industry support scheme, especially if generic producers can be excluded from supplying lower-cost alternative therapies.
Indeed, both these desired outcomes reflect self-interest rather than a sincere desire to help those affected by HIV/Aids. There is no scientific or evidence-based research to support the claim that abstinence works to prevent the spread of HIV/Aids. And in economic terms, the greater the supply of generic alternatives, the more people with HIV/Aids can be treated for a finite amount of dollars.
It is not hard to see, then, that behind this US offer lay the political and financial power of core elements of the Bush administrations domestic support Christian fundamentalists and the large drug companies.
First, as a tight presidential election race develops, George W Bush needs Christian fundamentalist votes to turn out for him in a score of swing states if he is to defeat John Kerry in November 2004.
Second, to mobilise this religious base, he needs massive amounts of money to buy media time and organisational support. Here, the American drug companies play a crucial role, for they are the biggest contributors to the Bush Republicans bigger even than the oil or automotive industries.
Under Bush, the drug companies have seen their investment in the Republican cause repaid many times over. The administration has secured extensions of Medicare drug benefits to elderly Americans that are worth some $500 billion over the next decade yet at the same time, the United States government is prohibited from acting as a single purchaser of drugs in a way that could force drug prices down.
Moreover, after successful US drug-company lobbying, free trade agreements signed with seven countries demolish local drug-purchasing schemes [Australia, and its Pharmaceutical Benefits Scheme (PBS), is among those affected]. This will result in higher drug costs across the board.
The world answers
But the United States strategy at Bangkok met obstacles of its own. Many observers at the Bangkok conference, led by UN secretary-general Kofi Annan and Frances President Chirac, were not impressed by the USs double-edged funding offer - and in effect rejected it.
As a result, the United States walked away from the global programme on Aids (Unaids) and from multilateral cooperation to contain HIV and the smile froze on the face of Randall Tobias, the US Aids czar and former chief executive of (the Bush-contributing) Eli Lilley & Company.
In response to the setback, Tobias made it clear that the US will now direct its $15 billion fund to source premium-priced HIV drugs from the American drug companies, and HIV education services from a variety of American religious organisations and their international affiliates.
This official reaction was reinforced by bitter attacks from the USs Republican-supporting think-tanks on the various international HIV/Aids bodies. James K Glassman of the American Enterprise Institute (AEI), and closely linked to the Bush administration, attacked as ingrates and morons those who dared to criticise the United States at the sicko carnival at Bangkok (Australian, 15 July 2004).
It is time, he said, for the American government to stay home and just say no to the international community when it has the temerity to argue with the United States.
This rhetoric ignored the real impacts of the ideologically-driven HIV/Aids policies pursued by the United States administration: many millions infected, dying or dead from avoidable HIV/Aids infection; whole nations in Asia and the Pacific destabilised and their security undermined; and a massive victory for those who would portray the United States as waging war on the world rather than being its last, best hope.
