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Clinton Pardon Me, Africa

Clinton wonders why the West stood by and did little as the AIDS crisis in Africa exploded. He could start by answering why his administration didn't respond in the first place.
 
 
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How many times is Bill Clinton going to apologize to Africa?

In mid-July, the former President spoke at the 14th International AIDS Conference, which was held in Barcelona, Spain. He promised he would go to Africa "to lend visibility and support" to the battle against AIDS, which threatens to kill tens of millions of people there. He urged the wealthy nations -- particularly the United States -- to do more: "We should figure out what our share is, and we should pay it." He also said he did not know how the world ever allowed a preventable disease to infect 40 million people and possibly infect up to 100 million in the years ahead. His speech had a making-amends tone. In fact, the day before, he said in an interview he regretted not having done more regarding AIDS when he was president.

This is not the first time Clinton has confessed to Africa that he let it down. In 1998, he visited Rwanda, where four years earlier, about half a million people, mostly Tutsi, were slaughtered by Hutu extremists in one of the more efficient massacres of the twentieth century. At the Kigali airport, Clinton acknowledged that the United States and the world community did not move quickly enough to address that horrific act of genocide. But in typical Clinton fashion, he offered an excuse: "All over the world, there were people like me sitting in offices who did not fully appreciate the depth and the speed with which you were being engulfed by this unimaginable terror." That was not true. His administration knew in 1994 what was under way. Clinton and his aides were not unaware. But, in the aftermath of the military disaster in Mogadishu, Somalia (see "Black Hawk Down"), they chose not to address the "unimaginable terror" in another African nation.

In a similar vein, Clinton now wonders aloud why the West stood by and did little as the AIDS crisis in Africa exploded. He certainly is in a position to explain. He could start by answering the question, why did you and your administration not respond?

When Clinton arrived at 1600 Pennsylvania, the US government knew that an AIDS pandemic was coming in Africa. A 1991 classified study produced by the CIA predicted that by 2000 there would be 45 million people infected with AIDS virus, most in Africa. The following year, an unclassified version of the report, which was released by the State Department, foresaw infection rates of up to 30 percent for the sub-Saharan African population. For the next seven years -- while Clinton was in office -- the budget for combating AIDS overseas remained flat. (It was $124.5 million in 1992.)

As Kenneth Brown, the main author of the 1991 intelligence study, told The Washington Post in 2000, "Indifference -- that's the right word." A 1995 National Intelligence Estimate confirmed the earlier predictions, but that prompted no change in Clinton policy.

During the Clinton years, the Centers for Disease Control and the US Agency for International Development opposed paying for AIDS tests overseas. "The argument was that testing was too expensive, and it led to things that were more expensive," Gregory Pappas, a Health and Human Services official said to the Post . "The philosophy in development circles was, don't create demand. The implications of a lot of people knowing that they have HIV, instead of just dying of it, is [that] it creates demands on the development assistance agencies. It's a calculation that they're trying to postpone paying for interventions that they don't think they can afford." In other words, the prevailing view was, these people should die quietly. And USAID did not seek any extra funds for AIDS overseas. In 1996, USAID did not even fully staff its office on AIDS.

It is true that anti-AIDS treatments were quite expensive then. A buck devoted to an anti-tuberculosis program went farther in terms of saving lives. But a massive AIDS prevention program, had one been mounted, might have been able to slow the pandemic in Africa. Research in 1993 indicated that for $2.5 billion a year, half of infections predicted to occur by 2000 could be prevented. That amount was 20 times the global AIDS budget.

For most of its time in office, Clinton's administration devoted little attention or resources to AIDS in Africa. In fact, Vice President Al Gore sided with pharmaceutical manufacturers bitterly opposing the efforts of the South African government to pass legislation that would allow it to obtain cheaper AIDS medicine for its citizens.

After a 1999 intelligence study repeated the warnings of its predecessors -- it noted that by 2010, AIDS would reduce the gross domestic product of sub-Sahara Africa by at least 20 percent -- Clinton officials started to take moderate steps. The administration requested an extra $200 million for AIDS prevention abroad, and proposed a similar hike for 2000. But this spending was not in sync with the administration's belatedly urgent rhetoric. In January 2000, Gore claimed the world had a duty to "wage and win a great and peaceful war" against AIDS. Yet the administration was not calling for wartime funding levels. (Some members of Congress were proposing more global anti-AIDS money than the White House.) In August 2000, Clinton visited Nigeria and said, "We need to fight AIDS." But he presented no new initiatives. The previous month, his administration had offered $1 billion in loans to finance the purchase of AIDS medicine in Africa. But that meant African countries would have to add to their onerous debt burden -- a burden already crushing the health and social infrastructures of some nations.

By the end of 2000, as Clinton was packing up, 25 million people in sub-Saharan Africa were estimated to be infected with AIDS, and six to seven thousand were dying daily from it. Clinton had raised the US government's global AIDS budget to $340 million. But the UN was then calculating that a program designed to prevent and treat AIDS in Africa would cost $3 billion a year. For comparison's sake, Washington was sending $5 billion a year to Israel and Egypt.

Now the UN says it needs up to $10 billion a year to counter AIDS. The rich nations of the world have coughed up $2.1 billion -- but over three years. That equals 7 percent of the need. And George W. Bush has proposed raising US global anti-AIDS funding by $150 million to $200 million a year -- less than what Republican Senators Jesse Helms and Bill Frist have been pushing for.

Back to Clinton. When he had the chance -- and the power -- to address the devastation in Africa, he took a pass. Why didn't he figure out the US share for an anti-AIDS crusade and add it to his budget? It would surely be illuminating and instructive if he explained this. Might he claim that, as with the Rwanda genocide, he was not fully informed of the horror? A cynical guess might be this: AIDS in Africa, it doesn't poll well.

Responding to Clinton's profession of regret, a friend of mine who works for a church organization in Washington that lobbies for more foreign aid says that "from a religious perspective, contrition is positive and can be useful." Perhaps. I'm waiting to see how much time Clinton actually devotes to the AIDS nightmare in Africa. Will he spend his days delivering $250,000-a-pop speeches, or use them to cajole leaders of the industrialized nations to kick in more money? In and of itself, his contrition means little. It is easy to be sorry once you're out of office.

At the Barcelona conference, Clinton told the audience, "I call on you to hold me accountable" to his commitment to work on global AIDS. That sure sounded like something a politician would say. If he knew he was sincere about that commitment, why would he need anyone to keep the pressure on?

David Corn is Washington editor of The Nation.