After reading Greg Behrman’ book, “he Invisible People: How the U.S. Has Slept Through the Global AIDS Pandemic, the Greatest Humanitarian Catastrophe of Our Time,” I performed a quick survey of my Midwestern, politically middle-of-the-road family members. I asked them a simple question: What do you think the United States should do about the global AIDS pandemic? The responses I received ranged from “The global what?” to “I thought AIDS was over with,” to “Would you please shut up about global warming? It’s no hotter this summer than last summer.”
My family’s response is, I believe, typical: victims of the global AIDS pandemic truly are, in the eyes of much of America, invisible.
Any why not? The number of deaths from AIDS in the United States has plummeted since the introduction of anti-retroviral (ARV) drugs in 1996. The people I know who were supposed to die from AIDS are still very much alive and kicking, many of them as healthy as they have ever been. The war is over. We won. Right?
Unfortunately, no. The war is far from over, and we are hardly winning. For instance, 40 percent of the adult population in Botswana is infected with HIV. There, and in Zimbabwe and other nearby countries, the average life expectancy has dropped to under 40 years, and by 2010 could decrease to less than 30 years. In South Africa, by far sub-Saharan Africa’s most affluent and advanced nation, the infection rate is lower but still amazingly high—one in five.
There are currently more than 15 million AIDS orphans worldwide. That number is likely to increase to 25 million by 2010. Consider that the population of New York State is approximately 19 million, and you get an idea of what 25 million AIDS orphans looks like.
These stunning statistics beg an answer as to how this tragedy has been allowed to unfold. Behrman addresses that in this book. Behrman, a member of an aids task force of the Council on Foreign Relations Roundtable advising the Bush administration on improving U.S. global AIDS policy, relies on interviews with more than 100 individuals, many of them key political figures, policy makers or activists, to chronicle the actions—and inactions—of our government since the first identification of AIDS in the early 1980s.
Behrman has provided a meticulously researched history, but writing with a cinematic, nearly ferocious flair, he also manages to bring this sweeping, yet removed, story to life. He takes us to Africa, to backroom political haggling sessions, to wherever we need to go to better understand the global AIDS pandemic. We are there, and the force of his writing helps us to care about what is happening. The value of Behrman’s literary style cannot be underestimated in not only making this a highly readable book, but also in pressing an effective case for changing policies in Washington and abroad.
Behrman’s basic measure for judging global AIDS-fighting commitment is, logically, funding dollars. In the 1990s, during the first Bush and the Clinton administrations, the U.S. spent anywhere from $100 million to $215 million annually fighting AIDS outside the U.S., while spending as much as $10 billion each year combating the epidemic domestically. This incredible disparity seems even more egregious when one learns that infections worldwide outpaced those at home by a margin of at least ten to one.
But money is not the only measure by which Behrman charts policy ineptitude. The Reagan administration, for instance, is chastised for imposing a misguided morality on the disease, making vitriolic statements and banning infected persons from entering the country, and then otherwise sweeping the issue under the rug.
The Clinton administration is taken to task for, among other things, opposing South Africa’s attempt to obtain low-cost generic ARV medication. Behrman’s outrage at the lack of leadership and financial assistance provided by the United States is understandable. But the domestic focus of the U.S. effort, while not ideal, is perhaps excusable in light of the widespread gloom about making advances in treating Americans living with HIV until the emergence of ARV drugs.
After all, we were losing our own, and we needed to deal with it. Behrman, for all his meticulous research and analysis, seems to discount this, browbeating U.S. leaders for focusing on the problem in our own backyard rather than the one down the street. Such criticism seems politically naïve, given the enormous pressure for effective prevention and treatment here at home. Still, it is clear that more could have and should have been done, and that a less myopic approach would have resulted in a current situation far less dire.
Behrman responsibly focuses not only on failures, but successes, such as the work of Dr. Paul Farmer and of Doctors Without Borders, and the example set for the developing world by the Brazilian government bringing affordable AIDS treatment to its HIV-positive population. The work of rock star Bono in wooing ultra-conservative Sen. Jesse Helms to change his stance on AIDS funding also makes for a compelling story, one that helped make possible the climate for the current administration’s $15 billion AIDS-fighting initiative, which Behrman says is still “woefully inadequate.”
Still, my relatives in the Midwest—who vote regularly, I should add—might ask, “How does this affect me?” And it is this question to which Behrman provides the most compelling answer: The global AIDS crisis is as much a threat to the well-being of the United States as is terrorism or war. Populations in Africa, Asia, and Eastern Europe are becoming infected at an alarming rate, and because these populations don’t have ready access to life-extending ARV drugs, the effects of the disease, if left unchecked, will be devastating. The death toll will collapse national economies, destroy military capacity, and potentially lead to monumental governmental chaos. The world economy and political stability could find itself at significant risk, with no country—not even the United States—unaffected.
This scenario may sound needlessly alarmist, but the facts that Behrman outlines clearly suggest otherwise. His arguments are well constructed and eloquent—and difficult to refute.
Behrman is not alone in his analysis. A diverse array of leaders including Bill Clinton, Colin Powell, and Richard Holbrooke, a key foreign policy advisor to Democratic presidential nominee John Kerry, have each stated that there is no global crisis as serious or as deadly as the AIDS pandemic. Fortunately, with intelligent and informed individuals like Greg Behrman helping to shape U.S. policy, there is hope that the situation can be reversed.