The original URL of this article is:
The Council on Foreign Relations Does AIDS
by Ed Krales
January 02, 2006
In July, 2005, on the fifth anniversary of the U.N. Security Council resolution addressing the threat HIV/AIDS poses to the security of nations, the Council on Foreign Relations published Laurie Garrett's study entitled "HIV and National Security: Where Are the Links?"
Garrett, "Senior Fellow for Global Health" at the CFR, addresses problems not usually considered by HIV/AIDS workers and policy makers. Some of the topics she deals with are how the Black Death changed the political and social structure of Europe; the role of armed forces and UN peacekeepers in spreading HIV; how states are destabilized and the effect their instability has on the rest of the world; and Bush's "President's Emergency Plan for AIDS Relief". There is much technical information in the report but also many omissions and inaccurate assumptions.
Garrett outlines ideas on how to fight AIDS, minimizing the security threat faced by affected nations. Her prime concern is protecting police and the military from drug-resistant forms of the virus. Her secondary concern is tracking those people she considers responsible for spreading it.
Garrett's central recommendation: "Of all the tools of prevention, the only one likely to stop the pandemic is an effective vaccine." Thinking that finding a vaccine will save us assumes free or very low-cost distribution. But complete access is contrary to capitalist policies. The US, World Bank, WTO and IMF block full access to effective therapies available right now.
Consider the ongoing tuberculosis crisis. Dr. Paul Farmer's 2003 book 'Pathologies of Power' emphasizes that "tuberculosis deaths now - which number in the millions - occur almost exclusively among the poor, whether they reside in the inner cities of the United States or in the poor countries of the Southern Hemisphere. Many would find it scandalous that one of the world's leading causes of preventable adult deaths is a disease that, with the possible exception of emerging resistant strains, is more than 95 percent curable with inexpensive therapies developed decades ago."
We know how to stop several forms of HIV transmission. One of them, called mother to child transmission (MTCT) uses an inexpensive technique that is very effective. First, it is important to understand that newborns can't be breastfed by an HIV-positive mother or they too may become HIV positive. Clean water has to be provided with powdered baby formula. If unsafe water is used, babies could die from water-borne diseases faster than if they had HIV. Do we know how to make enough clean water in all locales? Yes. Do we do it? No.
Invention of an AIDS vaccine would be no guarantee that people who needed it would get it. Big pharmaceutical companies are getting rich on AIDS. Producing and distributing an inexpensive vaccine runs counter to their motivation - profit.
Garrett describes how DNA fingerprinting can show where different strains of HIV are located. She says the oldest viral sample was found in blood stored in the Congo in 1959. Today there are many different groups called "clades" that have mutated from the original virus. It's possible to know where a particular infection came from, and whether it developed locally or was imported. We know if infections were caused by injection, sexual transmission or another route. Injected virus doesn't need to mutate greatly to integrate itself into a new body. What the DNA fingerprinting can't tell us is whether the substance injected is illegal. It can't tell us if contaminated blood was transfused or if invasive medical equipment was properly sterilized. It can't tell us if a criminal act was committed.
Garrett makes two errors concerning DNA fingerprinting. The first concerns the heroin-trading routes from Burma. She points out that HIV infection follows poppy-growing and heroin-smuggling routes from Burma. "The genetic HIV evidence is a smoking gun fingering Burma. The Burmese HIV contribution to much of Asia poses a clear security threat to the region." Garrett also tells us that Burma was the world's number one opium producer until US-occupied Afghanistan took over that ignoble position in 2003. Garrett doesn't draw the implications of US-occupied Afghanistan producing 87 percent of the world's opium nor of so many police, military and government officials profiting from the trade.
The US is in a unique position to undermine heroin smuggling and use and dramatically reduce the HIV in its tow. It can buy heroin and sell it to users at prices below cost. This will drive any competitor out of business. When users come into the "government dairy" to buy their goods, they can be provided with a hot meal, clean needles and works. Nurses can give instructions on sterile injection methods and provide other health needs. Harm reduction, safe sex, and detoxification-rehabilitation programs can be offered: Rapid HIV testing and counseling can be done. Those who test positive can be offered treatment. The success of such a program could reach all the way to Colombia, where the US "war on drugs" is a costly failure and merely a cover for interfering in Columbia's civil war.
