For President George W. Bush, World AIDS Day was another occasion to pander to the Christian fundamentalist right wing that makes up the political base of his administration.

Speaking December 1, before an assembled audience of top officials, with an African family flown in for the photo op, Bush said, “I believe America has a unique ability, and a special calling, to fight this disease,” emphasizing US support for the “ABC approach to prevention.”

He told the audience, “We’re working with our partners to expand prevention efforts that emphasize abstinence, being faithful in marriage and using condoms correctly.” Bush claimed that this strategy was “pioneered by Africans” and has “proven its effectiveness.” He stated that through the New Partners Initiative, Americans “will further reach out to our faith-based community organizations that provide much of the health care in the developing world, and make sure they have access to an American assistance.”

The “C” in US AIDS strategy is entirely subordinate to the call for “abstinence” and “being faithful.” In August 2003, the Bush administration cut funding for an AIDS program working with refugees in Africa because one of the seven organizations involved provided family planning and abortion advice.

US AIDS policy has been condemned both inside and outside of Africa by AIDS activists and even some governments. A statement signed by 22 European Union member countries, led by Britain, said, “We are profoundly concerned about the resurgence of partial or incomplete messages on HIV prevention which are not grounded in evidence and have limited effectiveness.”

The UK’s International Development Secretary, Hilary Benn, asked by the Guardian newspaper if his government disagreed with the US, replied, “Abstinence works if people can abstain, but I don’t think people should die because they have sex. We need to make sure people have all the means (of prevention) at their disposal—condoms and clean needles. It includes education and access to sexual and reproductive health services. We are very clear about that.”

Ideologically motivated aid

According to a Guardian report of December 1, the United Nations special envoy for HIV/AIDS in Africa, Stephen Lewis, accused the US of “doing damage to Africa” by cutting funds for condoms in Uganda. “There is no doubt the condom crisis in Uganda is being driven by [US policies],” Lewis said in August. “To impose a dogma-driven policy that is fundamentally flawed is doing damage to Africa.”

In 2003, 120 million condoms were distributed in Uganda, but between October 2004 and August of this year, only 35 million were distributed. The wife of Ugandan president Yoweri Museveni, in an interview with the BBC World Service, equated condom use with theft and murder. AIDS activists are linking the shift in government thinking with US aid policy.

The US gave $459 million to the Global Fund to fight AIDS, Tuberculosis and Malaria in 2004 and pledged $414 million for 2005. The US accounts for one third of the fund’s $4.4 billion commitments, but most US funding for AIDS relief comes in the form of bilateral relationships with 15 countries.

These agreements were established through the President’s Emergency Plan for AIDS Relief (PEPFAR), set up in 2003. The Health Global Access Project (Health GAP) says that PEPFAR, “contains policies on prevention driven by ideological motivations which completely ignore scientifically proven methods.”

The Health GAP web site continues: “The Bush administration has tied PEPFAR funding to strict requirements such as mandating that 33 percent of prevention funds be spent on abstinence-until-marriage programs, limiting condom distribution to narrowly-defined ‘high risk’ groups, and demanding guarantees to explicitly condemn sex workers. These approaches all run counter to the establishment and continuation of comprehensive prevention programs which have demonstrated effectiveness in slowing the spread of HIV.”

The actual money promised in return for such policies is minuscule. PEPFAR has been allocated $15 billion over a five-year period, compared to $17.5 billion in 2005 alone for domestic HIV/AIDS spending in the US. Total AIDS relief spending is dwarfed by the $204 billion spent on the war in Iraq to September 2005.

An international epidemic

In 2003, the World Health Organization set the so-called “3 x 5” target under which 3 million people from low-income countries were to receive AIDS drugs by the end of 2005. As of June of this year, 970,000 people in low- and middle-income countries were on AIDS drugs out of 6.5 million who urgently need them.

Around 40 million people worldwide are infected with HIV. The Joint United Nations Program on HIV/AIDS has estimated that roughly 5 million people were newly infected each year since 2001. The AIDS Epidemic Update 2005, published November 21, says that HIV has claimed more than 25 million lives since the early 1980s, making it one of the most destructive epidemics in world history. Some 3.1 million people died last year alone.

Though the number of cases dropped in some specific countries, almost every region of the world saw an increase. Of the 5 million people infected last year, two thirds, or 3 million, were in sub-Saharan Africa. An estimated 25 million people in the region are living with HIV, an increase of 3.6 percent from 2003.

South Africa has the largest number of cases of any single country, with an estimated 5.2 million people, or 11 percent of the population, infected with HIV. India comes second, with 5.1 million people infected.

In Asia, more than 1.1 million people became infected and 520,000 died last year, up from 420,000 the previous year. Increases were also recorded in western and central Europe, where 720,000 people are now infected, up from 700,000 in 2003. An estimated 65,000 infections were recorded this year, with 30,000 deaths due to AIDS-related illnesses.

By far, the fastest rate of HIV infections was recorded in eastern Europe, and primarily in the former Soviet Union. Since 2003, the number of adults and children living with HIV in eastern Europe and Central Asia has risen to 1.6 million from 1.2 million—part of a 20-fold increase in the past 10 years. Drug users who share contaminated needles are said to be driving the epidemic in those areas, where it is also spreading among their sex partners. In the Russian Federation alone, there are an estimated 860,000 people living with AIDS.

Even the more advanced industrial countries have recorded an increase in HIV infections. In the UK, 58,300 are living with HIV with 7,275 new cases in 2004. Some estimates claim one in three HIV positive people in the UK remains undiagnosed. Around 40,000 people in the US are infected each year, and 18,000 people die.

An indictment of capitalism

Though AIDS arose more than 25 years ago as a product of nature, its persistence is an indictment of the capitalist profit system under which healthcare, like everything else, is subordinate to the profits of a parasitic financial oligarchy.

In 2004, a mere $690 million was spent on AIDS vaccine research and development from all sources, representing less than 1 percent of the total spent on all health-related research. Around 48 percent of global investment in new health products comes from the pharmaceutical industry, yet it accounts for just 10 percent of all AIDS vaccine funding.

A September 2005 newsletter of the International AIDS Vaccine Initiative cites the lack of a market as the main deterrent to the pharmaceutical companies spending more on AIDS vaccine research. The report states, “[T]he market for an AIDS vaccine is primarily in the world’s poorest countries, where the total market for vaccines is only about $500 million a year. This may sound like a big payoff, but it’s small when compared to drug profits that can soar to billions of dollars. In terms of profits, vaccines are sure to lose out since a vaccine may be used only a few times in a lifetime while drugs are often taken every day.”

In 2004, the top three pharmaceutical companies, Pfizer, GlaxoSmithKline and Sanofi-Aventis, had a combined sales revenue of $108.429 billion from research and development spending of just $21.75 billion.

America does indeed have a “unique ability” to fight this disease. As the richest and most powerful nation in the world, the United States has vast resources at its disposal. The billions spent on slaughtering Iraqi women and children on a daily basis, for instance, could be ploughed into AIDS vaccine research. Moreover, the giant pharmaceutical companies could be nationalized and their profits used to provide drugs to the 6.5 million who urgently need them. Such policies could only emerge from the fundamental restructuring of American society on a socialist basis.