AIDS AND AID: GLOBAL BLACKMAIL?
By Patricia Nell Warren
A & U Magazine July 2000
Earlier this year, South African president Thabo Mbeki, already known as
an independent thinker, made world headlines when he sent hand-addressed
letters about AIDS to President Clinton, and to U.N. Secretary-General Kofi
Annan and other world leaders.
What grabbed the headlines was Mbeki's questioning whether Western
approaches to AIDS theory and treatment were right for African countries.
Mbeki defended his right to consult with AIDS dissenters. He asserted that
it "would constitute a criminal betrayal of our responsibility to our own
people" if his government did not explore all avenues of combating AIDS.
According to the Washington , Mbeki "stepped up an emotional
controversy over his country's response to AIDS, saying Africans should
chart their own course on the disease."
Headlines also dwelled on Mbeki's invitation to several noted dissenters
to participate in an AIDS advisory panel prior to the upcoming 13th
International Conference on AIDS to be held in Durban, South Africa in July.
His letter expressed concern about pressures on South Africa to treat
pregnant HIV+ mothers and babies with some drugs. Mbeki said he had asked
his government to investigate growing controversy about "the toxicity of
certain drugs." According to a recent AP report, several deaths of South
African mothers and children had been attributed to AZT poisoning.
South Africa's deputy president Jacob Zuma supported Mbeki. According to
the Johannesburg , Zuma, who is spearheading the
government's anti-AIDS drive, said he believed "no scientists had a monopoly
on all knowledge about AIDS....The issues must be debated and all views are
According to the Washington , the White House tried to cover up
Mbeki's letter. After all, Mbeki was upsetting apple carts for U.S.
officials trying to squelch AIDS dissent at home. The said: "The
Clinton administration restricted distribution of the five-page letter,
April 3, in an effort to prevent it from becoming public. Several Clinton
administration officials and foreign diplomats expressed dismay at Mbeki's
decision to intensify what they see as a diversionary dispute and to bring
to a potentially volatile international forum. One official made a copy of
the letter available to the Washington Post, and South Africa's U.N.
ambassador, Dumisani Kumalo, confirmed its authenticity."
Opposition parties in South Africa, as well as officials and AIDS
activists in the U.S. countries, stirred up a firestorm of outrage at
actions. As I write this article, Mbeki is under fierce pressure.
Amid the flap about dissent, the deeper message of Mbeki's simple
heartfelt prose, and his deeper worry, was missed by many Americans. U.S.
outrage at Mbeki's position reflects our comfortable insulation from
developing nations' concerns. It also expresses that old missionary streak
that is still strong in this country -- the idea that we know what's best
poorer nations, that they should be abysmally grateful for our help. It's
time for us to take off the missionary hat and look carefully at how
developing countries may see AIDS politics.
The fact is: Mbeki's letter followed a significant January 10 speech
before the UN Security Council. This speech, by World Bank president James
Wolfensohn, used some very strong re-positioning language. Wolfensohn said:
"Many of us used to think of AIDS as a health issue. We were wrong. AIDS
no longer be confined to the health or social sector portfolios. AIDS is
turning back the clock on development."
The World Bank, a group of international investment entities organized
1944 to help rebuild the post-World War II world, is a major player in the
AIDS debate. It is also a powerful economic driver in the world today.
Americans who never gave a thought to the World Bank recently got their
look at its human faces on CSPAN. Wolfensohn and other WB officials tried
explain their position to the TV cameras, after anti-Bank student and labor
demonstrations had jarred Washington D.C. for days and hundreds of arrests
The Bank has now re-positioned AIDS as its "central development issue,"
even though malaria, tuberculosis and malnutrition still kill more people
worldwide than AIDS. (By the Bank's own admission, malnutrition alone kills
half the children in low-income countries.) The Bank is deeply involved in
financing and implementing AIDS-linked investment, and singles out HIV+
for global focus. And yes, it's true that the death from ANY cause of a
woman of child-bearing age, with consequent loss of her income to her
and nurturing to her children, is a direct blow to a nation's development.
Another big player in global AIDS policy is the United States. At the
time of Mbeki's letter, the U.S. government was already the biggest
contributor to international AIDS efforts. Following Mbeki's letter,
President Clinton went to Congress asking to double our international AIDS
funding. The White House is using its own dire re-positioning language --
World War II language -- by calling it our "Marshall Plan for AIDS." (The
original Marshall Plan was used to rebuild bombed-out Europe after 1945.)