Garrett's second medical forensic error concerns the HIV caught by peacekeepers. She says, "Uruguayan members of the UN peacekeeping force stationed in Cambodia acquired a unique AJE recombinant form of the virus and then passed it along upon return to Uruguay. This verified that the Uruguayan peacekeepers were engaged in misconduct and presented concern for the security of their home nation upon their return."
The form of HIV disease that the Uruguayan soldiers caught does not verify wrongdoing. It only shows that the soldiers did not use appropriate sanitation when using needles or other invasive medical equipment, or that they used local contaminated blood or blood products.
When people think of dirty needles, they usually think of illegal drugs. This isn't necessarily the case. When proper sanitation isn't used, injecting insulin, vitamin B12, or anything - legal or illegal - may transmit HIV. Tattooing done with a dirty needle may spread the virus, no matter how lovely the image produced. The form of HIV disease that the Uruguayan soldiers may transmit shows that some of the peacekeepers do not practice safe sex. Whether or not that sex is homosexual, heterosexual, free of charge or paid for, it is not criminal unless it isn't consensual and with an adult.
Rapists and pedophiles must be prosecuted as criminals. But criminalizing possible drug use and then tracking the "criminals" isn't going to help defeat the pandemlc. What criminalizing will do is provide the justification to attack various countries in the name of 'justice" or continue to fill jails with HIV-positive drug users.
The right approach is not to criminalize people with HIV but to teach them how to enjoy themselves without getting hurt. We have to teach people to adopt a self-protective attitude about sex and drugs. No matter how hard religious fundamentalists try, they will not be able to stamp out the fun of recreational sex and getting high. People enjoy sex and drugs.
Garrett's CFR report abounds in wrong conclusions. It's not possible to address them all without writing an equally long piece. But the errors that do need to be discussed are U.S. AIDS policy in general and one of its principle manifestations, the President's Emergency Plan For AIDS Relief (PEPFAR).
The CFR is right. People have the right not to become infected. Of course prevention of any disease is always better than treatment or cure, even if it is less profitable. They also have the right to adequate care if they do become HIV positive. Unfortunately, U.S. AIDS policy at home and PEPFAR around the world don't follow these principles. PEPFAR is a 9-billion dollar, 5-year program that is helping 15 developing countries fight AIDS. It's based on U.S. domestic AIDS policy. The U.S.A. presents its advice on HIV/AIDS prevention for domestic consumption on the CDC website. From the section "Preventing HIV Infection" comes the following:
"The most reliable ways to avoid becoming infected with or transmitting HIV are:
The problem with these "reliable" ways to avoid infection is that they don't work unless you live on the moon, alone. Half of all new U.S. infections occur in people between the ages of 16 to 24. Those youths aren't looking for "long-term, mutually monogamous relationships". They just want to have sex. The Gallup Poll Tuesday Briefing of 9/16/03 told us that sex between an unmarried man and woman was "Morally Acceptable" to 54 percent of all Americans and 69 percent of those 18 to 24.
Abstain from sexual intercourse (i.e., oral, vaginal, or anal sex).
Be in a long-term, mutually monogamous relationship with an uninfected partner.
Abstain from sharing needles and/or syringes for non-prescription drugs."
If money is not available to buy new needles, people use old ones over and over again, even if they aren't sterilized properly. Sharing contaminated needles or syringes to inject prescription drugs will spread the infection just as effectively as using illegal drugs.
Using condoms is mentioned as a secondary suggestion in the CDC piece. The Body, an online AIDS magazine (www.TheBody.com), included in its September/ October 2005 issue an article by Jim Pickett entitled "Pickett Fences: Squat Close to the Load." Pickett wrote that over 3,000 participants at the recent 2005 National HIV Prevention Conference were given manuals titled "Safety". The manuals had great information on lifting heavy loads, which has nothing to do with AIDS, but not a word about condoms. Maybe it's a lot easier to deal with AIDS if you don't have a hernia.
