Friday, 16 July 2010

How Obama Backed Away From The Global War on Aids

Dr. Paul Zeitz is the executive director of the Global AIDS Alliance, a position he's held since 2001. Over the past decade, he's led GAA to promote universal access to prevention, treatment and care, among other issues. As backlash against the Obama administration’s policies on global HIV/AIDS continues to mount, Dr. Zeitz shares his perspective with

We reached Dr. Zeitz this week via phone while he was traveling in Europe.

You’ve been at the forefront of the HIV/AIDS movement for nearly a decade now. Was there a moment in which you can recall first becoming committed to the global fight against HIV/AIDS?

In 1996, my family moved to Zambia as part of our commitment to issues of child health. While living in Zambia, it became apparent to me that as the HIV/AIDS epidemic was maturing, child health goals were unachievable. My family, coworkers and I really started experiencing this, and realizing, “Wow, everyone around us has just started dying.” [So many co-workers, neighbors and friends] were dying or taking their loved ones for burial…There was one day when my wife and I were called upon to use our family van to escort the casket of a 2-month-old baby boy named David to his burial.

The transformative moment for me occurred for me in 1998, when I was driving along the road by the university teaching hospital (UTH) in Lusaka, the capital city. UTH is known by the Zambians as the “departure lounge,” because when people arrived they were so weak, and there were not enough doctors, nurses, drugs, nor even rubber gloves, so they knew from experience that they’d go there to die. Driving past UTH, I came up to an intersection that I’d driven by a many times…People were walking around, and guess what they were doing? They were selling coffins.

I pulled over, and I wept. I declared to myself, I can’t be part of this charade anymore — I can’t be part of an era in which people say one thing and do another.

One of President Bush’s signature acts was the creation of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) — the largest single effort any nation’s yet made to scale up HIV/AIDS prevention, care and treatment. PEPFAR was a major victory for activists around the globe. How has the program been impacted since Obama took office?

Back in 2008, President Bush decided that before he left office, he wanted to authorize another 5-year PEPFAR cycle. Senators Obama, Biden and Clinton all cosponsored the bill to reauthorize the bill, known as the Lantos-Hyde bill, committing the U.S. government to providing $48 billion over five years [2009-2013]. It was a truly historic act by then-president Bush to really take the initiative to the next level.

During the 2008 campaign, Obama signed a pledge committing to $50 billion for global AIDS spending for the period of 2009-2013. He also spoke at the Saddleback Church HIV/AIDS conference and verbally committed to increasing global AIDS spending by at least 1 billion per year, if he was elected.

Then he got elected, then the transition team started governing, and within 18 months, everything’s changed.

Since Obama took office, what about his administration's approach have you found particularly disheartening?

We’d had breakthrough with Bush. Global leaders and stakeholders had committed themselves to universally scale up aids prevention and access to treatment. The whole global international community was in solidarity with the goal of universal access to prevention and treatment.

President Obama and his administration have taken a radically different position. It’s crystal clear that they don’t believe that HIV/AIDS treatment should be made available to everyone, because they think it’s too expensive. I’ve sat and others have sat in high-level meetings in which administration officials talking about how the U.S. government could not sustain the demands of a “treatment mortgage,” saying, “How can we afford this?”

The president has virtually flat-lined [PEPFAR] in his first two budget request. Even more shockingly, Obama has requested cuts to the Global Fund to Fight AIDS, Tuberculosis, & Malaria’s FY2011 budget — this despite how effective the Global Fund’s work has been as a multilateral financing instrument. It’s achieved remarkable results, saving an estimated 4.9 million lives. The Obama administration says they’re committed to multilateralism. So why do they want to cut U.S. government support of the program?