All the more reason why Americans need to think about this Bank speech,
and to remind ourselves that the Security Council is a war forum. We need
look closely at what substituting a "global war on AIDS" for the old "global
wars on fascism and communism" might portend for the world.
Nor is scientific dissent about AIDS theory the only issue here. Mbeki's
letter makes no secret of the fact that he is worried about developing
countries losing their right to make their own decisions on health policy.
The World Bank, along with the UN, WHO, UNICEF, UNAIDS and other
international powers and agencies, have already set a global AIDS policy in
place that implies little choice, if any, by individual countries. Behind
the ringing humanitarian rhetoric, what's happening is this: the original
"model" of HIV law enforcement and public-health policy that was first
developed in the U.S. -- the one that citizens of the U.S., Canada and EU
countries are now required to submit to -- is being applied to the rest of
the world. Loans and investment for developing countries -- perhaps even
disaster relief -- may be contingent on a country's willingness to implement
that HIV model within their own borders. For anybody who hasn't been
the policy boilerplate of WHO and the Bank, this means: mandatory HIV
testing, individual surveillance and case reporting, and directly observed
treatment (DOT), especially with women and children. Economic help may also
be contingent on a country's willingness to allow mass-marketing of
foreign-made HIV vaccines, drugs and tests to its citizens.
Global sales of AIDS drugs and tests, and AIDS vaccines that the World
Bank says it wants for every child born on the planet -- 10 billion of us by
the year 2050 -- surely have pharmaceutical companies glowing at the
of astronomical profits, even with the low prices required for selling these
products to developing countries. The World Trade Organization wants
millions of healthy workers and consumers who can be shuffled from country
country without diplomatic crises revolving around contagious disease. More
and more, the definition of world health centers on "HIV negative."
In other words, AIDS policy is now a key world commodity -- right up
with shiploads of computers, crude oil and wheat.
Whenever this kind of global money leverage is applied, truth and real
human needs can get crushed beneath the lever. Worse yet -- by linking every
person on earth to a blood test or vaccination certificate for a disease
has been declared "incurable", globalization of AIDS policy could leverage
every human life on earth. Not having an HIV-negative ID card could mean
job, no legal marriage, no benefits, no visa, no immigration. The one-world
folks can't get this kind of leverage with the bigger killers like malaria,
TB and malnutrition, because a person can be effectively treated for these
Leveraging countries on AIDS policy creates a clear danger of volatile
reactions. Like South Africa, other developing countries may feel they have
a right to independent thinking, especially on such an intimate issue as
their citizens' sexual health. Failure by the U.S. or the World Bank to
respect this right, or insensitivity to cultural and religious parameters,
will surely raise some hackles. In fundamentalist Islamic countries, for
example, foreign vaccines and tests will probably not be welcomed by men on
behalf of their women, who are kept strictly behind veils and closed doors.
Indeed, at a couple of recent world health conferences, there was violent
wrangling among different religious groups over proposed global approaches
abortion, birth control, definitions of "gender" and "family values."
Supposing a small country is declared a "global health hazard" because
refuses to toe the line on AIDS policy? Will it be embargoed? Nuked? Will
it fail to get "favored nation trade status" with the U.S.? Will the
Security Council send in UN troops? Are we going to have Vietnams and
Bosnias over AIDS?
Nor is World Bank investment a magic bullet of economic success. The
project coordinator of Resource Center of the Americas, Larry Weiss,
raked the Minneapolis for what he called the paper's
over World Bank structural-adjustment programs. "These," Weiss said,
"require poor countries to impose harsh austerity measures on their
populations and to turn their economies into sweatshop-based export
platforms. Failure to do so can result in a cutoff of international credit
a catastrophe scenario for their economies. More than 90 countries have
suffered structural adjustment." Added Weiss: "The Jubilee 2000 Coalition
-- comprising hundreds of faith-based and other organizations in more than
countries -- [notes] that 7 million children die each year as a result of
debt crisis." That is 5 million more deaths than the 2 million Africans
said to die of AIDS each year.