In the U.S.A., the medieval, fundamentalist approach makes controlling AIDS difficult. But the situation is much worse for developing countries that have to rely on PEPFAR for material support. PEPFAR goes further than the CDC. It mandates $3 billion to be spent on abstinence-only programs. On October 18, 2005, The Baltimoresun.com published Paula Tavrow's "Undermining the AIDS Fight". She wrote, "The U.N. special envoy for HIV/AIDS in Africa, Stephen Lewis, (declared that the administration's policy of emphasizing abstinence-only programs and cutting federal funding for condoms has undermined Uganda's HIV/AIDS effort. Sadly, Uganda is not alone."
Paddy Luzige, Senior Pastor/Overseer of the New Life Church in Kampala, Uganda, gave a talk at Saint Vincent's Catholic Medical Center's AIDS Education Grand Rounds last October. He brought into focus the depth of the failure of the U.S. program of AIDS relief in Africa. He insisted that he is not against condom use or any other effective technique to stop the spread of the virus. In fact, he wants to see education accompany condom distribution. Luzige emphasized that there are 52 tribes in Uganda, each with its own culture. He described cultural practices that could have direct impact on spreading AIDS. For example, a father must have sex with his son's new bride, and a young man should have sex with a married woman in order to leave his "poverty seeds" with her so that he can become rich. Sex with a woman right after male circumcision completes that ritual.
Obviously, education about condom use in these situations would cut down on HIV transmission. Luzige thinks that tales of Uganda's "success" fighting AIDS are false. These stories arose because there are few sick people in the cities. Once people become ill, they are taken back to their native villages to be cared for.
Thailand sharply reduced its incidence of AIDS by using a condom promotion program as part of its campaign. Garrett's CFR report omits to mention that an important part of the world-renowned Cuban AIDS prevention and control program is condom use.
As if the primitive U.S. program is not destructive enough, in June 2005 Bush buckled on his "chastity belt" and declared that anyone receiving U.S. funds must oppose sex trafficking and prostitution. In order not to lose funds to fight AIDS, a recipient has to stop teaching sex workers of either gender to adopt safe sex practices. They can't distribute condoms to their co-workers and clients and must stop being proponents of "HIV stops here". Sex workers must be further marginalized in order to satisfy official U.S. moral precepts.
In Africa, U.S. money has been donated to "faith communities" that know nothing about fighting the spread of HIV. The infection rate continues to rise and may even have been accelerated because additional U.S. dollars allow these faith communities to reach more people with more ineffective information.
To its credit, the Brazilian government said No to U.S. funds. Brazil said Bush's policies would undermine its attempts to control the spread of HIV. Brazil underlined this conviction by sending back the $40 million in "AIDS aid."
The Brazilians are saying that acceptance of U.S. "aid" - because of its primitive, unscientific and anti-sexual approach to a primarily sexually transmitted disease - actually results in an increase in the spread of the disease. The more US dollars accepted, the greater the increase in AIDS and in Brazil's death rate. According to actionaidusa.org, Dr. Paul Zeitz, DO, MPH, Director of the Global AIDS Alliance, declared that, "In turning down the U.S. grant, the Government of Brazil is actually protecting people at risk by ensuring science-based preventions are implemented rather than ideologically based preventions that have no basis in scientific reality. This is a phenomenal development by Brazil, a sovereign government which is finally standing up against policies that are doing more harm than good."
In the U.S., the lack of resolution to defeat Bush's program is mortifying. But don't get too comfortable with the idea that this state of affairs is all the fault of George Bush II. The strings attached to U.S. aid money won't disappear when the next U.S. president/emperor takes office. Every administration has its own strings attached to foreign aid. Remember the Clinton administration's threats against South Africa if it dared to produce generic anti-AIDS medication. Clinton also blocked passage of a domestic needle-exchange bill. If the bill had passed, thousands of lives would have been saved. Bush merely incorporated Clinton's domestic needle dogma into PEPFAR.
The CFR calls for an "increase in donor support for the Global Fund and other mechanisms aimed at reducing the spread of HIV and treating AIDS in poor countries." But how will increasing money spent on policies that actually spread HIV end the pandemic?
