Newsday, December 1, 2000
Laurie Garrett, Staff Writer

The United States is the largest single funder of global efforts to stamp out HIV, having donated nearly $1 billion this year to various countries' HIV/AIDS programs, and $225 million to the United Nations AIDS Programme in Geneva. In addition, the National Institutes of Health's more than $1.5 billion research budget dwarfs the combined total of other scientific efforts in the world. The Clinton administration is widely credited with having sharpened U.S. commitment, notably by naming the global pandemic a national security threat.

The uncertainty about the next U.S. president means other nations don't know what to expect from the administration-and thwarts their attempts at planning.

"We are watching your Florida vote count on pins and needles," a European diplomat based in Washington said, speaking on condition of anonymity. "All our efforts and delicate political successes could fall apart overnight if the wrong decisions are made in Washington."

It isn't just the dollars that matter, he continued, but the so-called bully pulpit that has been used by President Bill Clinton and members of his administration to nudge other heads of state into facing the reality of the disease.

United Nations Ambassador Richard C. Holbrooke, addressing a UN gathering yesterday organized by the American Foundation for AIDS Research, underscored the Clinton administration's support for global AIDS efforts, including pressure placed on pharmaceutical companies to lower their prices for AIDS drugs sold to poor nations.

But in an interview yesterday, Holbrooke expressed uncertainty about the nature of future U.S. commitments. "Nobody knows" what the future will bring for global health issues, he said. "Nobody is thinking about that issue. All we can do is state the objective facts. We all understand that denial leads to growth of AIDS. But policy will have to await decision from the top."

Among the facts outlined in the UN briefing yesterday were projections for Asia's pandemic, particularly in China, the most populous nation on Earth. Currently, most of the 36 million people living with HIV are in sub-Saharan Africa, but the far more populous Asian continent is the focus of concern.

Dr. Yiming Shao, deputy director of the Chinese government's national AIDS program, told the gathering that more than half a million Chinese are infected with HIV, and official projections estimate that, in the absence of effective prevention efforts, there will be more than 10 million HIV-positive Chinese by 2010. He said prevention efforts are fragmented, underfunded and subject to stigmatization and rejection by local political leaders.

The second largest nation in the world, India, has 5 million people infected with HIV, according to Dr. Bhaswati Bhattacharya of Columbia University. The Clinton administration has played a role in convincing India's political leaders to take the epidemic seriously, she said, and Gore has struck a similar theme, but Bush "is an unknown commodity," she noted.

One leader in the UN's fight against the pandemic, who asked not to be identified, said that because of the Clinton administration's AIDS- fighting role, including the president's visit to parts of Africa and Vice President Al Gore's chairing last winter of a UN Security Council special session on AIDS, "expectations are very high."

"There is a dangerous gap growing," he continued, "between stated political commitment and implementation of programs. And in the middle of that gap is money-what else? If money is not following the politics, we face a serious crisis of confidence and leadership" in the global fight against AIDS.

As if to underscore such concerns, Secretary of State Madeleine Albright issued a statement saying the world was losing the AIDS fight. With 10,000 people infected each day and 3 million dying this year, she said, this "staggering litany of loss" meant that despite "the heroic efforts of so many, we are not winning the war against AIDS; we are losing it."

Albright added that only strong leadership, backed by donors and "caring people everywhere," would "transform AIDS from a menace into a memory."

Gore's plans for international AIDS efforts were laid out last summer in a foreign policy document. In it Gore stated that he would continue to designate AIDS a national security threat, and he called for "substantial increases" in the government's funding commitments to overseas HIV programs. Spokesman Chris Lehane said yesterday that a Gore administration would follow the Clinton AIDS strategies, in a "continued and augmented" fashion.

It has been widely rumored in Washington that Gore would appoint current Surgeon General Dr. David Satcher as his Secretary of Health and Human Services. Satcher, a former director of the Centers for Disease Control and Prevention, has been a vocal advocate of Clinton administration policies on HIV/AIDS.

George W. Bush's transition team did not respond to repeated queries regarding the issue yesterday. Bush has not specifically addressed any aspect of global HIV/AIDS in his speeches or policy papers; he supports the GOP platform, which calls for support for funding to find an AIDS vaccine and cure.

The White House's current AIDS Czar, Sandy Thurman, told Newsday that the Clinton administration has enjoyed strong bipartisan support for its overseas HIV programs. She cited as another source of optimism names rumored as Bush choices for Secretary of Health and Human Services: former Rep. Roy Porter (R-Ill.) and former CDC director Dr. Bill Roper. Both men "have been very supportive" of the Clinton administration's overseas HIV efforts, Thurman said. {Correction: In a story Friday on AIDS and politics, the title and first name of Rep. John Porter (R-Ill.) were incorrect. (pg. A02 ALL }

Health finance analyst Gail Wilensky has also been cited as a likely appointee. Her positions on international AIDS efforts, however, have never been publicly stated.

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