There is an 800 pound gorilla in the room that nobody talks about, but which prevents our efforts to expand scientific knowledge about AIDS and other diseases from being translated into anything even approaching as healthful a world as existing science and technology could easily make possible. We work to develop better treatments and vaccines and we hope that business and government leaders will translate that knowledge into the best possible practical policies to help the millions of people on the planet whose lives are in the balance. But it isn’t happening.

The 800 pound gorilla that no one wants to acknowledge is that our business and government leaders are working against us and against a healthful society. They use organizations like the World Trade Organization, World Bank and the International Monetary Fund (IMF) to impose on Third World countries huge and insurmountable debt burdens coupled with "austerity" programs which destroy the infrastructures necessary to healthful societies. (See "Why Is Africa So Poor" below.) And they keep 40 million people from having health insurance in the U.S. Why? Because it is poverty and desperation, and only that, which force third world people to work in the sweatshops, plantations and mines owned and operated for the benefit of multinational corporations who, far from "developing" poor nations, are undeveloping them, holding them back and driving them down in order to extract their mineral and agricultural resources and obtain super cheap labor to enrich big investors. Likewise, in the U.S. it is fear of losing health insurance that keeps many people from quitting jobs they don’t like.

Elites make people controllable by making them economically and psychologically insecure -- deliberately making health care and economic security artificially scarce, keeping people poor and desperate, and using terror to keep them fearful.

There is increasing media coverage of Third World poverty. The Boston Globe, for example, reported January 26, 2003, "Yesterday, 24,000 people worldwide could have been saved with basic care...In all, over the last year, 8.8 million lives were lost needlessly to preventable diseases, infections, and childbirth complications." Dr. Long Viseth, a clinician in rural Cambodia, told the Globe, "AIDS is terrible but not as devastating as the everyday killer diseases that shouldn’t be killing people at all."

Yet the Globe’s report ignored the causes of these deaths, which have to do with economic and political forces from outside these societies. Those causes become more evident on examination of South African society, where life expectancy of persons born in South Africa has dropped astonishingly from 1996 to 1998--from 64 to 53 years. The end of apartheid brought the beginning of "neoliberal" policies favored by the IMF and World Bank: privatizing water supplies and electricity, for example. Poor South Africans cannot afford water or electricity. Since 1994, ten million have had their water and electricity cut off. The result has been an explosion of cholera.

Some might argue that corporate and government leaders don’t deprive people of healthful societies on purpose, that it’s just a side effect of doing business which these leaders work to minimize. But market-driven health care, a policy initiated in 1987 by the Committee For Economic Development (composed of CEOs and directors of 200 of the largest corporations in the U.S., only a few of which are insurance companies), restricts care and keeps millions uninsured. Clinton advocated a version of market-driven health care; he never called for universal health care for all Americans as a right, even though polls consistently showed Americans wanted this and would pay more taxes to get it. Market-driven health care was defended as a cost-saving measure. But a 1990 U.S. Government Accounting Office report on health care costs reported that the Canadian single-payer system had proportionately much lower costs than the U.S. because Canadian spending on insurance administration was lower. So why do our leaders veto health care as a right for all when it is both economically rational and what people want? The explanation is that making health care scarce is an intentional social control strategy.

The poorest people in the world seem to understand what causes their poverty and poor health. Argentinians, in massive rebellion against all politicians who enforce IMF austerity plans, toppled five governments last year. In Brazil, the largest vote ever received by a presidential candidate went to Luis Inacio Lula da Silva because he promised relief from the IMF/World Bank poverty-producing measures. "IMF riots" occur everywhere –– Ghana 1995, Indonesia 1998, Bolivia 2000, Equador 2001.

President Bush’s AIDS Initiative

Why would President Bush ask "Congress to commit $15 billion over the next five years, including nearly $10 billion in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean?"

Three reasons, none of which are a concern for the health of ordinary people, seem evident: 1. Corporate and government leaders fear that they must make such announcements, and back them up with enough action to look credible, or they may fail to contain the rising anger against them from poor people who know that their suffering and deaths are unnecessary. 2. As the CIA has stated, too many HIV deaths create instability that threatens the ability of undemocratic World Bank/IMF-backed governments to stay in power. 3. HIV treatments are like food and other necessities of life: elites control people not by completely denying them these things, but by controlling these commodities and allowing people to have them only in exchange for accepting their inferior position in an increasingly undemocratic and unequal world.

AIDS research will only be used the way we want it to be when "IMF-rioters" and millions of other people who are fighting the 800 pound gorilla win. They, not pro-corporate leaders, are the ones we need to support. Instead of devoting time at our professional conferences to hearing corporate and government leaders tell us how much they support our efforts, wouldn’t it make more sense to devote that same time to discuss how we can support popular movements around the world who are fighting these leaders and their destructive policies? One step might be to invite some of these people to speak to us and to honor their efforts.

It may be too much to expect CROI conferences to have keynote speakers who identify the real obstacles to achieving truly healthful societies, or who would present a framework within which we could have a realistic chance of improving rather than undermining the health of billions of people, but surely conceiving of such a framework is a task on which we as health professionals should be focusing our energy and attention, and within which we should develop our research.