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The West is coming up with the wrong answers about AIDS.
Financial aid alone won't stem the AIDS epidemic - political and economic reforms are desperately needed.

Philip Stevens
Medical Progress Today
December 1, 2005

Each year, while the number of victims rises, the AIDS-advocacy industry uses World AIDS day on 1st December to rehearse familiar themes. This year their tagline is "Stop AIDS. Keep the promise", an exhortation for more money to combat the disease.

The idea that AIDS in Africa and other poor countries can only be reversed with large sums of aid money is not often questioned. Who among us, except someone with an evident disregard for humanity, could argue against it?

But this wallet-first attitude is not providing sustainable answers to the AIDS problem. Instead, this year's World AIDS Day should be used as an opportunity to suggest some more effective approaches.

First, we must examine exactly what World AIDS day is asking us to support. Atop the list is further funding for the World Health Organization's flagship "3 by 5" programme, which had initially hoped to get three million people onto life-saving ARV treatment by the end of this year. With one month to go, it is almost certain that this target will be missed spectacularly.

The "3 by 5" programme is an example of a top-down programme that has failed because its strategy was hijacked by the AIDS-activist lobby. This lobby, drawing on its early demands for more and better AIDS treatments in the U.S. and Europe, has for years chanted "treatment for all" on the international stage. This is a misunderstanding of the forces driving the international AIDS epidemic. Dilapidated African health-systems are simply unable to distribute the medicines to all those in need, let alone monitor treatment. As a result of this misprioritization, the total number of people living with AIDS has actually increased since the programme started. This year saw the highest number of new infections since records began.

A more considered strategy in poor nations would have recognized the limitations of the treatment-first approach, and instead emphasized prevention. As we slide toward 2006, we should begin to tackle the real reasons AIDS is flourishing in many parts of the world.

The reason AIDS is so tenacious is not because of the cost of medicines, or a lack of aid. The reason AIDS has taken such a hold in Africa and parts of Asia is because these regions suffer from stifling political and economic oppression. Leading public health experts are unanimous that prevention is of paramount importance to combat AIDS. But until recently, President Mbeki refused to acknowledge that South Africa even had an AIDS problem, a factor that contributed to the advance of the disease in that country. By contrast, the government of Thailand acknowledged AIDS as a problem early and encouraged discussion and education, bringing infection rates down rapidly.

Yet recently the Thai government has oppressed intravenous drug users; police killed more than 2000 in 2003 and thousands more were imprisoned. The consequence: drug use was driven further underground and open discussion of the need to use sterile needles was made impossible. As a result, HIV infection rates are now soaring among drug users.

Economic oppression is an even more fundamental vector of this disease. When governments restrict the ability of people to start up businesses and exchange goods freely under the rule of law, poverty and hopelessness are guaranteed. People flee from the countryside looking for work, to be greeted with urban slums and unemployment.

Rent controls, oppressive planning restrictions and lack of land title mean there is a woeful undersupply of suitable housing. It is also impossible for people to use their houses as security against loans.

Poverty leads desperate parents to sell their children into the sex trade, and for poor women with few employment opportunities, prostitution is one of the few options available. Drug abuse is rife. In the poverty of the favelas in Brazil and the shanty towns of Africa and India, HIV finds fertile ground.

But this urban squalor need not exist if people had real employment opportunities and the ability to create wealth for themselves. Unfortunately, governments that restrict economic liberty make this impossible.

At the moment, the West is coming up with the wrong answers about AIDS. Giving more financial aid might please Irish rock-musicians, but in reality it is sustaining corrupt politicians and preventing Africa from helping itself.

Money for AIDS projects can worsen this; the Global Fund had to suspend grants to Uganda in August after uncovering evidence of systematic embezzlement. Meanwhile in Ghana, hundreds of spurious NGOs have sprung into existence with the sole purpose of obtaining Global Fund money.

Instead of salving its conscience by pouring aid money into Africa, the West could do something of far greater value by undermining the ability of political elites to politically and economically oppress their people.

Western governments should therefore be encouraging countries to institute property rights and foster respect for the rule of law. This is the only way the benefits of economic growth will reach the poor and allow them to escape the squalid conditions which spread AIDS.

The AIDS lobby for too long has been giving us the wrong answers to the wrong questions. Their experience of treatment in resource rich, democratic, accountable political systems doesn't translate well into nations where individuals lack basic economic and political rights. Freedom has brought prosperity to the West and ensured it has remained insulated from the worst of the AIDS crisis. Let's hear more voices in 2006 calling for this freedom to be extended to where it is most desperately needed.

Philip Stevens is director of the Campaign for Fighting Diseases, a London-based charity that promotes practical solutions to the diseases of poverty.

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