Left Field by Patricia Nell Warren

During the 2000 International AIDS Conference in Durban, South Africa, I reported on how the U.S. was evidently trying to coerce African countries into agreeing that big pharmaceutical companies could impose terms of AIDS treatment. U.S. aid would be forthcoming only if developing countries cooperated. My A&U article got reprinted widely because I was one of the few who wrote about this. Today, in 2006, with Congress’s recent renewal of the U.S.’s African Growth and Opportunity Act (AGOA), it’s time to return to this subject—to scrutinize the latest U.S. attempts to get Africans on board the pharma agenda.

The continent of Africa is home to an estimated 800 million people. Most live in the vast rural reaches of fifty-seven developing countries with a mind-boggling diversity of languages, ethnicities, religions, climate. Biggest: Nigeria, with over 128 million. Smallest: Seychelles, with around 80,000. In South Africa, which has the highest gross domestic product in the continent, people now experience some progress in democracy, stability, and growth. In Darfur (Sudan) and Zimbabwe, people are suffering horribly amid political and economic meltdown.

But large or small, most African countries have a common wish list: peace, food security, good health, good government, improved infrastructure, and the opportunity to trade with the world. And when they speak of “health,” they don’t mean just AIDS. They mean a whole range of deadly health challenges: malnutrition, malaria, tuberculosis, water-borne infections, and more. An estimated ninety percent of the world’s annual malaria deaths are in Africa. Malaria kills more children under five than AIDS does, and threatens far more pregnant mothers. Increasingly some African leaders are showing signs of frustration that Americans want to spotlight African AIDS as an isolated problem.

At first glance, the U.S.’s AGOA focuses on trade. President Bush signed it into law in 2000; it was modified in 2004 and 2005, and its life extended till 2015. The idea is to increase U.S. markets for African products and nix high tariffs that have been a barrier. So far, thirty-seven sub-Saharan nations meet the U.S. requirements for AGOA membership. Among other things, countries must qualify by dealing with their government corruption and human-rights violations. (I find it amusing that the Bush administration, which is shaken by a new corruption scandal every week, sets itself up as an arbiter of clean government in Africa.)

Today AGOA points to some modest U.S. successes for African-grown produce and apparel. For instance, if you drink a coffee specialty at Starbucks, you may be tasting the fine Bourbon Mayaguez Arabica coffee beans grown in Rwanda. But much remains to be done—especially since the Bush administration moves at first-gear speed even when human emergency is involved (as when aid to Katrina refugees was needed).

Among AGOA members, South Africa may have benefited the most so far. In July 2003, during President Bush’s visit to South Africa, President Mbeki said in his formal welcoming speech, “AGOA has had a very big impact in terms of the development of our economy.” When it was Bush’s turn to speak, he overflowed with compliments on Mbeki’s leadership, and added that AGOA is creating more jobs for Africans.

Typically, however, Bush’s speech positioned AIDS as an isolated issue. There was no mention of those other health challenges—malaria, etc. He said, “Over the next five years, we will spend $15 billion in the global fight against AIDS. People across Africa have the will to fight this disease, but often not the resources. And the United States of America is willing to put up the resources to help in the fight.” Ironically, only one-fifteenth of this $15 billion was to go to the Global Fund for AIDS, TB and Malaria, which the U.S. had already pledged to support. In his speech, Bush also said nothing about the efforts that many African nations are making, through AGOA, to fight malnutrition by building their own independent food security.

In short, the Bush administration evidently views AGOA as yet another conduit through which corporation-centered U.S. AIDS policy might be crammed into Africa.

That same year, Bush named ambassador Randall Tobias as U.S. Global AIDS Coordinator, meaning that Tobias would administer that $15 billion. Not surprisingly, Tobias was former CEO of Eli Lilly, a corporation that had lobbied to deny access to generic drugs and low-cost AIDS treatments for developing countries.

Speaking at an HIV/AIDS plenary of the 2003 AGOA forum, Tobias said: “Increasing trade and development, which provide the great benefits of which we are all aware, can also serve to create unintended consequences—conditions conducive for the spread of HIV/AIDS—conditions such as increases in economic and social inequality, consequences of the rural to urban migration of people, and problems flowing from the activities associated with the movement of goods.” Translation: Tobias saw AGOA as something that would create more AIDS, which in turn would create more opportunity for pharmaceutical profit.

AGOA has been hyping the President’s Emergency Plan for AIDS Relief. This is how Bush will spend the $15 billion announced in South Africa. It’s a five-year program that will dump $9 billion into fifteen African countries, $4 billion into 100 additional countries, $1 billion into the Global Fund to Fight AIDS, Tuberculosis and Malaria. Yet quietly, as I was writing this article, the rug was yanked from under U.S. support for the Global Fund. The House Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (LHHS) was working on the 2007 LHHS appropriations bill, and they earmarked some billions for the CDC and NIH, but slashed all monies for the Global Fund. So much for malaria and TB.

So AGOA may well offer “trade opportunity” to sub-Saharan Africa, but to the U.S. it’s yet another “profit opportunity” to push AIDS policies that enrich the pharmaceutical lobby.

However, the U.S. effort to keep AIDS singled out may find itself on a collision course with Africans’ own organized efforts to promote peace and trade among themselves—like the New Partnership for African Development. NEPAD’s goals have a wide range, from establishing democratic government, fighting poverty, and empowering women, through improving trade, education, infrastructure, agriculture, and the environment. Health is high on the NEPAD list. But AIDS is mentioned only in tandem with other pandemic diseases.

Likewise President Mbeki’s country has its own development program—ASGISA, the Accelerated and Shared Growth Initiative of South Africa. Earlier in 2006, during Mbeki’s state of the union speech to his own government, he pointed out that South Africa now has one of the largest AIDS treatment programs in the world, with 100,000 people receiving treatment. Yet he mentioned it in a larger context of aiming to improve his country’s healthcare infrastructure.

Who will win this deadly tug of war over AIDS policy? The U.S. and its corporate lobby? Or the African peoples who must live with the results of these policies? Stay tuned.

Author of fiction bestsellers and provocative commentary, Patricia Nell Warren has her writings archived at www.patricianellwarren.com. Reach her by e-mail at patricia@patricianellwarren.

Copyright © 2006 by Patricia Nell Warren. All rights reserved.

July 2006