"The criminal default of the Western world is beyond ethical comprehension."
-Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa

As he declared at a meeting of the Ecumenical Advocacy Alliance recently, Mr. Lewis was speaking of the failure of the wealthy nations of the world to direct resources, energy and passion to confront the AIDS tragedy in Africa and the Global South.

Confronting the AIDS crisis in Africa of course requires not only funds but a common agenda with African partners, specifically addressing the question of what we want and need to do. U.S. presidential leadership is critical to such a process, for such leadership helps to define the response of the United States and also galvanizes global action.

President Bush is going to Africa in January 2003, and his trip provides an excellent opportunity to advance the U.S. contribution to the fight against global AIDS. Indeed, the absence of a substantive reference to HIV/AIDS would rightly be seen as "beyond ethical comprehension."

The Africa advocacy community (of which the Washington Office on Africa-which prepared this article-and the PC(USA) Washington office are an active part), has worked in recent months to develop a sketch of what we would like President Bush to say about HIV/AIDS on his January trip. We have called it the U.S. Presidential AIDS Initiative.

We have attempted to define an initiative that would be comprehensive, one that would help to save families and communities affected by the AIDS crisis, that would extend the parent-child relationship, and would secure the future of young people.

Here is what we felt would be essential for this initiative.

Support access to affordable medications.
The United States should be prepared to fund, by 2005, an equitable percentage of the World Health Organization's (WHO) plan to provide anti-retroviral therapies to three million people in need of such treatment.
The U.S. should, moreover, support a limited exception to international patent rules-both existing now and as may be negotiated in the future-to allow the export of a broad range of affordable generic medications to poor countries, where such factors as lack of production capacity and insufficient market size inhibit efficient local manufacture.

Ensure prevention services and support for affected communities.
The United States should provide medications to prevent transmission of HIV from mother to child, as well as treatment to sustain and enhance the quality of life for mothers with AIDS. There should be a commitment to achieving an appropriate U.S. share of the goal by 2005; and then sustaining close to 80 percent coverage of the estimated two million women across the world with HIV who give birth each year.

The United States should also contribute its fair share to supporting an annual global investment in comprehensive HIV prevention in low- and middle-income countries. This global investment in prevention would increase from around $1.2 billion today to $4.8 billion in 2004.
(The latter figure has recently been termed "necessary" by UNAIDS, the Joint United Nations Programme on HIV/AIDS, which is the main advocate for global action on HIV/AIDS, and leads an expanded response aimed at preventing the transmission of HIV, providing care and support, reducing the vulnerability of individuals and communities to HIV/AIDS, and alleviating the impact of the epidemic.)

Such efforts should include effective economic, social, and public health strategies aimed at women and girls. Finally, the United States should support community-based care and support services to reach (by 2005) eighty percent of children orphaned or left vulnerable by the AIDS pandemic.

Provide adequate financial resources.
The president should include in his budget request for 2004 at least $2.5 billion for implementation of global AIDS programs, as well as additional funds to fight tuberculosis and malaria. At least 50 percent of the funds for global AIDS programs should be allocated to the Global Fund to Fight AIDS, Tuberculosis, and Malaria*, the crucial multilateral funding effort that will enter de-facto bankruptcy in the next four months without a major infusion of new funds. These funds, whether bilateral or multilateral, should consist of new monies-not the shifting around of old-and should be in addition to present development assistance and the new Millennium Challenge Account (MCA).
MCA was announced in March 2002, when President Bush stated that the U.S. would increase its core development assistance by "$5 billion over the next three budget cycles" (i.e., by 2006). These additional funds will go into the MCA.

This addition to existing development assistance will focus upon selected countries that meet the criteria of good governance, investment in the health and education of their people, and "sound economic policies." The number of beneficiary countries will be small, perhaps between eight and 15.

Cancel the debt of poor nations facing an AIDS crisis.
The presidential initiative should insist upon comprehensive debt cancellation for impoverished nations facing an HIV/AIDS crisis, with support for locally-determined processes to ensure that resulting savings are re-channeled to social needs. No such country should spend more than a maximum of five percent of total government revenues from internal sources on debt payments or future loans.

This is what we think President Bush should announce. It embraces treatment, support for people living with AIDS as well as for those who care for them, a sensitivity to the needs of children and women, and an affirmation of the place of community in responding effectively to the crisis. It recognizes that the United States is a part of the solution rather than a part of the problem, especially when its trade policies give real meaning to the World Trade Organization agreement that public health comes before private patents. And, it recognizes that we cannot move forward successfully in the fight against AIDS in Africa and around the world without funding. The United States has an obligation to do its share.

Sadly, Stephen Lewis has it right. "The criminal default of the Western world is beyond ethical comprehension." For President Bush to demonstrate such a broad understanding of the crisis, and such a commitment to a strong U.S. response as this, would stop references to a "criminal default." And January in Africa would be none too soon to do so.

Suggested Action:

We believe that President Bush should issue a strong statement on U.S. commitment to helping alleviate the HIV/AIDS pandemic in Africa and the Global South. The President's trip to Africa scheduled for January 2003 is an excellent chance for him to support the U.S. contribution.

Please call the White House Comment Line, at 202-456-6213, and send an email to the White House, at president@whitehouse.gov. Ask the president to support access to affordable medications, and to provide adequate financial resources for prevention and direct services.

GENERAL ASSEMBLY:

Jesus demonstrated the love of God by embracing those who had beenostracized because of illness or social status. While others in society blamed them as having brought illness on themselves because of sinful behavior and ostracized them from community and aid, Jesus embraced them and healed them. He dined with lepers. He healed the woman with an issue of blood. He made the blind see again. The church shows forth Jesus Christ when it ministers to and with some of the most rejected people in the world: people living with HIV/AIDS. Jesus also revealed the spirit of God working to free us from the bonds of sin embraced by our culture. Jesus shows how his disciples are called to struggle with that which prevents us from reaching out to those in need - whether it be racism, sexism, fear, or judgment.

As disciples of Christ who make up the church, we receive the exciting invitation to follow in Jesus' footsteps. Now is the time for the church to follow those footsteps and set a powerful example for the rest of the world. God is continually at work with people in all cultures, transforming us so that we reflect God's good will and purpose. May God fill us with compassion that moves us to action, and wisdom to know how best to offer our loving support to those in need.

The 213th General Assembly (2001) of the Presbyterian Church (U.S.A.), out of profound concern for families, communities, and nations ravaged by the HIV/AIDS epidemic [among other things]:

• Directs the Stated Clerk of the General Assembly to write a letter to the President of the United States, calling upon the United States government to allocate greater resources toward addressing the epidemic and poverty that fans it, as well as prevention and affordable treatment initiatives recommended according to the WHO Massive Effort, and to show flexibility regarding trade agreements and intellectual property rights so that life-saving drugs can be available to all affected populations.
  
  
• Requests the Presbyterian Washington Office and the Presbyterian UN Office to support advocacy efforts to address the Massive Effort Against the Diseases of Poverty, and the need to make affordable medication available to countries in the developing world. (Minutes, 2001, Part I, p. 336)