By Kari Huus Reporter
updated 9/30/2004 1:27:04 PM ET 2004-09-30T17:27:04

One of the few common threads between the Clinton and Bush administrations was acknowledgement the global spread of AIDS/HIV was not only tragic, but a security issue – threatening to bankrupt economies and produce failed states. In his confirmation hearings for Secretary of State, Colin Powell declared AIDS/HIV “a clear and present danger.”

The numbers are grim, and suggest efforts by the United States and the rest of the developed world are falling short. Some 8,200 die from AIDS each day. Three million died last year. And a new report from the United Nations says India and China are likely to see numbers as high as those in Sub-Saharan Africa.

In May of 2003, President Bush announced an initiative to spend $15 billion over 5 years to fight HIV/AIDS in Africa and the Caribbean. Washington is also the biggest contributor to the U.N. Global Fund to Fight AIDS, Tuberculosis and Malaria.

While the administration won kudos for addressing the issue, its approach is controversial – focusing funding on sexual abstinence, for instance, to appease American conservatives. Also, critics charge the administration with bowing to drug companies, and imposing conditions that make it more difficult for poor countries to make cheap generic antiretroviral drugs available.

And they note that very little of the promised aid has been doled out. Only about 25,000 people have been treated so far, despite a goal of 500,000 by the end of this year. Critics say the time and money would have been better spent by providing funding to the Global Fund, which is using anti-AIDS programs and strategies that are already in place.

“What Bush has done is cherry pick 15 different countries … and the sort of interventions and medicines he’s willing to finance,” says Sharonann Lynch, policy advisor for activist group Health GAP. “This policy and program is driven more by ideology than science.”

The presidential candidates are divided on whether U.S. emphasis should be on unilateral or multilateral programs—with Democrat John Kerry promising massive increases in funding for the U.N. program.

In addition, activists say, the fight against AIDS will depend on the United States and other developed countries agreeing to forgive massive foreign debt that crushes the poorest countries, says Jeffrey Sachs, a Columbia University professor and Special Advisor to United Nations chief Kofi Annan.

In Zambia, for instance, infection runs at 15-20 percent of the sexually active population but in the 1990s it spent about 20 percent of its GDP servicing debt and 2-3 percent on health and education.

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