More aid won't stop more AIDS...

...but better governments that foster prosperity and public health might.

AIDS ribbon 88 (photo credit: )
AIDS ribbon 88
(photo credit: )
Much of the spectacle from last week's UNAIDS came from battles between self-proclaimed progressives or conservatives over references to prostitutes and drug addicts in the final declaration. These semantic tussles aside, the real issue for the global AIDS industry is how to keep the cash flowing. The recent UN Special Session on AIDS in New York called for spending on fighting AIDS to be increased from $8.2bn a year to $22bn by 2010, a target resisted by the US, which fears it will be blamed if shortfalls occur. The idea that AIDS in Africa and other poor countries can only be reversed with large sums of aid money is certainly politically attractive. Politicians get a warm, fuzzy feeling when they sign large checks that show they are helping the needy. But showering the AIDS plague with cash will do nothing without real reforms. While extra funding is certainly needed for prevention and treatment programs, no amount of money will address the root cause of the crisis - political and economic oppression. AIDS is so tenacious not because of the cost of medicines or a lack of aid. The reason AIDS has taken such a hold in Africa and parts of Asia is because these regions suffer from government oppression that stifles prosperity, keeping their people in poverty and therefore ill health. Leading public health experts are unanimous that prevention is of paramount importance to combat AIDS. But political oppression has made it difficult to spread that message. UNTIL RECENTLY, President Thabo Mbeki refused to acknowledge that South Africa even had an AIDS problem, a factor that helped it spread rapidly there. Some religiously conservative Islamic, African and Latin American governments at the UNAIDS conference are reluctant to admit that drug users and prostitutes exist within their countries, meaning that prevention messages do not reach these highly vulnerable groups. By contrast, the government of Thailand acknowledged AIDS as a problem early and encouraged discussion and education, bringing infection rates down rapidly. Yet recently the Thai government cracked down on intravenous drug addicts and police killed more than 2,000 in 2003 while thousands more were imprisoned. The consequence: drugs were driven further underground and open discussion of the need to use sterile needles was made impossible. As a result, HIV infection rates are now soaring among drug users. Economic oppression is an even more powerful vector of all disease. When governments restrict the ability of people to start up businesses and exchange goods freely under the rule of law, poverty and hopelessness are guaranteed. People flee from the countryside looking for work, to be greeted with urban slums and unemployment. Rent controls, oppressive planning restrictions and lack of land title mean there is a woeful undersupply of suitable housing. It is also impossible for people to use their houses as security against loans. Poverty leads desperate parents to sell their children into the sex trade. For poor women with few employment opportunities, prostitution is one of the few options available. Drug abuse is rife. In the poverty of the favelas in Brazil and the shanty towns of Africa and India, HIV finds fertile ground. But this urban squalor need not exist if people had real employment opportunities and the ability to create wealth for themselves. Unfortunately, governments that restrict economic liberty make this impossible. At the moment, the West is coming up with the wrong answers about AIDS. Giving more financial aid might please Irish rock musicians and the activists, but in reality it is sustaining corrupt politicians and preventing Africa from helping itself. Money for AIDS projects can make things worse: the Global Fund had to suspend grants to Uganda last August after uncovering evidence of systematic embezzlement. In Ghana, hundreds of spurious NGOs have sprung into existence with the sole purpose of obtaining Global Fund money. Instead of salving its conscience by throwing aid money at the problem, the West could do something of far greater value by undermining the ability of political cliques to oppress their people politically and economically. Western governments should be encouraging countries to institute property rights and foster respect for the rule of law. This is the only way the benefits of economic growth will reach the poor and allow them to escape the squalid conditions which spread AIDS. The AIDS industry for too long has been giving us the wrong answers to the wrong questions. Freedom has brought prosperity to the West and insulated it from the worst of the AIDS crisis. We need to hear more voices calling for this freedom to be extended to where it is most desperately needed. The writer is director of the London-based Campaign for Fighting Diseases, an international development think-tank.