Wes Clark's Global AIDS Security Strategy

The world desperately needs real American leadership to fight the rising tide of AIDS, a key part of Wes Clark's strategy of using preventive engagement to rebuild alliances and enhance American security. Although AIDS is a preventable and treatable disease, in 2003, 5 million people worldwide were newly infected with HIV and a record 3 million people died of AIDS-more than all the deaths from wars and terrorism in the world combined. There are 40 million people living with HIV/AIDS today and more than 23 million have already died. If nothing is done, the best projections suggest that an additional 45 million people will become infected with HIV by 2010. Sub-Saharan Africa is by far the worst-affected region in the world, with 27 million people living with AIDS. In Botswana and Swaziland - the hardest hit countries - as much as 40 percent of the population lives with this disease that will kill them if they are not helped. AIDS kills people in their most productive years, striking across all of society to wipe out an entire generation of parents, farmers, doctors and leaders, leaving 11 million children orphaned in Africa, undermining civil society, destabilizing governments, and wrecking economies. The second wave of the AIDS crisis is threatening India, China, Russia, and other countries throughout the world, raising the specter of increased instability and more support for terrorism. A key part of Wes Clark's strategy of preventive engagement is leading the world to confront the AIDS crisis, turning it from a major threat to global security to an opportunity to demonstrate America's moral leadership. Wes Clark has a four-part Global AIDS Security Strategy:

1. Keep the U.S. commitment to combat AIDS, tuberculosis, and malaria worldwide - doubling funding to $30 billion by 2008.
2. Dedicate a large majority of U.S. funding to multilateral approaches like the Global Fund to Fight AIDS Tuberculosis and Malaria, while demanding results and additional commitments from our allies.
3. Base prevention and research efforts on the best available science, including overturning the global gag rule.
4. Unleash the power of the market to develop cost-effective vaccines for AIDS and other infectious diseases.

1. KEEP THE U.S. COMMITMENT TO COMBAT AIDS, TUBERCULOSIS, AND MALARIA WORLDWIDE - DOUBLING FUNDING TO $30 BILLION BY 2008

UNAIDS currently estimates that total AIDS funding in low-and middle-income countries is about $4.7 billion in 2003. While this is a considerable increase over the past several years, current spending represents less than half of what is required by 2005 ($10 billion) and less than one-third of what is required in 2007 and beyond. To meet the more than $10 billion that is required to fight the epidemic in 2005, funding from all sources must double from 2003 levels. Additional funding is also required for malaria and tuberculosis, the two infectious diseases most commonly associated with HIV/AIDS. The United States must lead the fight and demand that the rest of the world do all it can to reach these funding goals.

While sub-Saharan Africa and parts of the Caribbean are currently the hardest hit regions, other regions of the world must not be overlooked and additional investments must be provided to ensure that they do not experience the same horror sub-Saharan Africa has. Wes Clark pledges to expand upon the bipartisan U.S. Leadership Against AIDS, Tuberculosis and Malaria Act by focusing on expanding global AIDS funding beyond the 14 countries in Sub-Saharan Africa and the Caribbean.

• President Bush's broken promise for AIDS. In the State of the Union Address, President Bush promised $15 billion for global AIDS, but even this is not enough to keep pace with the rising demands of this moral challenge and potential threat to our national security. President Bush's budget request was only for $2 billion, not the $3 billion authorized in the U.S. Leadership Against AIDS, Tuberculosis and Malaria Act for 2004. At the same time this additional AIDS funding was not accompanied by necessary increases in other areas of development, like education and clean water. And the Bush Administration proposed cuts in some key areas, including a proposed 14 percent reduction in other global health programs and a proposed 18 percent cut in international disaster assistance.