How do you respond to the argument floated by the Obama administration — that investments in broader global health efforts (for eg., malaria, diarrhea etc.) are more “cost-effective” than support for HIV/AIDS treatment?
Sure — president Obama and his advisors Gayle Smith, Jack Lew, Zeke Emmanuel, that’s their logic. They say it’s not cost-effective. That’s their ideology. We challenged President Bush about his ideological approach to HIV prevention, because he was saying abstinence is the most important priority, and we challenge President Obama because [his administration’s] logic isn’t backed up by the science, either.

Treatment is an essential part of prevention. It’s the only way to get a handle on prevention. Look, a decade ago everyone said drugs were too expensive for Africans, that it wasn’t affordable. Drugs were $12,000- 15,000 a year, but President [Bill] Clinton, upon leaving office, used his leverage with his foundation — that and efforts with the Global Fund and PEPFAR means that the same drugs now cost $120 per person, per year. If [the White House] says that’s still too expensive, they’re right. But instead of saying we should let millions of Africans, Asians and Latin American die, let’s work together with the AIDS movement to get the prices even lower. They’re assuming we can’t afford it, that it’s a zero-sum game — and we radically disagree with that assumption.

When GAA has communicated these critiques, how have you seen the Obama administration respond?
This is the fourth administration I’ve personally interacted with while working on global health and development issues: Clinton’s second term, George W. Bush’s first and second terms, and now President Obama’s administration. It’s never been like this. I’ve had no meetings with the [National Security Council], no phone calls get returned, it’s completely different….in my experience, they’re very isolated and operating in a bubble, and they have their own off-track group think that’s not strategically aligned with the rest of the global aids movement. As far I know, the President has never had a discussion on these issues…I don’t think [Secretary of State] Clinton is actually committed to this issue. It’s not about the words. It’s about action. And they’re not acting.

What kind of reaction to the administration is Global AIDS Alliance hearing from your African colleagues and friends?

I’ve spent the last 20 years mostly in Africa. I work closely with African networks in many countries where we work very closely — Zambia, Mozambique, Nigeria, Uganda, Tanzania, Kenya, and South Africa. Many of my friends and colleagues are alive because of PEPFAR, and they openly acknowledge that, and express their gratitude to the people of the United States. When I hear those sentiments, I feel very proud to be an American.

So after Obama submitted his first budget request to Congress in February 2009, we started informing my African colleagues what was going on with the Obama administration, most people were in shock. After the hope of Obama’s election, it was like going into a grieving process, with the different phases of shock, denial, depression and outrage. [People] feel betrayed by Obama. As a man with African heritage, everyone thought that he would represent a different kind of American leader, one that would operate with integrity by keeping his commitments. The facts reveal that president Obama has no integrity on his commitments to Africa. He’s broken every one of them. Apart from PEPFAR, he committed to doubling foreign aid, to establishing a $ 2 billion global fund for education — he’s zero for three on these commitments.

This May, the New York Times ran an article that described the fight against HIV/AIDS in Uganda as “falling apart.” What are you seeing on the ground?

Right now, you have Africans being pushed away and getting told there’s no more drugs for them. They’ve stopped enrollment of new patients. My African friends see Obama with his Kenyan heritage, they’re seeing Obama spending increasing amounts, over half a trillion dollars for wars, and they see Obama generate $1 trillion for the Wall Street bailout in 30 days, and meanwhile they are being left to die. That’s how they’re viewing it.

Is this how the United States should show leadership? I’m embarrassed and troubled by the kinds of policies I see coming from president Obama and his administration.

In my view, the AIDS pandemic is the Holocaust of our time. Twenty-five million children, women, & men have already died; 2 million more will die this year, because the world just doesn’t take responsibility — even though we have the technology to stop these deaths. If we continue with the status quo response, another 10 million people will needlessly die from 2011-2015. We [can] stop the dying. The question for me is whether or not we can generate the political will.

To learn more about the Global AIDS Alliance's work, visit them here.

Photo Credit: khym54

Te-Ping Chen is a Editor. In recent years, her writing has appeared in the Nation Magazine, the South China Morning Post magazine, Le Soir, and

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