Newsday - March 7, 2000
Laurie Garrett, Staff Writer

Advocates are unable to explain what has prompted the sudden interest in the pandemic's impact in poor countries, after nearly 20 years of worldwide spread of HIV. The proposals have emerged from both political parties.

Some of the initiatives will get an airing in hearings before the House Banking Committee starting tomorrow.

Congressional insiders are confident that some form of HIV global prevention bill will be passed and funded. "The devil is in the details," said one Capitol Hill staffer, who spoke on condition she not be identified. "And in this case, some of the details are very devilish. But I'm quite confident that one way or another a reasonable piece of legislation is going to get finagled."

Interestingly, the proposals are being discussed without the backdrop of an overall AIDS strategy from any advocacy group, UN organization or U.S. government agency. Rep. Jim Leach (R-Iowa) has decided that the global AIDS pandemic "is my No. 1 priority," he said in an interview. "Why now? Maybe because the numbers are so large that it's anti-humanitarian not to deal with it."

Leach, who chairs the House Banking Committee, has introduced the World Bank AIDS Prevention Trust Fund Bill, which is co-sponsored in the Senate by John Kerry (D-Mass.). Their bill would create a $100-million trust fund, fed by U.S. donations from 2001 to 2005 and administered by the World Bank, that would be used for AIDS prevention efforts worldwide, with special emphasis on sub-Saharan Africa, India and the former Soviet Union nations.

African-American leaders-including the Rev. Jesse Jackson, former Rep. Ron Dellums and activist Randall Robinson-are backing a bill, sponsored by Rep. Barbara Lee (D-Calif.), that would set up a company to receive funds from the U.S. government and would, in turn, fund African HIV prevention efforts.

"Quite simply, the tragedy can no longer be ignored," Lee said in an e-mail interview. "I think that folks are finally realizing the magnitude of this crisis."

One report that underscored the expected scope of Africa's AIDS crisis was "The Global Disease Threat and Its Implications for the United States." The report was released in declassified form by the National Intelligence Council last month, and White House sources say the CIA-drafted classified elements are chilling.

Even the declassified version offers such evaluations and predictions as these:

HIV, coupled with tuberculosis, will continue to spread globally for at least 20 more years.

By 2010, AIDS will have reduced the gross domestic products of sub-Saharan African countries by at least 20 percent.

AIDS will spark famines. Already in Zimbabwe, for example, so many farmers have died in the epidemic that agricultural production has fallen by 50 percent in a decade.

Life expectancies in African countries are plummeting, because of HIV, and infant mortality rates are rising. In Zambia, for example, the CIA forecasts that by 2010-in the absence of AIDS-average life expectancy would reach 60 years, and infant mortality would be 97 per 1,000 live births. Because of the epidemic, however, Zambian life expectancy is expected to fall to just 38 years, and infant mortality will soar to 161 per 1,000 births.

Especially hard hit are Africa's military forces. Already HIV infection rates range from 10 percent of Ethiopia's Army to 60 percent of the Armed Forces of Angola and the Democratic Republic of Congo.

In a speech before Congress last week, Rep. Joseph Crowley (D-Elmhurst) said that the death toll in Africa now "is [the] equivalent of four funerals per minute." With fellow New York Reps. Charles Rangel (D-Manhattan) and Carolyn Maloney (D-Manhattan), Crowley last week proposed the Global Health Act 2000, which would spend $500 million on a package of global health and family-planning programs and another half billion on HIV prevention. That money would be funneled through the U.S. Agency for International Development.

Sens. Barbara Boxer (D-Calif.) and Gordon Smith (R-Ore.) are sponsoring the Global AIDS Prevention Act of 2000, authorizing $2 billion in USAID funds over five years. Kerry is carrying the White House's Millennium Vaccine Initiative, a multimillion-dollar plan that features $1 billion in tax cuts for pharmaceutical companies, a $50-million vaccine purchase fund and $900 million in low-interest loans for developing health infrastructures in poor countries.

President Bill Clinton raised the AIDS issue in his State of the Union address and said in a news conference last week that the solution to rising HIV, tuberculosis and malaria rates "must include the development and the delivery of effective vaccines."

The proposed $1 billion tax credit would go to drug companies that develop vaccines for these diseases, and the $50 million would be used by the private Geneva-based Global Alliance for Vaccines and Immunization to purchase those products and distribute them in needy countries. It's a controversial approach, some Capitol Hill insiders say, because the pharmaceutical industry garners the highest annual profits of any business sector.

Sensitive to such sentiments, four drug company leaders in meetings with the White House last week vowed to donate substantial amounts of currently available vaccines to poor countries.

Another controversy concerns who would be the recipients of this AIDS-fighting largesse. Vaccine initiatives, for example, are directed not to the National Institutes of Health but to drug companies and the private International AIDS Vaccine Initiative. Funds for prevention programs have traditionally gone to the U.S. Centers for Disease Control, the World Health Organization or UNAIDS, the global AIDS program.

Always watch for outdated information. This article first appeared in 2000. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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