When Bono Met Bush

With the sort of pomp and circumstance that could only be attributed to a rock star, Bono front man for the supergroup U2 and self-appointed spokesman for AIDS and Africa door-stopped President George W Bush at Chicago airport last Friday to give him a piece of his mind. Irritated that he should have to wait while the President’s plane took off, Bono marched onto the runway huffing that he would like to have a few words with Bush, as if the President were an unruly neighbour blocking his driveway.

After 10 minutes onboard Airforce One, the Irish musician emerged grinning and shaking hands with Bush as if the two were old poker buddies. ‘This is the President who has treated a million AIDS patients,’ he trumpeted boldly to the waiting media scrum.

An exceptional result a credit to Bono’s tenacity and Bush’s generosity, surely. Except that it’s a load of rubbish.

According to a 2006 UNAIDS report, 1.3 million people are being treated worldwide with Anti-Retroviral drugs (ARVs), the frontline treatment for AIDS. Of those, it is estimated that a little more than half a million are benefiting from money supplied by the Global Fund, the main conduit of the President’s Emergency Plan for AIDS Relief (PEPFAR). Although a third of the Global Fund comes from PEPFAR, the largest donor, it cannot claim sole credit for its successes. Other estimates put the number of people receiving treatment much lower: in the range of a quarter of a million, a far cry from Bono’s unbridled estimate.

As someone championing the cause of AIDS sufferers, Bono simply should have known better, or at least he should have read some of the documents he likes to bandy around. Bush, who earlier that week had been surprisingly quick off the mark to refute The Lancet‘s statistics on civilian deaths in Iraq,   made no efforts to correct him.

That the Global Fund needs more money is not in question. What must be more closely scrutinised is how that money is spent. During its first round of grant assessment and allocation in 2002, the Global Fund was faced with more proposals than it could fund, as well as a disturbing lack of clarity about how the money would be used. Many governments either lacked the facilities, knowledge, transparency or simply the proposal-writing skills to make the grade.

Compounding this problem, the funds contributed by PEPFAR come with strings attached. This has been a contentious issue fund recipients are effectively restricted to purchasing brand name drugs only, the majority of which, according to medical researchers are manufactured by US pharmaceutical companies. Denied the opportunity to purchase generic yet equally effective drugs, many countries watched their planned coverage dwindle from thousands to hundreds and, in some cases, to dozens of patients.

With a large percentage of the funds now returning to the US in the form of drug company profits, it has to be wondered just who is being generous to whom.

Furthermore, the condition that at least one third of PEPFAR funds be spent on ABC (Abstain, Be faithful, use Condoms) programs has been assessed as an unmitigated failure. By treating a medical issue as a moral one, the program has severely undermined attempts to stem the spiralling rates of infection.

Thanks to Fiona Katauskas

Uganda , long the poster child for US policy, recently discovered that A and B alone where not enough to guarantee success. After a prolonged shortage of condoms, it is estimated that infection rates between 2003 and 2005 nearly doubled from 70,000 to 130,000. There were several reasons for the shortage but to many it was clear that the US played an important role. Stephen Lewis, the UN Secretary General’s Special Envoy for HIV/AIDS in Africa publicly stated that:

There is no question in my mind that the condom crisis in Uganda is being driven and exacerbated by PEPFAR and by the extreme policies that the Administration in the USA is now pursuing in the emphasis on abstinence, far and away beyond that of condoms.

Research has repeatedly shown that abstinence-only programs have no long-term success in reducing risk-taking sexual behaviour, and that what works is more information, not less.

Despite a report by the Institute of Medicine, an advisory group to the US Congress, that investing millions of dollars in unproven abstinence programs ‘constitutes poor fiscal and health policy’ no one appears to be listening. That many of the organisations which have benefited from PEPFAR are religious and, in some cases, evangelical should come as no surprise.

These are just some of the problems that celebrity activists like Bono gloss over in their quest to reduce the suffering of millions to a sound bite. Donor governments need to come through with their pledges and stop tying the money to foreign policies or domestic interests. Recipient governments need to get their act together a taboo topic amongst many Western AIDS activists.

Of course, to Bono and the clique of celebrities who have flocked to his cause, these issues are non-starters compared to the singular notion that simply raising more money will make the problem go away. The simplistic idea that AIDS awareness can be treated like building a brand or promoting a new album is a disaster waiting to happen it ties the fate of millions to the fickle whims of the consumer.

For President Bush, however, it is welcome publicity in a time of flagging support at home and abroad. Sex scandals, corruption allegations and a messy war have been taking its toll on his Administration. With the total contribution of the US Government to AIDS relief a fraction of what it continues to spend in Iraq, being lauded by one of the most popular rock icons of our time is the sort of publicity that only lives, and not money, can buy.