AIDS and the World Bank: Global Blackmail?

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 Post, 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 Daily Mail & Guardian, 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 considered."

According to the Washington Post, 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 Post said: "The Clinton administration restricted distribution of the five-page letter, dated 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 it 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 Mbeki's 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 for 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 can 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 in 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 first look at its human faces on CSPAN. Wolfensohn and other WB officials tried to 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 were made.

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+ women 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 family, 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 to 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 reading 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 prospect 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 to 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 there 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 that has been declared "incurable", globalization of AIDS policy could leverage every human life on earth. Not having an HIV-negative ID card could mean no 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 diseases.

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 to abortion, birth control, definitions of "gender" and "family values."

Supposing a small country is declared a "global health hazard" because it 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, recently raked the Minneapolis Star Tribune for what he called the paper's "gushing" 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 40 countries -- [notes] that 7 million children die each year as a result of the 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 protest 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 Star Tribune 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 globalization.

A developing nation's health is no less fragile an environment than the Sahel. It has its own gene pool of inherited immunities and vulnerabilities, 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 well choose to look for long-term ends to malnutrition and poverty as root factors of disease, rather than go for the quick fix -- namely, coercing their people 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 to 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 yet been educated to textbook use of contraceptives, so no one would expect these women, or their families, to use antibiotics by the book. This education gap 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 doesn't 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" we 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 condition 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.

Now that the July AIDS conference in upon us, pro-globalization leaders are escalating their AIDS positions. At 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.

Author/journalist Patricia Nell Warren writes for A&U, the national AIDS magazine, where this article originally appeared.

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