The New York Times - February 3, 2001
Anthony Lewis

The grimmest figures are in developing countries; in sub-Saharan Africa 8.8 percent of people 15 to 49 years old are H.I.V.-infected. But the United States and other Western countries are hardly going to be immune from the consequences of the plague. As millions die around the world, leaving millions of orphans ù as whole societies crumble ù our moral posture will be challenged. So will our economic outlook, based as it is on global prosperity.

Those realities made it shocking that George W. Bush, in his first major decision as president, took an action that will increase the spread of AIDS. That was his decision to deny U.S. aid to family-planning organizations abroad that inform women about medical options including abortion.

Mr. Bush's press secretary, Ari Fleischer, explaining the decision, said, "The president does not support using taxpayer funds to provide abortions." But that was a non sequitur. Government funding of abortions abroad has been prohibited by law since 1973. The Bush rule says that clinics in developing countries will lose U.S. funds if they even discuss abortion with their patients.

What it means on the ground is this: A woman who has AIDS comes to a clinic somewhere in Africa or Asia. Drugs to prevent transmission of the disease to newborn infants are not available there. She desperately wants to avoid bearing the child. But the doctor or nurse cannot advise her on a safe, legal abortion if the clinic wants to keep its American funds.

Many family planning groups, knowing that women will not understand a refusal to discuss abortion, will decide to give up U.S. support. That will have drastic consequences, because U.S. dollars may provide most of the contraceptives.

The result? Families will not get contraceptives. Without them, more people will be infected with H.I.V. ù and in due course develop AIDS.

The gag rule on discussing abortion, first imposed by President Reagan, was dropped by President Clinton. But otherwise the Clinton administration's record on fighting the worldwide menace of AIDS was unimpressive.

The most shameful action of the Clinton years in this regard was the pressure Vice President Al Gore put on South Africa to keep it from going ahead with a plan to impose compulsory licensing on drugs made by the big international drug companies, so others could make and sell them far more cheaply.

The drug issue remains a crucial test of American understanding ù and honor. It was explored by Tina Rosenberg in The New York Times Magazine last Sunday in one of the most moving and important articles I have read in years.

In the United States and Europe, the anti-retroviral drugs that have made AIDS a containable disease for many sufferers cost either the patient or the society $10,000 to $15,000 a year. It has been widely assumed that poorer countries cannot afford them, and in any event do not have health systems that could use them effectively.

Ms. Rosenberg showed that those assumptions are false. Brazil now makes the drugs itself and has cut the cost by nearly 80 percent; government commitment has produced clinics to supervise the treatment effectively. Many lives, and much money, have been saved.

The big drug companies are frantically resisting the precedent. And they have great lobbying power in the United States, achieved by campaign donations.

Will George W. Bush find it in him to resist the drug companies? To lead a great American campaign to get treatment for the H.I.V. and AIDS sufferers around the world?

The example of the abortion gag rule gives little ground for hope. There, in the name of life, he imposed a policy that will produce more death: terrible death.

I doubt that he did it with knowledge of the consequences. He just wanted to please his anti-abortion supporters. So perhaps, on the larger issue, he may still decide that compassion and self-interest both demand serious American action to fight the AIDS epidemic.

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