28 April 2004

Fighting Global AIDS Is Good Business, Says Holbrooke, April 28, 2004

Former envoy cites private sector role in president's AIDS initiative

By Bruce Greenberg
Washington File Staff Writer

Washington -- Richard Holbrooke, former U.S. ambassador to the United Nations, who raised HIV/AIDS as a security concern in that body, is on a mission to mobilize the international business community to help reduce AIDS deaths and support those left behind through business-sponsored education and treatment.

Speaking on a panel at the Council on Foreign Relations in Washington April 28, Holbrooke, citing his past efforts to get the United Nations to create an AIDS action plan, applauded "the president's efforts and this administration's efforts in providing the financial means to assist in the fight against HIV/AIDS in that part of the world where the need is greatest."

Unfortunately, he said, "awareness is very high, but commitment is very low" when it comes to the international response to the AIDS pandemic, which is what the world has to work to overcome.

Holbrooke is tackling that now as president and CEO of the Global Business Coalition on HIV/AIDS, a private sector organization that has engaged 140 companies based in 19 countries to develop programs that will provide treatment and support for those suffering with the disease and those experiencing its devastating social and personal effects.

He said that a major impediment in dealing with AIDS globally is that many governments -- and people -- are still in a denial phase. They believe they have no AIDS problem.

India, for example: "If India does not change its policies now -- and the HIV infection rate is hovering past 1 percent in three of its states already, and India has the second largest number of AIDS cases in the world after South Africa ... -- then India will become the leader in this area. We have to use our resources to wake the Indians up to this," he warned.

AIDS testing, Holbrooke said, is not effective in Africa and Asia because "very few people volunteer for anything in this part of the world. They certainly don't volunteer to find out if they have a potentially fatal disease, because in their cultures they would be stigmatized and ostracized. And this is why we are spending so much money on anti-retrovirals rather than testing.

"The single most important statistic in all this is that 95 percent of people in the world who are HIV-positive do not know it."

While testing is key to breaking the cycle of HIV transmission, Holbrooke said, the current political climate will not allow for making it mandatory. "But at a minimum," he said, "there should be some form of mandatory testing, such as prior to marrying."

And for those who test positive, he said, "you must initiate some form of treatment."

Indeed, said John Lang, deputy to U.S. Global AIDS Coordinator Randall Tobias, treatment often encourages testing, because people see that patients can get better. "This emboldens others to seek testing," Lang said, "because they realize that if they are infected, they also can get treated."

Holbrooke said he was happy that the debate over abstinence versus safe sex and faith-based versus secular programs has largely been muted over time. He lauded President Bush for "removing this type of volatile subject from the political and cultural landscape."

"President Bush's leadership," he said, "was indispensable in triggering leadership in other countries," which "underscores the need specifically for American leadership in this battle."

On the issue of generic versus branded drugs for the developing world, members of the panel noted that the U.S. position has often been that generics produced overseas may be impure or ineffective.

This position may not be in the best interests of the world's sick, Holbrooke said, since there has been no convincing argument that generics are intrinsically unsafe.

"Everyone, except the U.S., seems to think that generics work already," he said, which creates the impression that the United States is on the side of the mega-pharmacy conglomerates. "We are getting harried at the Global Business Coalition on this subject," he added.