Most Generous Country

Today I saw a link to an interview done with bush in Ireland. Noted was the interviewer’s willingness to ask Bush difficult questions. I don’t personally think she was that rough on him, and he roughly just stayed on his talking points and shouted her down when she tried to call him on it. But he mentioned as contrast to the horrible things we’re doing in the world, that we’re also very generous. An example he gave was PEPFAR, his law to help prevent and treat the AIDS epidemic.

I’m currently reading “Confessions of an Economic Hitman” which has made me extremely skeptical of foreign aid. So I thought I would try and find out where that money is going. has some interesting numbers and a dissection of the program. Of course they had to file a freedom of information act request to get the numbers, and one set of the numbers was so badly kept as to be useless. Pretty much exactly what you’d expect.

The big number I was looking for was how much of the money was going to US based companies. Because after all, if we’re going to help poor brown people, let’s at least further subsidize rich white people while we’re at it right?

Here’s the interesting facts: 1. About half of the treatment money is going for antiretroviral drugs, which at the beginning were required to be highly expensive name-brand drugs approved by the Food and Drug Administration and provided largely by major American pharmaceutical companies. More recently, some two dozen generic formulations have been approved for PEPFAR use by the FDA. 2. Congress mandated that one-third of the prevention money (about 20 percent of the total appropriated) be earmarked to go to abstinence and fidelity programs. A 2006 Government Accountability Office report concluded that this spending requirement was hurting other programs in the field, such as prevention of mother-to-child transmission. 3. The discussion of condoms is routinely discouraged as a primary prevention approach among youth and cannot even be mentioned to those under age 15 in school programs, even if they are already involved in sexual conduct. Condoms can be addressed in out-of-school settings among youth who engage in high-risk behavior. 4. In general, at least two-thirds of all foreign aid funds never leaves the United States, according to a Congressional Research Service report. The money buys U.S. products, pays for U.S salaries, overhead, benefits packages, travel, American-made vehicles, office expenses, computers and other equipment. USAID awards 87 percent of its consultant dollars to U.S.-based firms.

So, US taxpayers are paying US drug companies artificially high prices (while generics have been approved, there’s only sparse evidence they’re being used) for drugs, and paying christian organizations to spread christian values about sex. Good times.

You can see from the public integrity page how the results are going. Seems that when you de-emphasize condom use, and emphasize abstinence only programs, infection rates go up. go figure.

But either way, you’d be within your rights to question the generosity of largely giving aid dollars to american companies for programs that have a shaky record of effectiveness. To be sure, ARV drug treatment for africans is pretty awesome, and I think that part of the program is a great success, how much PEPFAR is still paying for those drugs might not be, but it sounds like it’s getting there.

However I can’t find solid numbers anywhere for prevention. All I’m looking for are infection rates of the member countries for the years that PEPFAR has been working. Lots of people including the Government Accountability Office aren’t happy with the results, but I can’t find them. The Office of Global AIDs Coordinator’s own report [PDF link] is mysteriously silent about prevention rates, and only reports on prevention of mother to child infections.

But it also shamelessly proclaims they’re using the best evidence based prevention program in the world, despite better success rates from many other countries outlined in the study above, and condemnation from multiple groups that condom advocacy has long been proven to work better.

Apparently PEPFAR is undergoing some changes in the current legislative sections that should make the program more effective. I guess we’ll see.

Sidenote: I also thought it was funny that Bush was using people who’s hands were cut off by Saddam as an example of how bad he was. As far as I know, our buddies Saudi Arabia will cut off your hand for simple theft. And the bar for beheading is pretty low too. Yet we’re not storming their borders to stop the injustice are we?

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