Weiss argued that the Star Tribune ignored nearly two decades of
against World Bank policies in Bolivia and dozens of countries -- protests
that frequently reach the level of full-scale rioting. Another supporter of
protest is African leader Arthur Mbanefo, Nigerian ambassador to the UN and
chairman of the G-77 group of the world's poorest countries. Said Mbanefo:
"Many countries have rejected the results of various policy initiatives of
the World Bank...We are very supportive of demonstrations that could
forcefully handle those concerns."
Mbeki himself, while a student activist traveling in other African
countries, may have seen at first-hand the tragic results of World Bank
ventures in the Sahel, that vast sweep of fragile semi-desert in sub-Saharan
Africa. There, according to the Worldwatch Institute, 30 years of Bank
investment in expanded stockraising actually helped speed up land
destruction, desertification and human deaths from famine. As the World Bank
itself admits on its own website, it had to rebuild its relationship with
South Africa after Nelson Mandela came to power, because South African
politicians viewed the Bank as "an inflexible, authoritarian sponsor of
failed economic policies."
Weiss's criticism of the can apply to most U.S. major
media, who have done a lousy job of informing Americans about the dark side
of economic globalization, and the real reasons why we have a reviving
student/labor protest movement in the U.S. Now our major media are doing an
equally bad job of telling people about the dark side of health
A developing nation's health is no less fragile an environment than the
Sahel. It has its own gene pool of inherited immunities and
its own unique mutations of different pathogens, and other localized factors
that can inter-react in unimagined ways with ill-advised and politically
motivated medical meddling from outside. So that nation's leaders might
choose to look for long-term ends to malnutrition and poverty as root
of disease, rather than go for the quick fix -- namely, coercing their
into health compliance, bombing them with cheap or free foreign-made AIDS
vaccines and drugs. Those leaders may not want to risk the tragic medical
consequences and the political resentments that might irrupt among their
people as a result.
Indeed, the very idea of drenching the world's 6 billion population with
powerful antibiotics is a scary one. Even here in the U.S., where we like
view ourselves as medically sophisticated, doctors and citizens have taken
such a casual approach to antibiotics that strains of drug-resistant
organisms have emerged here. In some developing countries, women haven't
been educated to textbook use of contraceptives, so no one would expect
women, or their families, to use antibiotics by the book. This education
explains why WHO is filled with enthusiasm for DOT (directly observed
treatment). DOT is viewed as the best substitute for trusting the world's
people to take their own medications, especially for tuberculosis as a
co-factor in weakened immune systems. In some developed countries, DOT
doesn't just mean requiring the patient to travel to a clinic and take pills
under the doctor's watchful eye. DOT also means jailing a patient who
cooperate, and applying forcible treatment, even removing at-risk children
from families if necessary.
In the U.S. and Canada, AZT treatment is already being forced on HIV+
mothers and children, as we know from court cases where mothers are
challenging this penal-law approach to family health. This is the "model"
are exporting. When WHO talks about need for global DOT "surveillance" and
"control," this is essentially what they mean. What's to prevent these
extremes of "control" from being required in Africa, or India, as a
of foreign aid? Especially with mothers and children? Especially since
mothers are seen as keys to global economic development?
No one who has been following these trends I've mentioned would have been
surprised at President Mbeki's letter.
As this issue of A & U goes to press and the July AIDS conference
approaches, pro-globalization leaders are escalating their AIDS positions.
the beginning of May, four U.N. envoys -- Costa Rica, Ukraine, Zimbabwe and
the Czech Republic -- called on the UN General Assembly to adopt new
strategies for international AIDS "cooperation." The White House jumped on
the bandwagon by declaring AIDS a "national security threat" to the U.S.
Reuters reported, "U.S. officials worry it could undermine economies,
threaten military establishments and governments and cause other regional
problems." Major drug companies swore they would lower drug prices for
African countries. The House approved the AIDS "Marshall Plan" for Africa.
No wonder the president of South Africa is worried. Mbeki's stand may be
only the beginning -- a groundswell of fierce resistance to global AIDS
policy, from developing nations who might choose to view it as blackmail.
AIDS policy statements of the World Bank, World Health Organization, may
found on their websites at www.worldbank.org and www.who.org.
Author/journalist Patricia Nell Warren writes provocative commentary for A
& U and other magazines. Her email address is firstname.lastname@example.org.