The 15th international AIDS conference opened in Bangkok July 11 with elephant parades and Thai dancers in abundance.

The Hollywood glitterati were also there in force–Richard Gere, Ashley Judd, Rupert Everett, Oprah Winfrey and the current Miss Universe, Jennifer Hawkins, all trooped over to do their bit.

AIDS is such a magnet to the stars. It’s difficult to imagine them getting as concerned about chlamydia or human papilloma virus (which causes cervical cancer).

Of course, on a global scale AIDS continues to cause utter devastation–in the Soviet Union, 60 per cent more people are HIV positive than two years ago.

In Eastern Europe and Central Asia injecting drugs is fuelling the epidemic where 80 per cent of new infections are in people under 30. In Africa, where more than 70 per cent of the world’s HIV-positive workers live, the economic consequences alone are terrifying.

Kenya, Mozambique, Ethiopia, Tanzania and Zimbabwe each have more than a million workers affected; Nigeria has 2.4 million and South Africa 3.7 million. It is reckoned that 2 million people with AIDS will be too ill to work by 2005 unless they have access to life-prolonging antiretroviral drugs.

Access to these drugs was the focus for the conference and for the much publicized anti-American protest outside it.

Months earlier, the World Health Organization (WHO) launched its “3 by 5” program–a global initiative to provide antiretroviral therapy to 3 million AIDS patients in developing countries by 2005.

The United States is by far the largest contributor to the worldwide AIDS prevention budget–the Bush administration has committed $1.5 billion to its own initiative, which seeks to double the number of people in Africa who have access to the drugs in the first year of the five-year plan.

This is in addition to another $390 million given through multinational channels. In all, the U.S. contributes twice as much cash as the rest of the world combined.

Yet Randall Tobias, Bush’s AIDS tsar, charged with overseeing the spending of this budget, was greeted with scorn and derision at the Bangkok conference.

Tobias was formerly head of the large drugs manufacturer Eli Lilly, and therefore an easy target for those who accused him of “pandering to the pharmaceutical industry.” The reason for this charge is the U.S.’s refusal to accept non-patented drugs approved by the WHO, as safe.

Patented drugs cost more, which means that fewer people can be treated. However some non-patented drugs may not work as well as non-patented ones, as experience with anticonvulsant drugs, for example, has shown.

Tobias defended his stance by saying his only concern is that the drugs should be “safe and effective” and that the U.S. will buy drugs from any nation if these criteria are met.

In other words, the U.S. stipulation respects the right of Africans to be treated with the same high-quality drugs as Americans and Europeans. One American journalist even pointed out that the Bush administration has gone out of its way to make it cheaper and faster for non-patented drug firms to get clearance in the U.S. to make antiretrovirals, but so far no company had applied.

Tobias was further criticized because, although the U.S. sent 200 people to Bangkok, numbers were down by more than 200 from the Barcelona AIDS conference just two years earlier.

In response, he said that it had not been the best use of taxpayers’ money to send so many delegates previously and that, rather than a lack of commitment to combating AIDS, it showed determination by the U.S. to use funds appropriately. You can bet the U.S. scientific delegation had more economical accommodation than the Hollywood one anyway.

Perhaps the root of the hostility to Tobias and to President Museveni of Uganda, who was given an equally frosty reception, is revealed in the comment of one AIDS activist reported as saying, “He’s worse than we thought. Tobias is the front man for Bush’s ideology-driven policies on prevention.”

This ideology is, of course, that of encouraging people to abstain from sex outside of marriages, to be faithful to one sexual partner whether married or not, and to use condoms if appropriate after that. This is known as the ABC model, and it has led to huge reductions of HIV in Uganda.

Indeed, without such a strategy to change risky sexual behavior, surely greater access to life-prolonging drugs will make the AIDS crisis worse.

This is not a battle of science versus ideology, but rather a battle of two ideologies. One sees sex as a human right to be enjoyed at whatever cost; the other sees sex as a gift so be shared only within a committed, faithful relationship–which from a New Testament perspective (1 Cor 7:9) surely means marriage?

While the currency of marriage is increasingly devalued, no amount of dollars or euros is going to stop the spread of AIDS.

Dr. Trevor Stammers is a senior tutor in general practice at St. George’s Hospital Medical School in London. This column appeared in the Baptist Times and is used here with permission.

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