Expand public commitment to global AIDS battle

NOT long after bubonic plague arrived at Florence in the spring of 1348, Boccaccio sat down to write his great satire, the Decameron. It described the ravages of the Black Death in terrifying detail. Those who could afford to flee rode off in closed carriages to their country estates. When servants went to town for provisions, they were ordered not to bring back bad news.

Six and a half centuries have passed, but Boccaccio's nobles would find our response to the AIDS pandemic quite familiar. In Europe and North America, access to life-saving drugs is almost a matter of course, and mortality rates from AIDS have fallen sharply. But 70 percent of the infections reported last year — 28 million human beings — were in sub-Saharan Africa. Fewer than one in a thousand is being treated, and prevention efforts have been hamstrung by inadequate funding.

In Africa alone, AIDS kills 2.3 million people each year. That's equivalent to the entire population of Greater Seattle, from Everett to Federal Way, dying every 12 months.

After years of inaction, the international community has finally begun to mobilize against AIDS in the developing world.

In June 2001, United Nations Secretary General Kofi Annan unveiled a special public-private partnership, the Global Fund to Fight AIDS, Tuberculosis and Malaria. During the first round of applications, over 300 proposals from around the world were sent to the fund's technical review panel. They ran the gamut from prevention of neonatal HIV transmission, to promotion of condom use, to antiretroviral therapy. The fund has announced that about $170 million in grants would be provided in the first year to 40 of the projects that applied.

In the slow-motion fight against AIDS, this qualifies as good news. These projects will be a good start toward coordinated global action against the disease.

Unfortunately, they are only a drop in the bucket. While health economists estimate an annual need of at least $7 billion, current pledges to the Global Fund total only $1.9 billion — less than $800 million of it for 2002. The U.S. commitment this year is just $300 million. Of the G7 industrialized nations, our contribution represents by far the smallest proportion of gross national product.

Even longtime opponents of foreign aid recognize that we must give more. U.S. Sen. Jesse Helms, R-N.C., a frequent antagonist of American AIDS activists, called recently for an additional donation of $500 million. "I have been too lax too long in doing something really significant," he told a Christian group. "I'm so ashamed that I've done so little."

Shame may be appropriate, but so is self-interest. AIDS is not just Africa's health crisis, and fighting it is not an act of charity. Great pandemics such as cholera, plague and HIV are "diseases of globalization," looming over all countries and regions. Left unchecked in Africa, the virus that causes AIDS has already begun to mutate, threatening to spread elsewhere and defeat currently available treatments.

Moreover, AIDS is a foreign-policy nightmare in the making. It is decimating an entire African generation. Life expectancy in Botswana has plummeted by nearly 20 years in the past decade. Throughout the sub-Saharan region, an estimated 12 million children have been orphaned by the disease, and 40 million orphans are projected by 2010. These children are destitute, deprived of the food, education and nurturing they need to develop into healthy adults and contributors to a stable society.

At a time of great geopolitical uncertainty, this prospect is even more threatening. Having just fought a war in one failed state, Afghanistan, we would be shortsighted in the extreme if we allowed others to sink to those depths. Our choice to invest in those living with AIDS can forestall the need for costly, even deadly future interventions. As we mobilize war against the forces of destruction, it is essential that we also make available the instruments of healing.

It is a matter of national security.

For years, Northwest-area medical and public-health researchers have played a leading role in the fight against HIV/AIDS. More recently, through the Bill & Melinda Gates Foundation, that private commitment has expanded considerably. The AIDS pandemic, however, is beyond strictly private solutions: It is time to expand our public commitment, as well. As constituents, we must ensure that Washington's elected representatives take a leading role in giving the Global Fund the support it so urgently requires.

The millions dying unnecessarily in poor countries of Africa and Asia are not just victims. They are messengers from an apocalyptic landscape; they remind us that the modern plague has not yet been checked. AIDS presents the great moral, medical and political challenge of our generation. We can, like the nobles of the Decameron, choose to silence the messengers.

Or we can choose to heal them.

Dr. Stephen Gloyd, left, is a professor at the University of Washington School of Public Health and director of UW's International Health Program. Aaron Shakow, right, is a fellow at the Program in Infectious Disease and Social Change, Harvard Medical School, and a member of the Seattle-based Northwest Coalition for AIDS Treatment in Africa, www.scn.org/ncata.