AIDS: Grappling with a global crisis

Saul Kanowitz

December 1, 2006

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Dec. 1 is World AIDS Day, a day focused on remembering the tens of millions of people who have died from AIDS worldwide and the more than 40 million currently infected, many in oppressed countries. AIDS care and prevention programs are still underfunded or nonexistent in many countries. AIDS medicine for those infected is extremely expensive. Transnational pharmecutical corporations and the imperialist governments that promote them have continuously sought profits over people’s lives.

In December 2004, the Joint United Nations Programme on HIV/AIDS issued its annual update on the global AIDS epidemic. The report describes the terrible impact the disease has had on oppressed countries throughout the world. The most devastated region is sub-Saharan Africa.

The large number of infected people in sub-Saharan Africa is not based on the epidemic running its natural course. It is a result of the neo-colonial status imposed on these countries by the imperialist countries.

Around 39.4 million people worldwide have HIV/AIDS. Two-thirds of these—25 million—live in sub-Saharan Africa. Three million people died of the disease in 2004, including one million dead in southern Africa.

These numbers highlight the magnitude of the HIV/AIDS crisis on the African continent today. The crisis is acute in other parts of the world as well, but it is most urgent in Africa. The prevalence of adults with HIV/AIDS in sub-Saharan Africa is 7.4 percent, compared to 0.6 percent in North America. (AIDS Epidemic Update 2004, UNAIDS)

Global funding to combat AIDS was about $6.1 billion in 2004. It is not enough. The United Nations and World Health Organization estimate it would cost between $7 and $10 billion a year for prevention and treatment in oppressed countries.

Neoliberalism overturns Africa’s gains

In the 1980s, at a time when the AIDS epidemic was surging, the economies of oppressed countries were hard hit by the global economic crisis. Many poor countries in Africa and elsewhere needed billions of dollars to sustain their economies. The only practical way to get money quickly was in the form of loans. For African countries to qualify for loans, the World Bank and the International Monetary Fund required deep cuts in social services and forced privatization of public health—so-called structural adjustment programs.

These programs reversed the expansion of public health and access to social services, which was common in newly independent African countries.

For example, Kenya reduced child mortality by nearly 50 percent in the first two decades of independence due to expanded access to public services. Life expectancy rose from 44 to over 50 years across sub-Saharan Africa after independence.

In Zambia, primary health care was made available for the first time on a mass scale in the post-colonial period. As a result, infant mortality was reduced from 123 per 1,000 in 1965 to 85 per 1,000 in 1984. In Tanzania, the number of health care facilities was greatly expanded. Three quarters of the population lived within five kilometers of a health facility in the 1980s. That is no longer the case. (“Hazardous to Health: the World Bank and IMF in Africa,” Africa Action, April 2002)

The countries of sub-Saharan Africa whose economies came under the control of the IMF and the World Bank saw their per capita income decline by 25 percent during the 1980s. Not surprisingly, poverty—a predictor of disease—morbidity and mortality rose during the 1980s due to forced cuts in government spending on social services.

In the 42 poorest countries in Africa, spending on health care fell by 50 percent during the 1980s. People were charged “user fees” for health services that had previously been free. This resulted in dramatic drops in people’s use of health services.

By the 1990s, most African countries had to pay more to finance their foreign debt than they spent on health or education. The sub-Saharan nations’ interest payments to foreign banks in 1997 were four times higher than what they spent on health care.

The number of people infected with HIV/AIDS jumped drastically in the 1980s. At a time when health and social services needed to expand to stop the spread of the epidemic, the opposite happened. This was not an accident.

The capitalist ruling class has a long history of taking advantage of natural or human-made crises to subjugate workers and the oppressed all over the world to the dictates of private ownership. U.S. imperialism now leads the way. While shedding crocodile-tears for those suffering from HIV/AIDS, the actions of the U.S. government and private pharmaceutical companies show that capitalism puts making profits above the health of humanity.

Trade agreements hurt the poor

While the AIDS epidemic was reaching global proportions in the 1990s, the imperialist countries, spearheaded by the

U.S., imposed new and unfavorable financial agreements on poor and oppressed countries. The World Trade Organization was born out of the World Trade Agreement, signed in 1994. This agreement outlawed trade barriers that protected oppressed countries from being pillaged by huge transnational corporations.

The WTA included the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which strengthened patent and copyright holders’ rights. The world’s largest corporations hold the bulk of these rights. However, TRIPS also contained a section allowing poor countries to produce high-priced products cheaper at home or to buy cheap products from other countries.

