As the AIDS Bureaucracy Cashes In, the Prospect of a Cure Dims

The big news on AIDS is that there is no news. After 20 million deaths over 25 years, there should be some news -- of a vaccine, of a cure -- but there’s nothing on the horizon. And in no small part, it’s because politics has squeezed out science.

Last month I traveled to Bangkok to cover the 15th World AIDS Conference. Many luminaries -- Kofi Annan, Nelson Mandela, CEOs of various pharmaceutical companies, actress Ashley Judd -- were there, all talking The Language of Concern and Compassion. But nobody talked seriously about a vaccine or a cure; the phantom of this opera was the prospect of actually eradicating the virus.

Activists blame the U.S. government and the pharmaceutical companies. Uncle Sam, they say, underfunds condom distribution. Given the activists’ antipathy to abstinence-eager Texans, it probably won’t do much good to point out that the dreaded Bush administration is spending more on condoms than Clinton’s ever did. This year, the U.S. Agency for International Development is expected to donate more than 500 million condoms to poor countries around the world.

The “Big Pharma” story is less straightforward. Activists say the drug companies have underfunded R&D.; But the truth is that the drug makers have spent tens of billions of dollars on fighting AIDS. Now, however, they are quietly pulling back. Why? Because they no longer see profits ahead. The drug companies are being pressured into basically giving away their existing anti-AIDS meds in Third World countries, home to 95% of the 38 million people infected with the virus.

Even so, they are routinely vilified; the chief of Pfizer, Hank McKinnell, was booed off the stage in Bangkok. If a pharmaceutical company were to come up with an AIDS-smiting “silver bullet,” Magic Johnson would gladly pay the sticker price, while everyone else would demand it free. If you’re Pfizer, it’s hard to make money that way.

Absent any short-term hope for a cure, the activists seem determined to make the band play on -- that is, to preserve maximum sexual freedom for all, no matter what the cost. In Bangkok, all discussions on abstinence were dismissed; out in front of the convention center was a giant condom, described as a “victory monument.”

In the lobby stood a display honoring -- yes, that’s the right word -- sex workers; the Debby Project, the Australian art protest troupe that sponsored the exhibit, declared: “It is not necessarily degrading to have intimacy with strangers. In fact, it is one of the most liberating things you can experience.”

Tragically, avant-garde thinking on AIDS is returning to where it was two decades ago: No pesky disease should get in the way of sexual liberation. That was the overwhelming message, and it’s a killer. In the words of Abner Mason, a member of the Presidential Advisory Council on HIV and AIDS, who was appalled by what he witnessed in Bangkok: “They think they’re defending a lifestyle. But actually, they’re creating a death-style.”

But now there’s a new twist: The creation of a permanent, self-perpetuating AIDS bureaucracy that has a vested interest in maintaining the disease but little interest in curing it. For every case of AIDS today, somebody -- usually a middleman of the type well represented in Bangkok -- gets money.

The world now spends about $4.7 billion a year on AIDS. About two-thirds of that comes from the U.S. And both governments and nongovernmental organizations have figured out that if they make enough noise, they can get even more for AIDS treatment. President Bush has pledged to spend an additional $15 billion over five years, and John Kerry has pledged to double that.

And of course, any number of big-name foundations -- Bill Gates, Bill Clinton, Elton John -- are writing checks too. Thus has “Big AIDS” -- the network of caregivers, consciousness-raisers and, of course, condom distributors -- become a big business. Five million people contracted HIV last year -- and as for the next 5 million, they’re worth billions too, according to a grim dollars-for-dying formula.

In this new environment, when funding streams correlate with victim streams, the vision of a cure as a goal yields instead to perpetuation as a goal.

And if perma-funding for the dying becomes the new “mode of production” -- that is, a lucrative career path for the press-savvy and the politics-connected -- then a legitimating superstructure of ideology will emerge. Indeed, I heard it articulated by Gregg Gonsalves of the Gay Men’s Health Crisis in New York City, who told fellow activists in Bangkok that the key to fighting the AIDS epidemic was “documenting the work of the community, tapping into the community, acknowledging the work of communities.”

As for science? It seems that people power is more important than laboratory power. Amid all this well-funded sound and fury, the AIDS virus survives. Unimpeded by vaccines, unthreatened by eradicating medicine, it is free to continue striking, infecting and -- following what scientists know as a Darwinian inevitability -- mutating into newer and more lethal forms.

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James P. Pinkerton is a fellow at the New America Foundation in Washington.