Miami Herald - July 24, 2000

The $1 billion loan offer from the U.S. Export-Import Bank to sub-Saharan Africa countries to buy anti-AIDS drugs is like the proverbial gift horse. It shouldn't be rejected -- and it shouldn't be examined too closely.

The strings attached to the loans, notably the new debt it would load onto impoverished nations, raise questions about its appropriateness. These countries are trying mightily to gain debt relief from wealthy nations and deserve to have it. But with AIDS on a rapacious death march through much of Africa all assistance is lifesaving.

Stemming the epidemic will require much more than loans and drug purchases. Many countries are literally dying of AIDS. Of the 34 million people infected with the HIV virus around the world, about 25 million of them live in sub-Saharan Africa, according to United Nations estimates. Already the disease has claimed 19 million lives, nearly as many as died in World War I.

With so many people dying each day, the wisest course is quickly to get as much help as possible to ground zero. The $1 billion loan can be combined with a $500 million commitment from the World Bank to help these countries purchase reduced-priced drugs, buy medical equipment and develop the services they need to thwart the disease. Every dollar that arrives can ease suffering and prolong lives.

The fact that the Bank offers generous terms (less than 7 percent over a five-year span) makes the loan more palatable. The Bank also has pledged to monitor the effectiveness of the outlay of cash and to make adjustments as needed in the terms.

The loans, of course, are barely a palliative -- far from a solution. The medical care that the money will provide cannot stem the disease's mass slaughter. AIDS has gone past the point where it could be bought off with infusions of money.

To blunt the disease's spread, sub-Saharan Africa will need to follow the example of Senegal and Uganda, which have cut their infection rates to 2 percent and 8 percent, respectively. By comparison South Africa has an infection rate of 20 percent and Botswana's rate is 36 percent.

In Senegal and Uganda, the governments used aggressive education programs aimed at teaching that the disease is transmitted through sexual contact and that the best protection is regular use of condoms. Simple, cheap and effective.

In addition to education, effective treatment of AIDS in these African countries will require programs to change traditional and cultural attitudes about sex and massive investments in gradually more sophisticated equipment, facilities and treatments.

Still, by its pledge the Bank joins other institutions in demonstrating that it will not sit by idly while needy people are claimed by history's deadliest disease in part because they lack the money to fight it. Others should follow this example.
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