Frist's Trip to Africa Yields More Excuses on AIDS Spending

To the editor:

Senator Frist, on his current trip to Africa, has described his meeting with a young South African mother living with HIV/AIDS as "humbling" and "one of the most deeply moving moments of his life." During this same trip, Senator Frist has chastised South Africa's political leadership about its failure to recognize the magnitude of the AIDS problem. However, in the U.S. Congress, Senator Frist continues to undermine efforts to commit serious resources, a promised, to the global fight against the pandemic. This undermining started in the summer of 2002 when he took $500 million off the table in the Senate to given President Bush a press corps opportunity to announce his smaller, five-year plan to reduce mother-to-child-transmission - a plan just started, over a year later, in Haiti. This summer, Frist has again shuffled the deck in the Senate for the White House, undermining legislative efforts to appropriate the entire $3 billion authorized just weeks earlier in another press corps event (the famous, $15 billion-over-five-years Global AIDS authorization bill). Instead Senator Frist has backed the administration's effort to limit 2004 appropriations to $2 billion and to completely undermine the Global Fund to Fight AIDS, TB, and Malaria, reducing the U.S. donation to $200 million, much less even than that paid in 2003.

Senator Frist says that $2 billion is all that is needed in 2004 because of a lack of "absorptive capacity" in Africa and other developing countries. Even if capacity were an immediate bottleneck issue, the moral response would be to invest in medical infrastructure, systems, and personnel and to do so as quickly and massively as possible, at a rate much higher than $2 billion. But, this "absorptive capacity" excuse is a plain lie. According to UNAIDS, there is underutilized capacity to deliver antiretroviral therapy in developing countries such that an additional 600,000-700,000 people could be on treatment tomorrow using capacity that existed as long ago as 2001. Current estimates of capacity are even higher, suggesting that nearly 2 million people in developing countries could be on lifesaving ARV's if there were an adequate commitment of resources, rather than the mere 300,000 currently receiving such treatment.

Senator Frist, a doctor who has taken the Hippocratic oath, has an ethical obligation to be truthful about the medical crisis he has observed first hand. Nine thousand people will die of AIDS today and the same number tomorrow and the same the day after. Each person living with HIV/AIDS that Frist sees in Africa is a person whose life matters. Given the underutilization of existing capacity and the unnecessary delay in expanding that capacity further, it is a breach of Dr. Frist's medical ethics for him to make excuses for inaction. So instead of patting itself on the back, blaming capacity, and pointing fingers elsewhere, the U.S. should pay more sooner both to fully utilize existing capacity and to scale up medical capacity as quickly as possible. If the U.S. did so, the WHO goal of treating 3 million of 6 million people living with AIDS by 2005 would be easily achieved.

Professor Brook K. Baker, Northeastern University School of Law
400 Huntington Ave., Boston, MA 02115
617-373-3217
b.baker@neu.edu