First, we should
emphasize prevention. USAID
does not think we can effectively treat 
the millions of Africans who have AIDS. The infrastructure is not in place. Corruption is too great.
Patient compliance with the drug regimen is not likely to be high;
the end result will be
drug-resistant AIDS. Africans
have to change their sexual practices--it's unsafe as well as immoral.
The
US government has problem trying to work through and with NGOs because of
their involvement in family planning. The
Bush administration wants to promote strong family values and sexual
abstinence outside of marriage. If
Africans change their behavior, then they don't need condoms.
If we do
participate in a treatment program, we insist on using existing facilities in
Africa. We should insist on testing, and should ensure that we get
the records so that we can get a handle on AIDS, TB, malaria, dysentery,
population growth. Most of the data has been invented by people with
their own agenda. No one knows what the situation really
is. Has the AIDS problem been hyped beyond facts?
That's the position taken by the eminent African history scholar, Geshekter
--he's
advised us and the State Department.,
and we regularly have him in after his study trips there. He brings us
word from others who have "been there, done that." Their
reports belie the alarming statistics that are flaunted.
The US should give some limited support towards the global
AIDS fund; we almost have to. A negative feature of the fund is that no donor will have
control over how its money will be spent.
Governments, foundations, and NGOs are not
likely to donate freely because of this rule.
That is just pouring money into a leaking honeypot.
Maybe State likes that, but we don't. At US insistence, the
global trust fund will operate under the World Bank.
(The WB president is always an American, and the World Bank does
have the ability to analyze proposals for funding, to get the funds out and to
account for their use.)
We all know that the best policy is a public health response,
not a personalized clinical medical response. These states need a basic
health infra-structure. The World Bank can direct support towards a
viable long-term health delivery system, and in the meantime put monies
towards prevention.