South Africa invoked this section in 1997 to import generic anti-retroviral HIV/AIDS treatment drugs from India. India is the world’s largest producer of generic drugs. Patent law in India only protects the method of production and not a drug itself. Corporations there cannot assert a monopoly over the drug as corporations in imperialist countries can. Thus, generic anti-retroviral drugs cost $140 per year in India versus $10,000 for the name-brand equivalent in other countries.

The U.S. and the European Union responded by threatening South Africa with trade sanctions. Thirty-nine pharmaceutical companies including, Merck, GlaxoSmithKline and Bristol-Myers Squibb took the South African government to court to try to prevent its use of generic drugs.

In April 2001, after years of legal battles, the companies dropped the case. A global campaign had exposed their motives—to protect the super-profits they were earning by selling anti-retroviral drugs at ridiculous prices.

But the victory was bittersweet. In South Africa, millions had already died because they could not afford the drugs.

Later, at the 2001 WTO meeting in Doha, Qatar, a struggle led by African countries ensured that TRIPS would be interpreted “to promote access to medicines for all.” However, it is still unclear whether or not countries without domestic drug production capabilities can import generic drugs without violating trade agreements.

While some concessions have been won by oppressed countries in the struggle to cope with the AIDS epidemic, the underlying conflict between the search for capitalist profits and human health requirements is unresolved.

The main obstacle in combating the AIDS epidemic is not a lack of political will or material resources. It is that private ownership is considered more important than the needs of ordinary people. This has resulted in the bulk of resources and technology being held by corporations in imperialist nations.

The imperialists draft laws, like WTA, that reinforce their positions and impose them on weaker nations. As of January 1, India, the world’s leading generic medicine supplier, is supposed to comply with WTA requirements and protect product patents. If India conforms to the WTA “the world’s supply of new affordable generic drugs will essentially disappear.” (Fact Sheet: Changes to India’s Patents Act and Access to Affordable Generic Medicines after 1/1/2005)

Struggling for care in the U.S.

At the onset of the HIV/AIDS epidemic in the United States, the government didn’t just fail to respond to the crisis. It turned a medical crisis into a social crisis as well.

The most racist and reactionary forces in the U.S. were blaming Haitian people and gay men for the epidemic. Racists calling for Haitian immigrants to be quarantined were not rebuked by the government. The corporate media covered anti-LGBT bigots who deemed AIDS “God’s retribution against homosexuality.” Instead of addressing the epidemic on a rational and scientific basis, the capitalist class promoted fear and panic to victimize people with HIV/AIDS.

It took massive struggles led by groups like ACT UP—AIDS Coalition to Unleash Power—and other progressives to get the government to address the unfolding public health calamity. The U.S. government spent money on research, treatment and prevention only after the crisis threatened to overload the health care system and affect wider sectors of society.

Once funding began, pharmaceutical corporations competed to be the first to develop a treatment and cure. For greedy capitalists, the promise of a monopoly on life-saving treatments was a pot of gold at the end of the research rainbow.

A different system, a different solution

The island nation of Cuba has managed the HIV/AIDS epidemic remarkably well. The infection rate is 0.05 percent of the Cuban population, the lowest in Latin America.

Cuba was particularly well equipped to cope with HIV/AIDS because its health care system is highly developed and free to all citizens. From 1980 to 1990, the number of physicians per 1,000 people in Cuba rose from 1.4 to 5.3. (World Health Organization)

Instead of closing health services as the epidemic unfolded, Cuba responded with a comprehensive national plan. In 1983, Cuba established the National AIDS Commission — a government initiative—to manage the epidemic. It began screening all blood donations in 1986 for HIV. There has been no known transmission of HIV via the blood supply as a result.

Cuba also established sanatoriums or hospitals specifically to treat HIV positive people. Between 1986 and 1993, people with HIV/AIDS were required to live at the facilities. Detractors of the Revolution criticized this approach as an infringement on these people’s rights.

But in Cuba, unlike the U.S. and other imperialist countries, there was no campaign blaming the sick for the epidemic. Instead of blaming the victims, Cuba employed rational and epidemiological methods to limit the spread of infection.

The Cuban program centralized scarce resources to provide maximum care and treatment for all afflicted. Those Cubans living at the sanatoriums received full salaries from their jobs and high-calorie diets as part of the total approach to care.

While treating the sick, the Cuban government also launched a comprehensive educational campaign on the use of condoms to stop the spread of infection.

At the end of 1993, an ambulatory care system was opened for all who wanted to leave the sanatoriums. More than 40 percent chose to remain.

Cuba’s success in treating and halting the devastating HIV/AIDS epidemic serves as an example for all the world’s countries. Although it has minimal resources and is blockaded by the U.S., Cuba has been able to respond in an effective and humane way because its heath care system is not run for profit. It is based on providing for society. The result has been lifesaving.