Newsday - Monday, July 8, 2002
Laurie Garrett, Staff Correspondent

The U.S. delegation is led by Health and Human Services Secretary Tommy Thompson, and includes officials from his department as well as the State Department and U.S. Agency for International Development.

Thompson is the only cabinet-level official to have attended an overseas AIDS conference, which are held every two years. At his side yesterday was Dr. Louis Sullivan, who addressed the conference in San Francisco in 1990 as HHS secretary for President George Bush. That administration was viewed as uncaring about AIDS, and Sullivan was met with jeers and boos.

Thompson yesterday repeatedly used the word "passionate" to describe this Bush administration's commitment to fighting HIV and AIDS throughout the world.

"No administration in any nation has ever made fighting HIV/AIDS as high a priority as this administration," he said, calling HIV "one of the most significant problems to face our world in this, or any other, time."

The administration's 2001 budget for international HIV/AIDS efforts came to $726 million. The proposed budget for 2003 calls for spending $1.3 billion.

Thompson noted several times that "the U.S. government, alone, now accounts for more than 40 percent of donor assistance spent on HIV/AIDS in the world."

But that hasn't kept the United States from coming under fire. Britain has cited it and other wealthy countries for failing to make a contribution commitment based on the country's gross national product. The British government has proposed that all wealthy nations strive to budget 0.7 percent of their annual GNPs to development and health efforts in poor nations. The current U.S. commitment reaches only 0.01 percent of America's GNP, and by that standard falls behind the other 20 wealthiest nations.

When asked about such a goal, Thompson said, "We are definitely committed to this fight, as evidenced by the fact that we have almost doubled our spending for AIDS." But "the goal of 0.8 percent - I can't say. It's above my head, it's at the secretary of the Treasury and OMB ."

Last week, the White House announced it will create a $500-million fund to implement programs to prevent mother-to-child transmission of HIV in Africa and the Caribbean. But the move met criticism because the money will not go to the Global AIDS Fund, and the plan's emphasis on saving babies appears to exclude treatment of the mothers or fathers.

"We intend to treat the mothers," Thompson said adamantly. "Treat the mother, treat the child," he said, and building infrastructures for delivery of the medicines are the long-term goal. But few poor nations are ready to administer such efforts, so he said the short-term goal is to save babies through use of single doses of the drug nevirapine, taken at delivery.

The target is to "reduce mother-to-child transmission by 40 percent within five years in 12 countries in Africa and the Caribbean." he said. "It is not only a goal, but I want you to know this is a passion."

The Bush administration considers HIV a "major foreign policy and strategic priority for the United States," State Department representative Jack Chow said. Thompson noted that "unless we do something, there are some countries that are going to be unstable" because of AIDS, forming "fertile ground for terrorism."

That point was driven home by a U.S. Census Bureau forecast that predicts that within eight years many African and Caribbean nations will experience dramatic reversals in life expectancies and population growth. The estimates are even more grim that those released last week by the UN AIDS Program.

Life expectancies by 2010 are predicted to fall to 27 years in Botswana, 34 years in Namibia and Zambia and 33 years in Swaziland. By 2010 at least 51 nations in the world will have experienced severe drops in life expectancies, the report predicts.

The most striking forecasts involve nations in Africa and the Caribbean; in the latter, Honduras, Guyana, the Bahamas and Dominican Republic take the hardest hit. In Botswana, in the absence of AIDS the annual death rate was 5 deaths per 1,000 people. By 2010, Stanecki said, it will be 42 per 1,000.

By 2020, Stanecki predicts, South Africa's society will have lost so many adults to HIV and AIDS that the majority of the population will be between 1 and 30 years old.

At the opening ceremony last night, speakers stood with their backs to the stadium used in the 1992 Olympics. Each urged the crowd to end 20 years of internal bickering and unite in a loud call for a worldwide response to the epidemic.

"Perhaps, science and medicine still need more time; but politics and society cannot wait any longer," Spanish author Jose Maria Mendiluce told the audience.

Dr. Peter Piot, UN AIDS director, put the matter bluntly: "We did not come to Barcelona to renegotiate promises. We are here to ignite leadership, to keep the promise.

"We must make an uncompromising attack on stigma - that's not negotiable. We must strengthen the alliance that will deliver an HIV vaccine - that's not negotiable. We must deliver both prevention and treatment at full scale - that's not negotiable. We must find 10 billion dollars - that's not negotiable."
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