Charity at Home

The battle against AIDS holds lessons for development.

THE DEBATE about HIV-AIDS often reflects the wider argument about development in poor countries, and the 16th International AIDS Conference, held last week in Toronto with 24,000 scientists and activists in attendance, confirmed that tendency. The conference underlined a lesson that the development business ought to embrace more readily: The prospects for advance in poor countries depend not just on programs launched within their borders, but also on programs launched in the rich world.

Consider the cycle that HIV-AIDS has gone through. Five or six years ago, most experts believed it would be folly to treat people in poor countries who were infected with the virus: Anti-retroviral drugs seemed prohibitively expensive; persuading impoverished people to adhere to a complex medical regime was said to be impossible; and the experts insisted that scarce HIV budgets should be aimed at preventing new infections. But around 2003, the experts reversed themselves. Political pressure had forced drug companies to cut prices and tolerate cheap generics, so anti-retroviral treatment seemed affordable. Illiterate people had proved capable of taking medicines punctually. And the experts pointed out that the first step toward preventing new infections was to encourage people to get tested for the virus -- which in turn made it essential to offer the incentive of treatment.

So in 2003 the World Health Organization announced a goal to get 3 million people in poor countries into treatment by 2005. A year after that deadline, about 1.6 million are receiving medicines, but long before the goal is met, the cycle is again turning. At the Toronto conference, prevention received more emphasis than treatment, for the good reason that virus continues to infect 4 million healthy people annually. Of course, the AIDS experts know this isn't their first experiment in prioritizing prevention. So they hope this time to bring new tools to the challenge: vaginal microbicides that kill the virus before a woman is infected; campaigns to circumcise men, since circumcision greatly reduces the odds of infection; and perhaps, eventually, a vaccine.

A microbicide or a vaccine would be the product of research conducted mainly in U.S. and European laboratories: Hence the lesson that the fate of the poor world depends partly on programs launched in rich countries. It's a valuable lesson that goes beyond the AIDS virus, because other aspects of development can also be advanced with new technologies or practices adopted in rich countries. Vaccination drives in poor countries have been helped by the invention of ingenious syringes that block after one use, preventing children from being hurt or infected by blunt or dirty needles. Agricultural output has been helped by new crop technologies -- and could be helped much more if Europe were to abandon its anti-scientific suspicions of genetically modified seeds. Corruption can be addressed not just by campaigning against it in poor countries-- but also by pressing oil and mining companies in the West to disclose royalty and tax payments to poor governments in their financial statements. Economic growth in poor countries could be boosted by efforts in rich countries to cut tariff barriers and farm subsidies.

If past battles against AIDS and underdevelopment teach anything, it is that rich and poor countries are interdependent, that programs launched by outsiders in poor countries are tough to implement, and that whatever can be done at home can be mutually beneficial and therefore a priority.