Bush Trip to Africa, July 2003
Stop Number Three: BotswanaHIV/AIDS will be a central theme throughout President Bush's trip, but it may be a particular focus on Botswana, where the HIV/AIDS infection rates are over 36 percent, and even higher in some parts of the country. Key question for the Bush team on AIDS: will they ensure access to AIDS drugs and support prevention messages that include condoms? Bush administration officials will focus on the President's Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003, which is designed to provide $15 billion over the next five years to fourteen countries, twelve in sub-Saharan Africa, including $1 billion to the Global Fund for HIV/AIDS, TB and Malaria. President Bush signed the bill into law on May 27, although the funding has not yet been appropriated by Congress. The U.S. president should insist that programs to reduce discrimination against women and girls should be a central part of fighting HIV/AIDS. This includes strong support for girls education and for keeping schools safe for girls; reduction of unequal property and inheritance laws that contribute to women's economic dependence and fall especially heavily on women widowed by AIDS; good access to reproductive health services; and basic protections against sexual violence, abuse and coercion, including domestic violence. U.S. support for strengthening rape prevention programs and programs that provide legal and medical services to rape survivors would be an important step. In the United States, the Bush administration has financed "abstinence only until marriage" programs that crowd out comprehensive sex education in U.S. schools. These programs teach that abstinence is the most reliable means of preventing HIV transmission, and that condoms are not reliable or effective for this purpose. Such ideas leave young people without an understanding of basic HIV prevention. The abstinence program is now being exported to Africa, where abstinence-only programs are inherently incompatible with the realities of abuse and discrimination that women and girls face. This espousal of abstinence-only as the central prevention message is likely to have a destructive effect on promising initiatives to provide education on HIV and other sexually transmitted diseases (STDs) to young people. In addition, many parts of Africa face condom shortages that will only get worse if the U.S. pursues an anti-condom policy. The president should speak out in favor of continued support for access to condoms and comprehensive HIV/STD education programs. The Bush administration has insisted that the success of Uganda against HIV/AIDS was due in large part to the country's reliance on "abstinence-only" approaches to education about HIV. In fact, Uganda's success in reducing HIV prevalence was built to a significant degree on increased use of condoms, and education programs have relied on a range of prevention messages. The U.S. government continues to block international agreements that could be the best hope for generic medicines for Africa. At the World Trade Organization summit in Doha in November 2001, the U.S. agreed with other member states that the WTO should give primacy to urgent public health concerns over intellectual property protection. The member states agreed to flesh out an agreement by December 2002 that would facilitate the issuing of compulsory licenses and other measures that would enable countries, especially low-income countries, to get the lower-cost drugs they need to stem epidemics, including HIV/AIDS. There is still no agreement, largely because the U.S. Trade Representative has blocked consensus positions that have emerged. The best thing that President Bush could do for African countries affected by HIV/AIDS would be to ensure that the U.S. Trade Representative stop representing the interests of pharmaceutical companies and start reflecting the president's stated goal of leadership against HIV/AIDS in Africa. The U.S. should support the post-Doha consensus that it blocked last February, which would facilitate optimal use of the World Trade Organization public health provisions for all countries. Further, the U.S. should pledge not to pursue trade sanctions or other punitive measures against any country making use of compulsory licenses or engaging in domestic manufacture of generic antiretroviral drugs. More information from Human Rights Watch is available online: Suffering in Silence: The Links between Human Rights Abuses and HIV Transmission to Girls in Zambia, Human Rights Watch Report (January 28, 2003)
Kenya: Double Standards: Women's Property Rights Violations in Kenya, Human Rights Watch Report, (March 4, 2003)
Human Rights Watch Letter to the US Trade Representative on Doha and AIDS (November 7, 2001)
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