AIDS Fight Demands Serious Money and Serious Plan

Greg Behrman is the author of "The Invisible People: How the U.S. Has Slept Through the Global AIDS Pandemic, the Greatest Humanitarian Catastrophe of Our Time," to be published by Free Press in June.

Last week, the Office of the U.S. Global AIDS Coordinator gave Congress its five-year strategic statement for enacting the Bush administration’s $15-billion Emergency Plan for AIDS Relief. The plan seeks to “turn the tide of the global pandemic,” and it is the boldest commitment ever to combat global AIDS. In its proposed form, however, it stands little chance of turning that tide.

The world knows no greater threat to human life than AIDS. Over the last 20 years, 25 million people around the globe have died of the disease. More than 40 million people are currently infected. Reasonable estimates predict that by this decade’s end there will be 100 million or more global HIV infections, and 25 million AIDS orphans.

The disease is more than a humanitarian catastrophe; it is a moral crisis and a profound threat to U.S. and global security. It is beginning to eviscerate national economies. And the pandemic is generating social and political pressures that will soon threaten the integrity and viability of sub-Saharan African states. If they collapse, terrorists and transnational criminal elements will find refuge and sustenance in the debris.


The Bush administration’s plan begins to address many of these challenges. It has specific near-term goals: preventing 7 million new infections, treating 2 million infected people and caring for 10 million people over the next five years in some of the countries most acutely affected.

The plan’s “emergency” posture highlights the importance of moving urgently and opportunistically to meet its goals. It uses local authorities, healthcare workers and community members to ensure that U.S. efforts cohere with local needs. All of these elements mean it should be able to produce much-needed near-term results.

The cardinal -- and immeasurably fatal -- flaw of the administration’s program, however, is that it is only an emergency plan, not a long-term strategy to defeat global HIV/AIDS. The key missing ingredient is the building of health infrastructure.

Currently, a staggering global deficit in health centers, clinics, equipment and services, in healthcare workers and administrators, is crippling international efforts to combat the pandemic. Without robust health infrastructure, once the five-year plan runs its course and its targeted 2 million patients are under treatment, the affected countries will be no better off in their ability to test, treat and care for the additional tens of millions of people who will still be in desperate need of help.

The president’s initiative needs a simultaneous second track. The United States must work in concert with other countries, international institutions and nongovernmental organizations to fund and organize the more comprehensive and critical effort of building sustainable health infrastructure.

The World Health Organization Commission on Macroeconomics and Health found that essential health “interventions” could be met in the developing world with $34 per capita a year (the developed world spends more than $2,000 a year per capita on health). To meet that goal, WHO called for increased expenditures from the developing countries, but it also called for international donors to provide $27 billion a year by 2007 and, to meet increasing needs, $38 billion a year by 2015. The U.S. share would be roughly $9 billion a year by 2007 and $13 billion a year by 2015. For less than 10 cents of every $100 of gross national product, WHO estimated, $186 billion in economic output a year by 2015 would be generated through life extension and enhanced productivity. Most important, WHO found that by 2010 these efforts would be saving 8 million lives a year.

The developing world must be equipped to test, treat and counsel a huge number of patients in the decades ahead. Such capabilities would drive prevention as well.

In addition, a vast upgrade in health infrastructure could allow developing countries to tackle tuberculosis, malaria and their many other pressing health challenges. Healthier societies would strengthen these states’ economies and institutions -- the essential elements in a sustained battle against AIDS.

The United States and its international partners must move now. Much hangs in the balance. The commitment is affordable, the threat is dire and the opportunity is incomparable. In addressing the enormous need for health infrastructure, the United States and its international partners could chart a strategy that would save countless lives, provide a prodigious boost to global economic output and help safeguard the United States and people around the world from one of the gravest threats known to mankind.