Anger at the International AIDS Conference
— Sam Friedman
AT THE OPENING ceremonies for the International AIDS Conference in Spain in July, I was in a room with 15,000 other people, many of whom are medical doctors, virologists, psychologists or social workers.
The Spanish Health Minister was trying to speak, but was drowned out by a group of some hundred (or more) local activists. None of the people sitting around me knew the specifics of what she had done wrong, but none of us seemed to be angry with the protestors. Indeed, many of us were grinning, and thought it was probably a well-deserved rebuff.
A day or two later, her American equivalent, Tommy Thompson (Secretary of the Department of Health and Human Services, and one of the architects of the attack on welfare as governor of Wisconsin), had his speech disrupted by activists, mainly from the United States.
Once again, no one I talked with was particularly upset, and many were delighted. What is happening is that even many of the scientists and doctors involved with AIDS are getting angry, and indeed even somewhat radicalized, by what they are seeing.
Put simply, the global HIV epidemic is out of control, and the governments and corporations that have the resources to deal with it have been big with promises but short with cash.
State of the HIV Epidemic
According to a report issued by UNAIDS shortly before the conference, 40 million people are now living with HIV infection. Three million died last year due to the disease.
The epidemic is spreading rapidly—five million were infected in 2001—and the spread of HIV in Eastern Europe and Asia promises to increase these numbers drastically.
In the absence of rapid and large-scale action, 45 million more people will become infected by 2010; UNAIDS estimates that at least 29 million of these infections are preventable. Treatments do exist that can greatly ameliorate the disease, and prevent death for many years for a large percentage of the infected.
Even though mass protests and the actions of drug producers in India and Brazil have led to drastic price decreases for these medications, only 30,000 of the 28.5 million infected people in Africa, compared to 500,000 of 950,000 North Americans, are receiving these drugs.
UNAIDS has estimated that relatively small amounts of money could prevent most new infections and provide medications for many millions of the infected. The program was scheduled to begin in 2002 with about $10 billion a year and this amount would gradually increase.
Governments promised to provide these funds two years ago, and mechanisms have been set up to disperse them effectively—but the promised money has not arrived. Approximately $1 billion is on hand.
Imagine that! Three million people died last year, five million got infected, and the virus is spreading into the huge population centers of Asia, but all the governments of the world cannot mobilize $10 billion a year.
Now this amount of money seems daunting—but it is only about $40 per head for each resident of the USA. Another way to think about it is that in 2001 HIV killed as many people as 1,000 September 11 attacks, and yet is being given (by all governments) only about $1 billion, while the United States spewed out $60 billion in a special appropriation for the military within a few days after the World Trade Center was destroyed.
Other comparisons are that the United States brings in about $8 billion per year through taxes on alcohol, and spends $23 billion to buy military aircraft.
Righteous Anger, Little Politics
Thus, it is no wonder that the thousands attending the AIDS Conference were angry. Indeed, during plenary sessions at the Conference, one speaker after another lambasted the inaction of governments, the greed of corporations, the negative effects of the WTO, the International Monetary Fund, and other neoliberal trade and financial organizations.
The doctors and scientists in the audience would nod in agreement. There were times I could almost imagine that I was at a meeting of supporters of the "anti-globalization" movement. Indeed, I think that AIDS researchers and providers probably agree with much of the analysis of what is wrong in the world with the youth and others who have demonstrated against the IMF or WTO.
What is lacking, among many of those present at the Barcelona AIDS Conference, is a politics of what to do about it. These same people who accepted the shouting down of the Spanish Health Minister and of Tommy Thompson as well-deserved, behaved rather differently at the closing ceremony of the conference a few days later.
They gave considerable applause to ex-President Clinton when he stood to speak; and, after he finished a rather demagogic talk, many gave him a standing ovation. This for a man who did very little to fight HIV/AIDS in Africa or Asia when he was president; and who condemned thousands of Americans to AIDS by refusing to fund needle exchange.
The acceptance, even applause, for Clinton probably reflects what I think is the most common political approach among the researchers and the front-line prevention and care workers in the AIDS field. They are angry, but still hopeful that the self-evident horror of the epidemic, and the relatively limited amount of resources that (we are told) could greatly stem its impact, will lead "good Czars" among the politicians to do what is right.
Even the U.S. government, which is widely recognized to be well behind others in seeing the importance of a response, has realized that AIDS is a "national security issue." (This is because many of the soldiers who prop up allied dictators are infected; and also because mass anger at the failure of governments to act in Africa, East Europe, or Asia could become the basis for mass radicalization.)
So far, of course, the self-evident horror of the epidemic has not led to action. This is why doctors and others are angry, and to some degree supportive of activists who demonstrate and even those who shout down politicians or who "trash" the booths of some of the pharmaceutical companies in the exhibit hall.
Radicalism, War and AIDS
There is also a sizeable radical current in the AIDS world. Some of this is expressed in organized activist groups, but it goes much beyond that.
For example, I have a friend who is a medical doctor in Australia. He has been in the forefront of efforts to deal with HIV and hepatitis C among injection drug users in Australia and Asia. Politically, he has always seemed well to my right. Prior to the Afghan War, he focused his criticisms of the United States on its destructive War on Drugs policies.
Now, he has generalized his anger and his critique. During the AIDS conference, he gave me a hard time about the arrogant and destructive behavior of the U.S. government in the military and diplomatic arenas—even though he knows that I oppose U.S. arrogance and imperialism.