• Wes Clark promises to keep our commitment to fight AIDS worldwide - doubling funding to $30 billion by 2008. Wes Clark pledges to provide $30 billion from 2004-08 for AIDS, tuberculosis and malaria - one-third of the total amount needed to combat these diseases worldwide. This funding would not only be allocated to programs and services but also toward creating the infrastructure that is necessary to ensure that services reach those who need them. These resources would be used for:

  • Prevention. AIDS is a preventable disease but more needs to be done to boost the effectiveness of prevention programs. Prevention efforts are enhanced when they are linked to care and support services as people are encouraged to get tested for HIV if they know treatment will be available. For those who test HIV-positive, treatment, care and support not only improve their quality of life, they also decrease the spread of infectious diseases (particularly tuberculosis and sexually transmitted infections). The spread of AIDS can be slowed by a combination of education, abstinence, monogamy, testing, campaigns against drug abuse, and the use of condoms. On the South African version of Sesame Street, Kami, an HIV-positive character, encourages open talk about stopping AIDS. The fact is that HIV is mostly spread by unprotected heterosexual sex. Yet the Bush Administration only wants to focus on abstinence, unrealistically and ideologically turning its back on condom use - which public health experts agree is one of the cheapest and most effective ways to stop the transmission of HIV. Wes Clark will lead with straight talk and realistic policy, not ideology.

  • Mother-to-child transmission. Each month in South Africa, 8,000 babies are born to HIV-positive mothers. One of the most cost-effective means of curbing the spread of AIDS is reducing the transmission from mother to child. A single dose of an anti-AIDS drug (nevirapine) given to a mother during labor and baby at birth can cut the chance of infection by half. New drugs show great promise at preventing the transmission of HIV by breastfeeding, which is crucial since many women in the countries hit hardest by AIDS cannot afford formula as a substitute for their own breast milk. And focusing AIDS prevention, treatment and care programs on women more broadly can play an important role in reducing mother-to-child transmission.

  • Treatment. AIDS is a treatable disease and anti-retroviral (ARVs) therapies and medicines to treat opportunistic infections have changed the lives of those infected in the western world. Yet in the developing world, where the disease is most prevalent, most HIV positive people have no access to these life-extending drugs. The life of a person living with HIV/AIDS can be extended by years or even decades with proper administration of anti-retroviral drugs (ARVs). These drugs have a "Lazarus effect" and can have patients out of bed, back at work and caring for their families within months. Still, of the 6 million in need of ARVs, only 5 percent or 230,000 people are receiving them (the majority of which live in Brazil). However, in the past few years the price of ARVs have dropped dramatically. Most recently, under the leadership of President Clinton, generic ARVs are now available for 36-38 cents per day - providing a real opportunity for treatment for the millions of people suffering from AIDS around the world. Wes Clark endorses the WHO's plan to put 3 million people on ARVs by 2005 and would coordinate the U.S. treatment efforts with the 3 by 5 initiative. Along with expanding access to care and treatment services, Wes Clark would also work to strengthen health services, human resources not only to benefit ARV delivery but also the delivery of other health services.

  • Research. Wes Clark will encourage new research for an AIDS vaccine, for better ARVs, for drugs to fight opportunistic infections, and other promising measures by increasing Federal support for these efforts and encouraging science-based decision making.

  • Providing for orphans. The AIDS pandemic has left behind millions of orphans-the most helpless victims. Orphans who live in households headed by people who are not their relatives suffer from higher rates of poverty and worse schooling, blotting the prospects of an entire generation. Approaches to addressing the growing crisis of AIDS orphans and other vulnerable orphans include special strategies for orphans' schooling, increasing access to health care, encouraging greater legal protections to prevent abuse, and using tax incentives and other means to encourage the adoption of AIDS orphans.

