The Moral Calculus of AIDS

Sometime between today and 2010, the AIDS crisis in Africa will become the moral litmus test of the post-cold war era. That is because rich countries will no longer be able to deny they failed to prevent a plague in Africa not seen since the Black Death of the 14th century.

The US has known about the AIDS pandemic for quite a long time. Back in 1990, a couple of intrepid national intelligence officers got permission to study the burgeoning growth of the disease. Interagency Intelligence Memorandum 91-10005, which was distributed to classified channels in July of the following year, projected that there would be 45 million infections by the year 2000 -- a number, the report noted, greater than all the combatants killed in World War I, World War II, Korea and Vietnam combined.

For those disgruntled by the CIA's recent miscalculations -- notably, its failure to predict the Soviet Union's economic collapse -- there may be reason to take heart. Memorandum 91-10005 was impressively accurate: Today there are anywhere from 34.3 to 53 million people with HIV and AIDS, and the number of new infections of HIV, the human immunodeficiency virus that causes AIDS, is estimated at 15,000 a day.

The only problem with the report -- tragedy, is actually the more appropriate word -- is that for the last 10 years the White House and Cabinet agencies ignored it. Even leaders of the World Health Organization, which also predicted AIDS in the tens of millions in the early '90s, met the news with indifference. Pouring over the numbers, the most powerful health officials on the planet concluded that prevention and treatment were just too expensive.

"I can't think of the coming of any event which was more heralded to less effect," James Sherry, director of program development for the Joint United Nations Program on HIV/AIDS, or UNAIDS, said in July 2000 interview. "The bottom line is, the people who are dying from AIDS don't matter in this world."

6,000 a day

Such indifference may be distant geographically, but it is just as destructive as the indifference governments and individuals displayed toward the Nazi genocide. According to the World Health Organization, less than one tenth of the 36 million people infected with HIV/AIDS can afford drugs used to treat the disease. Unlike in the West, where the triple AIDS cocktail has prolonged the lives and improved the health of those infected, people with AIDS in poor countries simply die - in Africa, at the rate of 6,000 a day.

A 15-year-old in South Africa has a better than even chance of dying of AIDS. One in five adults there is infected with HIV. None of the countries with high infection rates can afford the per-patient $10-15,000 price tag of non-generic HIV drugs. What this could mean in the long run is that African countries will soon face a social, economic and political devastation of apocalyptic proportions. Pulitzer Prize-winning journalist Tina Rosenberg predicts that South Africa -- once considered the miracle country of the continent -- will be one-fifth poorer by 2010 if help does not come soon.

AIDS is also not just an African crisis. Although approximately 70 percent, or 25 million, of the world's AIDS cases are in Africa, with the majority in sub-Saharan region, the plague is taking victims in the Caribbean as well. More than one in 50 adults in the islands south of the US are HIV-positive. In Eastern Europe and the former Soviet Union, the number of infected doubled last year. The numbers of HIV cases in India, Thailand, Brazil and practically every other poor country with meager health care budgets also has leapt to a point where no one can deny that AIDS has become a global epidemic.

But here's the rub.

Solving the world AIDS crisis will require something that governments, international lending institutions and multinational companies -- the other flank of international governance -- often lack: compassion and the ability to see beyond profit. Racism also will have to be factored into such moral calculus.