In 2001, The Global Fund to Fight AIDS, Tuberculosis, and Malaria was established to coordinate international HIV/AIDS policies and distribute funding from many governments, health organizations, and religious institutions. The Global Fund has been successful by matching their programs to the specific needs of the nations most affected by HIV/AIDS. And The Global Fund has been willing to apply practical solutions for preventing HIV and treating AIDS, without being influenced by parochial religious viewpoints.
 
However, the Bush administration is now attempting to change that. The administration is positioning itself to ensure that Randall Tobias, Ambassador for AIDS Coordination, is appointed to lead The Global Fund’s committee for policy and strategy. This would give the Bush administration undue influence on international HIV/AIDS policy, and would likely be a death sentence for many living with the disease.
 
In 2003, after pledging to spend $15 billion on international HIV/AIDS prevention and treatment, the Bush administration created the President’s Emergency Plan for AIDS Relief (PEPFAR) to oversee the disbursement of the funds and HIV/AIDS policy. Randall Tobias, a former Vice President of the pharmaceutical company Eli Lilly, was appointed to administer PEPFAR. Under Tobias’ leadership, the administration has been plagued by poor politics, bad medicine, and questionable ethics.
 
The position of PEPFAR on the global use of AIDS medications has been consistently criticized since its inception. None of the $15 billion that PEPFAR distributes can be spent on generic drugs from foreign manufacturers, unless they have been approved by the U.S. Food and Drug Administration. Although the administration first characterized the global AIDS pandemic as a “crisis” in January of 2003, the FDA did not implement a fast-track program to approve generic AIDS drugs until almost a year and a-half later. The difference between the annual cost of generic versus brand AIDS drugs is very significant.
 
The annual cost of generic antiretroviral drugs per person averages approximately $140, compared to approximately $470 for brand drugs. Many foreign pharmaceutical manufacturers have successfully developed effective AIDS drugs. And the need for these drugs is staggering. Of the 28 million HIV-positive people in Africa, only 4% are receiving antiretroviral drugs. Yet it was not until January of this year, fully two years after the Bush administration referred to AIDS as a global crisis, that the FDA approved of generic drugs manufactured by a South African company.
 
In February, the Government Accountability Office, the non-biased investigative unit of Congress, released a report criticizing the administration for its position on the global use of AIDS drugs. The report stated that the administration’s plan is at odds with the strategies of international health groups and neglects the preferences
of the nations in need. It criticized the Bush administration for not allowing the use or distribution of generic antiretroviral AIDS drugs that have not been approved by the FDA, given that the World Health Organization and other international health agencies have approved of multiple generic AIDS drugs.
 
The administration’s policy on AIDS prevention has severely influenced by conservative religious politics. Fully one-third of the international funds spent on prevention programs, approximately $130 million, are mandated to be spent only on promoting abstinence before marriage, and cannot be used to address the use of condoms or safer sex. 
 
Ambassador Tobias gave a speech in 2003 in which he stated that condoms were not effective in preventing AIDS. Of course, this was contrary to commonly accepted
medical science. His speech prompted the government of Uganda, one of the African nations with the highest rates of HIV/AIDS, to announce that condoms were no longer appropriate for use. Two months later, while speaking at the World AIDS Conference, Ambassador Tobias “flip-flopped,” to coin a phrase the administration used to their benefit in last fall’s election, when he corrected himself and stated that both condoms and abstinence can be useful in preventing the disease.
 
Federal funding for domestic and international HIV/AIDS research by the National Institutes of Health and the Centers for Disease Control and Prevention have been influenced by conservative religious politics. An evangelical Christian political organization known as the Traditional Values Coalition released a list of AIDS scientists and programs that it asked the Bush administration to prevent from receiving federal funds. And the National Institutes of Health is now required to subject grants to programs that pertain to sex outside of marriage to additional reviews before they can be approved. And scientists at both the National Institutes of Health and Centers for Disease Control and Prevention have complained that research proposals with the terms “homosexual,” “prostitute,” and “drug user” in
their title are routinely rejected for funding.
 
The conservative Family Research Council, who, according to its literature, “champions marriage and family as the foundation of civilization, the seedbed of virtue, and the wellspring of society,” has close ties to President Bush. It publicly informed the Bush administration that it would not continue to support it if it sent a large number of condoms to Africa. Presumably, a small number of condoms being shipped to Africa, to prevent a small number of HIV infections, were acceptable.
 
And William Bennett, the former Secretary of Education and Director of the White House Office of National Drug Control Policy under President Reagan, who is now a scholar with the conservative think tank Empower America, informed the Bush administration that regarding Africa, “condoms must no longer be considered the first line of defense against HIV.…” 
 
If Ambassador Tobias is successfully installed as the leader of The Global Fund’s committee on HIV/AIDS policy, the Bush administration will almost certainly attempt to inject conservative religious politics into the organization. But rather than simply meddling with politics as usual, the administration will be meddling with the lives of millions of HIV/AIDS patients. And the prognosis will be grim.