In a slap in the face to the international AIDS community, the US slashed by three-quarters its delegation to the world’s most prestigious HIV/AIDS event, the biennial international AIDS conference held in Bangkok this week.

The decision caused the cancellation of about 50 presentations and scores of training sessions at a conference noted for its action-oriented agenda.

According to the US, the decision was prompted by cost. However, at the previous international conference in Barcelona, US Health secretary Tommy Thompson was heckled by AIDS activists and many believe this is Thompson’s revenge.

An anonymous US health official quoted in the Washington Post, said that by snubbing the international AIDS community, the US was sending a message that “the US wants to be engaged but the US wants to call the shots”.

Last month, it was made public that any US government health experts had to get permission from the US Office of Global and Public Health, and agree to promote US policy, before they could be consultants for the World Health Organization (WHO).

Democratic Congressman Henry Waxman said the move was an attempt by the Bush Administration to “tighten their controls over their professionals and their scientists … to favour their right-wing constituents”.

This week, respected British journal The Lancet , questioned this decision – particularly as the Office of Global and Public Health is headed by a political appointee.

“Unfortunately, the policy is just the latest in a series of events – including editing health information on websites for the public, changing the conclusions of public-health reports, preventing the attendance of many US scientists at the international AIDS conference in Bangkok – that look very much indeed like improper political interference in science,” said the Lancet editorial.

Aside from pulling back from involvement in international events and bodies, the Bush administration has also established funds to promote its own agenda on HIV/AIDS.

Last year, US president George W Bush set up his President’s Emergency Plan for AIDS Relief (PEPFAR), a $15-billion initiative restricted to helping 14 countries to fight HIV/AIDS.

Many critics see PEPFAR as a slight to the United Nations-initiated Global Fund to fight AIDS, Tuberculosis and Malaria set up in 2002.

The Global Fund is an international partnership between governments, business and civil society. Grant applications need to be made by multi-sectoral country co-ordinating committees, and are evaluated by an independent expert committee.

The US has committed $200-million a year to the fund, which falls far short of its fair contribution to the international fund.

A  third of PEPFAR’s funds are for programmes that promote sexual abstinence, while prevention efforts aimed at promoting fidelity are also favoured.

But, says says UN Population Fund Executive Director Thoraya Obaid: “Abstinence is meaningless to women who are coerced into sex. Faithfulness offers little protection to wives whose husbands have several partners or were infected before marriage. And condoms require the cooperation of men. The social and economic empowerment of women is key.”

In addition, PEPFAR, which is headed by former chief executive of the Eli Lilly pharmaceutical company Randall Tobias, will only pay for antiretroviral drugs approved by the US Food and Drug Authority (FDA). Bush gets significant backing from big pharmaceutical companies.

UN AIDS Envoy Stephen Lewis has raised doubts about whether PEPFAR-funded projects will be able to supply the cheapest antiretroviral drugs possible.

He has also questioned the desirability of bilateral funding programmes.

“For one thing, donor countries pick and choose, so countries that desperately need funds are excluded, said Lewis, noting that some of the most heavily affected countries, including Swaziland, Lesotho, Malawi and Zimbabwe, are excluded from PEPFAR.

“Very often the donor will dictate uses of their funds which are not consistent with the national AIDS policies of recipient governments. The Global Fund speaks to a process which is rooted at the country level, and in which virtually every stakeholder has participated,” added Lewis in an interview with Africa Recovery.

The PEPFAR programme heavily favours 12 African countries despite the fact that India now has the second greatest HIV positive population after South Africa, while the epidemic in parts of China is growing very fast.

Botswana, Côte d’Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia are the African beneficiaries, together with Haiti and Guyana in the Caribbean

At the same time, the Bush Administration has renewed its interest in Africa in what commentators are describing as a new imperialist scramble for Africa.

“Washington has realised that it is dependent on strategic raw materials and is increasing political and military accords with the majority of African countries in an effort to secure its supply lines,” according to latest issue of Le Monde diplomatique.

“US strategy in Africa has two main axes. The first is unlimited access to the key markets, energy and other strategic resources, and the second the military securing of communication channels, particularly to allow the transport of raw materials to the US.”

The US is particularly interested in alternative oil supplies to the volatile Middle East, with Nigeria, Angola and Gabon offering such prospects.

Also of interest are raw materials such as manganese (for steel production), cobalt and chrome (for alloys in aeronautics), vanadium, gold, antimony, fluorspar, germanium and industrial diamonds.

“The US is trying to establish partnerships with all countries, using a range of pretexts,” argues Le Monde diplomatique.

“The US claims, for example, that the South African army would be incapable of conducting a large-scale operation because a large proportion of South African soldiers are infected with HIV, and further claims that Pretoria would need massive support from Washington to reinforce those unreliable elements.

“As a result, South Africa is preparing to rejoin the Africa contingency operations training assistance (Acota) programme. In reality, it is South Africa’s strategic position that is of interest to the US.”

While it would be wrong to caricature all US government aid for HIV/AIDS as being part of an imperialist plot, it would be naïve to believe that such funds come without strings attached.

Bilateral aid keeps the wheels of global diplomacy well-oiled, and South Africa is a significant beneficiary of PEPFAR funds.

But the US retains control over who gets this money and there is a danger that this massive influx of funds could go to projects that may not be in line with our country’s priorities on HIV/AIDS and could distort service delivery.

The US would like to be able to announce how many people it is helping with ARVs, for example. It thus figures that projects getting PEPFAR funds will be large urban projects.

This has the potential to widen the gap between rural and urban areas, and between rich and poor provinces.

Our government needs to join AIDS activists worldwide to pressurise the US to put more money into the Global Fund, which gives stakeholders in countries themselves the power to decide which HIV/AIDS projects need funding.

The fight against HIV/AIDS cannot be subjected inappropriate political agendas, particularly given the increasingly devisive role that the US is playing in the  international HIV/AIDS arena.  – Health-e News Service.