• Addressing global AIDS as part of global development. Global AIDS can only be addressed as part of the broader challenge of global development. Without adequate nutrition, clean water, and adequate general health care, people living with AIDS will not benefit from comprehensive prevention, care and treatment services. And moving towards universal childhood education - in addition to it's many other benefits - has a demonstrated effect on increasing awareness of HIV/AIDS and reducing the transmission of the disease. That is why Wes Clark's Global AIDS Security Strategy would increase funding for other development goals (such as the internationally adopted Millennium Development Goals) - we cannot tackle global AIDS and the broader health and development challenges just by shifting money from one priority to another.

• The special importance of education in combating AIDS. Wes Clark is committed to achieving the all of the Millennium Development Goals, including the goal of ensuring that by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling. Research shows that a combination of education strategies for both in-school and out-of-school youth is critical for increasing awareness of how to prevent the spread of AIDS. Strategies that move towards gender equity, focusing on girls education, have proven especially effective in preventing the transmission of AIDS.

• Addressing global AIDS as a national security issue. By destroying governments and hollowing out entire societies, the AIDS pandemic nurtures terrorist movements that thrive in chaos and misery. Soldiers in Sub-Saharan Africa have higher prevalence rates of HIV - as high as perhaps 40 to 60 percent in Angola and Congo according to a U.S. National Intelligence Council study. This means that soldiers are literally dying in full companies from AIDS, not combat. And AIDS, like poverty, makes wars in Africa vastly more lethal, as in Congo. Conversely, if America leads in the struggle against AIDS, then it will win the deep gratitude of millions of people across the world.

2. A MULTILATERAL APPROACH THAT DEMANDS RESULTS

The United States cannot solve the global challenge of AIDS alone, but instead needs to leverage the resources of our allies around the world to develop a coordinated response to the challenge of AIDS. Leadership by example together with accountability produces results.

• President Bush's rejection of a multilateral approach. President Bush's budget only requested $200 million for the multilateral Global Fund to Fight AIDS, Tuberculosis and Malaria, one-tenth of the total amount authorized for global AIDS. Although bilateral approaches to AIDS - like those by USAID, HHS, the State Department, and other U.S. government agencies - are key to the U.S. government response to the epidemic, in order to be truly effective, they should complement and expand upon the resources channeled through multilateral approaches.

• Under Wes Clark's Global AIDS Security Strategy, the large majority of U.S. resources would be dedicated to multilateral approaches. Under Wes Clark's Global AIDS Security Strategy, a large majority of the additional funding by the United States would be devoted to multilateral approaches like the Global Fund to Fight AIDS, Tuberculosis, and Malaria and other multilateral mechanisms, like GAVI and the World Bank's MAP for Africa. In addition, Wes Clark's plan would strengthen the United Nations, UNAIDS, and other organizations that are at the front line implementing the fight against AIDS.

• The Global Fund is the basis for a coordinated, tested approach to global AIDS. UN Secretary General Kofi Annan pushed for the creation of the Global Fund, a public-private partnership that has been operating since January 2002. It does not create a new, duplicative bureaucracy but instead is a streamlined operation with low overhead that provides a financing mechanism for innovative and coordinated strategies to address AIDS and other infectious diseases in developing countries. Working through the Global Fund, in addition to its bilateral work, ensures that the United States can leverage its resources and coordinate with other countries and donors, minimizing bureaucracy and duplication that make responding to AIDS more difficult for donors and recipients alike.

• Demanding results from the Global Fund. The Global Fund has strict technical review of proposals and uses leading international auditors like KPMG and Crown Agents to audit and monitor all of its programs. But the United States should not simply commit billions of dollars to a promising strategy, but instead should set and monitor its own criteria for success, work with the Global Fund to achieve this goals, and only continue to contribute to the Global Fund if these criteria are being met and exceeded. As President, Wes Clark would ensure that governments do not misappropriate Global Fund money for other purposes. Furthermore, the United States would insist that the Global Fund shows results mobilizing substantial resources from our allies around the world as well as foundations, NGOs, and private companies.