Indeed, he knows that my response to September 11 was, among other things, to take part in peace demonstrations, to write an article about how the Afghan War would spread HIV around Central Asia and perhaps well beyond (which is forthcoming in AIDS), and to write a book of poems opposing the war from the perspective of someone whose office in the World Trade Center was destroyed.
This point is worth phrasing in another way: War spreads HIV and other diseases. The U.S. "War on Terror" has undoubtedly led to many new HIV infections among refugees who have been sexually assaulted, among drug users in Pakistan who have been forced to inject drugs due to disruptions in the opium and heroin supplies, and perhaps among U.S., Canadian or other soldiers who have coerced or bought sex from Afghans.
Furthermore, the enormous expenditure of money on war and its preparation have diverted funds from AIDS research, prevention and care, and reduced the priority governments and corporations have put on finding the $10 billion a year that they had promised for the global effort against AIDS.
The doctors, researchers and front-line caregivers and prevention educators at the AIDS Conference know this. And it helps to fuel their anger.
Towards an "AIDS Left"?
At the Conference, I engaged in a degree of discussion with people over whether it would make sense to organize an explicit left wing in "the AIDS movement." This perspective is based on several observations:
HIV/AIDS is increasingly becoming a "big issue" both in national and international politics.
The HIV epidemic is structured by the very patterns of exploitation and oppression that structure the world. The epidemic is spreading rapidly in the poorest countries and in those that have been forced into political and social crisis ("transitions") by the rigors of a "globalized" economic crisis (combined, in many cases, with struggles from below by students, workers, peasants, and others affected by these crises).
Within countries, it is the poor, the workers, the racially/ethnically subordinated, women, and sexual minorities who often bear the brunt of the epidemic. There is mounting evidence that the increasing inequality fostered by neoliberalism is associated with HIV spread.
Efforts by left forces have already had important positive effects in the AIDS epidemic, although in most cases we have been a small part of larger movements. Such movements have:
Fought for, and made some (but limited) progress in getting the prices of medications for developing countries lowered.
Fought for, and had some success in, defending the civil liberties and privacy rights of those infected or at risk.
Fought for, and in many cases won, a place at planning tables for people with HIV/AIDS, for gays and lesbians, for injection drug users, for sex workers, and for women, and for racially/ethnically subordinated groups. This "place at the table" is clearly much less than is needed, however.
Been part of mobilizations-from-below that have established a variety of AIDS service organizations and prevention programs in a wide variety of countries.
Problems of the Movement
The absence of an explicit left may have contributed to a number of failures of the movement:
HIV research remains dominated both by individualism and by a "medical model" ideology that sees health as an issue of doctors and other biomedically trained personnel treating patients one by one. This model incorporates the concerns and needs of drug companies and medical institutions and predisposes thought toward individualism (as the appropriate way to think about "patients") and away from community-based prevention or socioeconomic change.
Front-line workers in HIV prevention and AIDS care and research remain by and large under-unionized. Where unionized, they generally lack means for expression of their particular needs. Workers' political needs in the HIV/AIDS field lack articulation except through unions dominated by neoliberal-affected versions of social democracy, liberalism or "plain and simple" unionism.
There has been a failure to establish an effective alliance of AIDS movements with many insurgent forces around the world. These include the youth and workers who have been holding demonstrations against globalization; the workers who have been fighting a wide range of corporate and governmental belt-tightening demands (such as the unemployed piqueteros whose demonstrations have energized the revolt in Argentina); and the rural and urban poor who have been fighting corporate and latifundista pollution and resource destruction in their communities.
Thus, at a time when it is becoming clear that HIV/AIDS is a part of "big politics and economics," HIV/AIDS activists and researchers continue to function primarily at the level of local communities or national policies.
The wealthy and powerful have their own ways to further their interests in this crisis, whether these interests involve ignoring HIV where this seems best, or profiting from it. The interests of the huge majority of the people of the world around HIV/AIDS (as around all issues) remain unrepresented or, where ostensibly spoken for, misrepresented.
One way to approach this might be to try to develop an explicit "AIDS left." But many friends might oppose the "politicizing" of public health.
Some of these may see the response to HIV/AIDS as science-driven, but most are not so na<139>ve. But many others may think that a posture of political neutrality is the most effective way to get good public health.
Others may take a position "against politicizing science" for less benign reasons. One group of these will be representatives of upper middle class patients, whose needs are being met quite well, or some researchers whose main constituency fits this model.
Still others will be officials and mid-level employees of national or local health departments—for whom the "science-based public policy" perspective is a deeply institutionalized organizational defense mechanism that obscures political failures by their respective states.
Of course, the largest opposition would be from the main defenders of the current socioeconomic order. In this case, such opposition would be especially likely from high-level government officials, drug companies, and some UN officials.
Their response might mix red-baiting with a "science-based public policy" argument—even though their response to the HIV epidemic has flouted the recommendations of scientists and human decency alike. Some might also use the existence of an organized AIDS left as an excuse to justify bad policies that they would implement in any case.
The biggest difficulty, however, may be to find a short-term role for an AIDS left. In the long run, however, its value (if successful) is clear—a way to help organize people for political and social struggles that are needed both in order to get this epidemic under control and also to deal with a lot of other huge problems.
Sam Friedman has worked in AIDS research for many years, and has had poetry published in several journals. Previously he specialized as a sociologist in studying rank-and-file labor movements. On September 11, 2001, he was late for work to the World Trade Center, where the office of his organization was destroyed (everyone there escaped safely).
ATC 100, September-October 2002