Policy likely to face protests

U.S. AIDS

Despite Bush's $15 billion in aid, official may get chilly reception at summit

July 11, 2004|By Mary Curtius | Mary Curtius,LOS ANGELES TIMES

WASHINGTON - As the man in charge of the Bush administration's $15 billion plan to treat millions of HIV-infected people in underdeveloped nations, Randall Tobias might expect a hero's welcome at the International AIDS Conference opening today in Thailand.

Instead, the U.S. global AIDS coordinator is likely to be greeted by the protests of activists opposed to the administration's policies and to Tobias.

Tobias, some activists said, could expect a reception similar to the one given Health and Human Services Secretary Tommy G. Thompson at the last conference. Thompson was booed off the stage at the 2002 conference in Spain.

Since then, the administration has launched the most expensive effort ever by a government to fight AIDS internationally. Yet neither the financial commitment nor the power Bush has given Tobias to mobilize the U.S. bureaucracy has won over critics, who charge that the administration's efforts are hamstrung by political and ideological concerns.

"He's been worse than we thought," said Sharonann Lynch of the AIDS organization Health Global Access Project of Tobias. "Tobias is the front man for Bush's ideology-driven policies on prevention and on treatment" of AIDS.

Lynch said Tobias has given his critics fodder by emphasizing abstinence and faithfulness as ways of preventing AIDS while playing down the role of condoms, and by not embracing generic drugs as substitutes for more expensive, patented brands.

Conservative supporters of the president's program argue that it is meeting with resistance because an entrenched international network of AIDS experts and activists doesn't like being told that their methods have failed to end the epidemic.

Rep. Mark E. Souder, an Indiana Republican who strongly supports the president's efforts to combat AIDS internationally, said the criticism of the U.S. program was politically motivated.

"Every action taken by President Bush to elevate the fight against AIDS, both domestically and globally, has been greeted with derision and whining by activists who can't bear to see the president's compassionate conservative agenda achieve the results that the previous administration failed to deliver," Souder said.

The U.S. program seeks to double the number of people with access to AIDS drugs in Africa in its first year, vastly expanding treatment and prevention efforts in hard-hit African nations, the Caribbean and Vietnam. In the five-year time frame of the program, it plans to treat 2 million HIV-infected people with antiretroviral drugs and provide palliative care for 10 million HIV-infected people and AIDS orphans.

Tobias says his critics' vehemence mystifies him.

"This program gets a lot of criticism," he acknowledged in an interview in his Washington office. Bush, he said, "is doing so much," yet "a lot of the critics are saying, `You should do more.'"

Health GAP opposed Tobias' appointment from the outset last year, Lynch said. Her group feared that, as head of the pharmaceutical firm Eli Lilly and Co. in the 1990s, Tobias would protect drug company interests by preventing underdeveloped nations that accept U.S. money from using lower-cost generic drugs.

"He is illustrative of overall Bush policies of pandering to the pharmaceutical industry," Lynch said.

It is a charge Tobias strongly rejected, saying in an interview from Vietnam that his speech to the AIDS conference will urge greater unity.

"I would like to encourage everybody involved to really get focused on the fact that the enemy here is apathy, stigma and denial as opposed to each other," he said. "I would think that there are better places for people to put their energies."

In his first year on the job, Tobias, who had no background in public health, said he has been transformed by the suffering he witnessed in nations ravaged by AIDS, even as he has learned that the world of international treatment and prevention of the disease is filled with political land mines.

As chief executive of Eli Lilly, Tobias traveled frequently to the capitals of African nations, meeting with business and government elites. He thought himself a worldly man.

But nothing in his corporate experience, he said, prepared him for the realities of AIDS that he has encountered since coming out of retirement for the administration post.

"I'm not naive," Tobias, 62, said. "But I had never sat in the dirt inside someone's home, where, because I was coming, they had swept the dirt to make this space as nice as possible."

Although Tobias says he will urge unity in Thailand, the administration's critics say the policies he is promoting provoke division. The administration's refusal to accept generic drugs approved by the World Health Organization as safe and effective has angered health professionals and activists. Patented drugs are costlier, which means that governments and nonprofit organizations would be able to treat fewer people.

Activists are also angry about Thompson's decision to limit the U.S. delegation to the AIDS conference to 50 people this year - down from more than 200 at the conference in Spain. The administration viewed previous U.S. delegations as unnecessarily large.

Thompson's decision forced U.S. scientists who had planned to attend the conference to withdraw 40 scientific papers, and caused the cancellation of U.S. seminars and workshops.

The Los Angeles Times is a Tribune Publishing newspaper.

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