U.S. Official May Prove Unpopular at AIDS Conference

As the man in charge of the Bush administration’s $15-billion plan to treat millions of HIV-infected people in underdeveloped nations, Randall Tobias might expect a hero’s welcome at the International AIDS Conference opening today in Thailand.

Instead, the U.S. global AIDS coordinator is likely to be greeted by the protests of activists opposed both to the administration’s policies and to Tobias.

Tobias, some activists said, could expect a reception similar to the one given in 2002 to Health and Human Services Secretary Tommy G. Thompson, who was booed off the stage at the last conference, in Spain.

Since then, the administration has launched the most expensive effort ever mounted by a government to fight AIDS internationally.

Yet neither the financial commitment nor the power President Bush has given Tobias to mobilize the U.S. bureaucracy has won over critics, who charge that the administration’s efforts are hamstrung by political and ideological concerns.

“He’s been worse than we thought,” Sharonann Lynch, of the AIDS organization Health GAP, said of Tobias. “Tobias is the front man for Bush’s ideology-driven policies on prevention and on treatment” of AIDS.

Lynch said Tobias had given his critics fodder by emphasizing abstinence and faithfulness as effective ways of preventing AIDS while downplaying the role of condoms, and by failing to embrace generic drugs as substitutes for more expensive patented brands.

Conservative supporters of Bush’s program argued that it was meeting with resistance because an entrenched international network of AIDS experts and activists did not like being told that their methods had failed to defeat the epidemic.

Rep. Mark E. Souder (R-Ind.), who strongly supports the president’s efforts to combat AIDS internationally, said the criticism of the U.S. program was politically motivated.

“Every action taken by President Bush to elevate the fight against AIDS, both domestically and globally, has been greeted with derision

The U.S. program seeks to double the number of people with access to AIDS drugs in Africa in its first year, vastly expanding treatment and prevention efforts in hard-hit African nations, the Caribbean and Vietnam. Over five years, the goal is to treat 2 million HIV-infected people with antiretroviral drugs and provide palliative care for 10 million HIV-infected people and AIDS orphans.

Tobias said his critics’ vehemence mystified him.

“This program gets a lot of criticism,” he acknowledged in an interview in his Washington office. Bush, he said, “is doing so much,” yet “a lot of the critics are saying, ‘You should do more.’ ”

Health GAP, or Global Access Project, opposed Tobias’ appointment from the outset last year, Lynch said. Her group feared that as head of the pharmaceutical firm Eli Lilly & Co. in the 1990s, Tobias would protect drug company interests by preventing underdeveloped nations that accept U.S. money from using lower-cost generic drugs.

“He is illustrative of overall Bush policies of pandering to the pharmaceutical industry,” Lynch said.

Tobias strongly rejected the charge. In an interview from Vietnam, he said his speech to the AIDS conference would urge greater unity.

“I would like to encourage everybody involved to really get focused on the fact that the enemy here is apathy, stigma and denial as opposed to each other,” he said. “I would think that there are better places for people to put their energies.”

In his first year on the job, Tobias, who had no background in public health, said he had been transformed by the suffering he witnessed in nations ravaged by AIDS, even as he had learned that the world of international treatment and prevention was filled with political landmines.

As chief executive of Lilly, Tobias traveled frequently to the capitals of African nations, meeting with business and government elites. He thought himself a worldly man.

But nothing in his corporate experience, he said, prepared him for the realities of AIDS that he has encountered since agreeing to come out of retirement for the administration post.

“I’m not naive,” Tobias, 62, said. “But I had never sat in the dirt inside someone’s home, where, because I was coming, they had swept the dirt to make this space as nice as possible.”

Although Tobias said he would urge unity in Thailand, the administration’s critics said the policies he was promoting provoked division instead.

The U.S. refusal to accept generic drugs approved by the World Health Organization as safe and effective angered health professionals and activists. Patented drugs are costlier, which means that governments and nonprofit organizations will be able to treat fewer people.

Activists also were angry over Thompson’s decision to limit the U.S. delegation to the AIDS conference to 50 people this year -- down from more than 200 at the Barcelona conference.

The administration viewed previous U.S. delegations as unnecessarily large.

“We did a re-look at whether or not this is the most efficient, effective way to use the funds available and concluded that we could do with less,” Tobias said. “In previous years, there has been an awful lot of money spent in ways that may not be the most productive use of U.S. taxpayers’ dollars.”

But among critics, the decision to limit this year’s participation was seen as evidence that the administration was less interested in multinational efforts to fight AIDS -- including the global AIDS fund that the U.S. helped found -- than in promoting its own program.

Thompson’s decision forced U.S. scientists who had planned to attend the conference to withdraw 40 scientific papers, and caused the cancellation of U.S. seminars and workshops.

“This should be a great opportunity for the United States to provide global leadership,” said Rep. Henry A. Waxman (D-Los Angeles). “Yet the way the Bush administration is handling our investment and treating the rest of the world is squandering that opportunity.”

Some activist groups were willing to say the administration -- and Tobias -- had accomplished a great deal since Congress appropriated the first of the $15 billion in emergency funds in January. Tobias, who carries the rank of ambassador and reports to Secretary of State Colin L. Powell, has a staff of 35, operating out of a satellite State Department office.

“The man has been put into an incredibly challenging position, and we do think he has been facing it with a lot of genuine enthusiasm,” said Erin Chapman, policy director for rock star Bono’s nonprofit organization called Debt, AIDS, Trade, Africa.

Tobias, Chapman said, “really seems to care about this, and he’s getting things done. Money is moving. Things are happening.”

So far this year, the administration has released three installments of grants for the 15 targeted countries, a total of $850 million.

If the administration is having a hard time winning praise for its efforts, it is not because its programs are without merit, said one emergency fund grant recipient. Rather, the AIDS campaign is being met with hostility because the United States is held in low regard in the wake of its invasion and occupation of Iraq.

“We have to face the reality that America, in this day and age, doesn’t have a great reputation in the international community,” said Jack Galbraith, president and chief executive of the Catholic Medical Mission Board.

Despite the criticisms, Galbraith said, “$15 billion is a lot of money,” and the U.S. deserves recognition for being willing to make that sort of commitment.

“People say we should be doing more,” he said. “To be honest with you, everybody should be doing more.”