Abstract
Five years ago, the Clinton administration declared the global HIV/AIDS pandemic a national security threat. Some reacted with disdain, but even the intelligence community, as far back as 1991, had acknowledged the peril. A detailed report predicted that, within the decade, 45 million people would be infected–more than the number of combatants killed in World War I, World War II, Korea, and Vietnam combined. To date, more than 20 million have died, and more than 39 million are infected.
Staggering as these numbers may be, they fail to convey the horrifying structural dimensions of this crisis. AIDS not only kills people, but also hollows out the core of societies, weakening the ability of communities, states, and entire regions to forge and maintain even the most basic institutions necessary for peace and security. The disease's impact is even more severe in conflict zones, where health surveillance is uneven if undertaken at all and HIV is spread, unrestricted, by soldiers and the civilian victims forced to flee their homes.
The HIV/AIDS pandemic is rightly regarded as an emergency, but this designation should not prompt a response that is more characteristic of short-term humanitarian relief than long-term development. It is no coincidence that HIV prevalence is greater in the world's poorest and weakest countries, for it is in these places that there is little with which to counter the spread of the disease: Infrastructure is limited in scope and poorly maintained; health and education services are grossly inadequate; and budgets are constrained by debt. A truly effective effort demands that the United States consider an increase in the overall aid budget and redouble its efforts to erode the gains of global poverty. Infrastructure may be expensive, but it is a wise investment. The same physical infrastructure needed to deliver vital medicines also serves local trade and foreign investment, the expansion of social services, and the movement of humanitarian goods and services in times of crisis.
HIV/AIDS is weakening states and communities faster than we can strengthen them. We are all aware of the threats posed by weak states–AI Qaeda planned its September 11, 2001 attack on the United States from Afghanistan. President George W. Bush rightly pointed to the threat posed to America by weak states in his 2002 National Security Strategy, but three years later we have no plan, no dedicated resources, and no evident political commitment to making the investments necessary to counter this threat. The Bush administration's Millennium Challenge Account is not the answer, since it limits foreign assistance to those countries already functioning well. It is not enough to only invest in capable states–the United States must also invest in making more states more capable.
Nor should nations torn by conflict be exempt from effective AIDS strategies. During the civil war in El Salvador in the 1980s, for example, UNICEF successfully negotiated “days of tranquility” to allow polio vaccination campaigns. While managing HIV/AIDS requires more than the limited access provided by that model, negotiating “peace corridors” could, for example, allow for AIDS education and treatment along transport routes, within militaries, or among refugee or displaced populations. Similarly, incorporating AIDS programs into immediate post-conflict efforts could allow for the prompt resumption of disease surveillance efforts while also serving as a noncontrover-sial confidence-building measure among previously warring factions.
Finally, good science will prove a better guide than ideology. Abstinence is a personal choice, and the Bush administration's decision to make it the cornerstone of policy in countries where many women have no choice is at best na'ive and at worst irresponsible. Almost three decades into the struggle to defeat the HIV/AIDS pandemic, medical experts, health practitioners, and the men and women whose lives are directly threatened have learned what works. We should listen to them, rather than impose our own ideals. To do less is to condemn millions to death.