A Victorious Battle in a Long HIV War

Monday was World AIDS Day; it was the 20th anniversary of the awareness-driven tradition, but it passed with a critical piece of the issue almost completely absent from discourse. At the heart of the HIV pandemic is the core problem of gender imbalance, both in Africa and the broader world. It's a fact few recognize, and something I didn't comprehend until working for one of the world's leading HIV activists, Zackie Achmat.

Women are twice as likely to contract HIV/AIDS through heterosexual intercourse than their male partners are, simply by nature of physiology. In recent years, it's been the leading killer of black women between the ages of 25 and 34 globally. But the problem extends well beyond simply whether the male or female body is more disposed to contracting the disease.

The paradigm from the early years of the AIDS epidemic — and the reality we see in the United States, where roughly only a quarter those who die of AIDS in a given year are female — does not hold true in the world at large. What was once a "gay" plague is now a plague that disproportionately affects women.

While President Bush's commitment to the issue has been wildly lauded this week as an accomplishment amid major failures in his tenure, I want to take pause to think carefully about his approach.

First and foremost, figures the administration cites — such as doubling HIV spending from $15 billion to $30 billion — must be put in context. This is money to be spent over five-year periods, not a single fiscal year.

It's also worth noting that early in the initiative, the administration insisted that drugs be purchased from only brand name manufacturers of drugs, which typically cost 200 percent or 300 percent more than generic equivalents.

That said, the Bush administration has put 1.7 million patients on antiretroviral drug regiments, literally life-saving formulas that allow victims to live nearly complete lives even after the disease has advanced substantially. Some 240,000 children have been born HIV-free as a result of U.S. support.

But I want to focus on the president's reliance on abstinence programs as a critical component of the PEPFAR campaign. There's credible evidence that aggressive abstinence programs often do yield extremely positive results — in the short term, only to receive a violent backlash in later years. It's a bell curve statistical pattern that the world is watching play out in Uganda right now. But I think the Bush approach — regardless of how you feel about the role of religion in foreign policy — has another, troubling dimension that receives little attention.

Abstinence programs fuel local gender norms; they bolster societal value and appreciation for traditional marriages — marriages that in both the U.S., and to a much larger extent in the Third World, subvert female will and opinions to those of men.

There's no disputing that funding abstinence only programs strengthen the family — but do we really want to strengthen traditional values at a time when a great portion of new reported HIV cases come from loyal wives who've been infected by straying husbands? When traditional values continue to protect a man's right to rape his wife and physically abuse her?

The fight to advance abstinence is also up against the tide of American pop culture, possibly the most powerful force on the global airwaves, which — through music, television and film — is pushing squarely in the other direction.

Perhaps the best way to truly strengthen families, and the most effective way to go about battling this epidemic, is to step away from what supposedly builds sturdy households — abstinence and faith programs — and instead pursue a course that restructures the power dynamic within marriages.

When it is within a woman's power to leave a marriage or to choose her partner based on affection rather than economics or familial pressure — there lies the solution to the pandemic.

This is why micro-credit programs and initiatives that empower women to seek education and careers rank most critical, albeit least celebrated, dimensions of an effective counter HIV/AIDS policy.

We know that the fight against HIV/AIDS is among the most tangible of all the obstacles we face to develop the globe's least financially privileged states. Our successes are measurable, as is the distance we still have to travel.

We know that we face a world where only 30 percent of those who need treatment have access to it, and a world in which five people are infected for every two that gain access to treatment.

At the root of the Bush plan is both conservative compassion and a realist assessment: The administration considered global HIV/AIDS an issue of national security. Let's hope those conditions that give rise to HIV/AIDS — poverty and disempowered women — will be considered as dangerous to the United States as the pandemic in the Obama years.

Let's hope the compassion of the Bush years, as heavily advocated by Colin Powell and White House speechwriter-turned-adviser Michael Gerson, remains through the coming decade. And let's hope it stays true to form, advancing family and monogamy as core principles — but in a more nuanced way, one that gives power to those this plague has turned its fury against.

Brian Till, one of the nation's youngest syndicated columnists, is a research associate for the New America Foundation, a think tank in Washington. He can be contacted at till@newamerica.net. To find out more about the author and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.

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