The Bush administration and the Democratic Party are driven by the ideology of profit, not medical science. The CFR is likewise dedicated to corporate globalization. Its report repeats the fantasy that the wealthy world has an interest in starting "development programs aimed at bringing the poor world into the global economy, from which it may eventually derive sufficient wealth to absorb the costly exigencies of AIDS". This statement ignores the broader issue of resource availability and use. The U.S.A. with 5 percent of the world's population uses 27 percent of its resources. Add the resource-use of the G8 and other rich countries, and what is left for the developing world to get rich on? The CFR also ignores the procedure that the wealthy world follows when it invites a country into its "parlor". When India was invited into the WTO, a condition was to stop generic medication production. (See "The Origin of AIDS: An Ethical Inquiry")
The CFR writes that treatment and medication "must be a priority in highly afflicted states" and warns us that social unrest could develop if these were only available to the "valued elite human resources". Unrealistically, the CFR appeals to the people who actively block access to HIV meds, to provide them for everyone.
AIDS wasn't created by a conspiracy of corporate scientists bent on destroying blacks, gays and drug users. Once AIDS appeared, however, it is naive to think that it did not become part of the arsenal of weapons used by the developed world in its continued domination of the rest of the planet. People have been dominated many times in the past through food and water control, so why not use AIDS?
What is the point of Garrett's CFR report? After describing the changes in the Catholic Church and feudalism caused by the Black Plague, it doesn't describe what might happen in the developing world under the shroud of AIDS. The comparison isn't made because the CFR defines a nation's security as maintaining the climate for the U.S. to do business. The human horror of AIDS is of little concern. Therefore, the solutions promoted to defeat AIDS will maintain profits and provide a stable business atmosphere if or when some developing countries fail. The U.S. will be able to gain police and military loyalty in failed states by providing life-saving drugs. The CFR is part of the class struggle and wants to contribute to its victory.
What could happen is that the U.S., WTO, WB, IMF and G8 will continue to offer "aid" to fight AIDS. Once they move in to administer the aid, it will be very hard to get them out. Tens of millions of people will be too busy trying to stay alive to organize a fight-back. If the U.S. cabal succeeds, the developing world will become a loading dock from which to send all its wealth to the developed world. Its many and varied cultures will be replaced by the monoculture of capitalism. "Disneyland" will be built, enclosed by fences for U.S., European, or other corporate managers, their families and guest workers. Sprawling ghettos will surround the fenced-in areas. The local police and military will have access to AIDS meds. The rest of the people will be forced to battle AIDS any way they can. Bill Gates, Bill Clinton and others will provide humanitarian relief for a tiny minority but won't interfere with corporate plans. Eventually people will see that capitalism, not AIDS, is the disease. Profit is its principle opportunistic infection.
In reality, we know what to do to begin to defeat AIDS. At "FOR0 2003," the 2nd forum on HIV/AIDS/STD in Latin America and the Caribbean, in Havana, Ms. Debrework Zewdie, the World Bank's Caribbean regional representative, suggested that the developing world adopt Cuba's medical model as the strategy for fighting the pandemic. (See "Cuba's Response to AIDS: Model for the Developing World") Unfortunately, almost three years have passed, and the World Bank has still not financed this project. What we must do is:
These steps aren't possible under U.S. leadership. The CFR wants to speed up its failed policies, but moving in the wrong direction never leads to the right destination no matter how fast you go.
- Fully fund the Cuban medical model and use it worldwide.
Restore local agriculture and build clean-water facilities. Without the "Big Three" - air, water and food - medication is worthless.
Take back from the pharmaceutical companies all HIV-medication production rights, beginning with the anti-AIDS drugs that were publicly developed, such as didanosine, stavudine and zalcitabine. New HIV meds are being developed using public funds. But as long as the manufacturing is done in secret and the marketing rights are given to private pharmaceutical companies, we won't be able to provide medication to all the people who need it.
Produce generic medications in facilities all over the world to ensure that local needs are met.
Expand the global medication-recycling program now in existence so that no useful medication is wasted until enough is produced generically.
We must unshackle ourselves from the interests of the corporate world. We need to build a grand coalition inside the U.S.A. and around the world that is interested in promoting public health, not private profits.
Edwin Krales is an HIV/AIDS nutritionist and health educator in New York City. He can be reached at firstname.lastname@example.org