• Multilateralism works for America. American leadership on global AIDS demonstrates American character and our shared humanitarian values. This creates goodwill overseas, strengthens our existing alliances and encourages new ones, and makes it easier for America to negotiate with foreign governments over core national security issues like nonproliferation and terrorism. Wes Clark has the experience to know that there is more to foreign policy than just bullying.

3. BASE PREVENTION AND RESEARCH ON THE BEST AVAILABLE SCIENCE, INCLUDING OVERTURNING THE GLOBAL GAG RULE

The success of Uganda shows that a successful national strategy can work: in Kampala, HIV prevalence has fallen from an estimated 30 percent a decade ago to 8 percent in 2002 - and falling. But the United States cannot lead this struggle if the global gag rule remains in effect.

• End the global gag rule. The Bush Administration's "global gag rule" prevents any American assistance from going to foreign organizations that talk to their clients about abortion or to foreign groups who do not accept the principle that an outside government can mandate how they treat their patients. This rule would be an unconstitutional violation of the first amendment if it were applied to domestic groups. Although this rule does not explicitly apply to HIV/AIDS programs, in effect it has a significant impact in this area because of the close links between family planning and prevention of the spread of HIV/AIDS. The Bush administration's insistence on the global gag rule has already shut down local community clinics that fight AIDS run by groups like the Cameroon National Association for Family Welfare and the Planned Parenthood Associations in Ghana and in Zambia. The fight against AIDS needs straight talk, not ideological gag rules.

• Support the empowerment of women and girls. In Sub-Saharan Africa, women between 15 and 24 are more than twice as likely to be infected with HIV than men. This will only change when countries begin to support the empowerment of women and girls by investing in comprehensive approaches to prevent the spread of HIV/AIDS, including better education, distribution of condoms, reducing stigma, increasing diagnosis, and more effective treatment.

• Fight the stigma associated with HIV/AIDS. Even in America, too many people see HIV/AIDS as a disease of outsiders, of people who are somehow different from us. Extremists cruelly scapegoat gay men and others. In Kerala, India, two orphaned children were kicked out of school for being HIV-positive. This stigma literally costs lives, by preventing people from getting tested. But AIDS is a killer that does not discriminate. People with AIDS do not deserve it. As President, Wes Clark will fight that stigma - reaching out to all people who suffer from this deadly disease, with genuine compassion and inclusiveness.

4. UNLEASH THE POWER OF THE MARKET TO DEVELOP COST-EFFECTIVE VACCINES FOR AIDS AND OTHER INFECTIOUS DISEASES

Although the government has an important role to play in conducting and funding basic research on HIV/AIDS and other infectious diseases, the most effective untapped resource in the effort to develop a vaccine for AIDS and other infectious diseases is the power and ingenuity of the market. Rather than trying to pick winners, Wes Clark's Global AIDS Security Strategy would unleash the power of private-sector innovation and competition by guaranteeing that whoever develops cost-effective vaccines would be rewarded.

• Pharmaceutical companies do not invest in vaccines for developing countries because they have no incentives. Developing countries, many of which spend less than $10 per person per year on health, are unlikely to generate the hundreds of millions (or even billions) of dollars required to reward firms for successful vaccine development efforts. As a result, the pharmaceutical and biotechnology industries, which estimate that they spend nearly $300 billion a year to develop new health technologies, spend far less than $1 billion each year to develop vaccines to protect against diseases that disproportionately affect developing countries.

• Guaranteeing a market for vaccines would stimulate innovation while ensuring that the vaccines are delivered to the people who need them most. Market-enhancement interventions - or "pull mechanisms" - create real incentives for accelerating innovation and ensuring affordable supply of needed vaccines where traditional commercial incentives fall short. These commitments could take the form of specific legal contracts to encourage the production of existing vaccines or the development of new vaccines against HIV, TB or malaria. In either scenario, these contracts would be closely associated with estimated demand from developing countries and provide for some sort of revenue guarantee as a means of offsetting some of the risks facing vaccine manufacturers.