AMERICA GIVETH, AMERICA TAKETH AWAY

In the battle against AIDS, the Bush administration is both savior
and scoundrel. Washington is the single largest financier of AIDS
programs in poor countries. But the administration uses its muscle to
extinguish necessary and successful programs it finds politically
objectionable, and to carry out ineffective ideological crusades.

First the good news. Washington's financing for AIDS treatment does
not go as far as it could because American programs have been buying
only expensive brand-name drugs, a sop to the pharmaceutical lobby.
Administration officials have said that without approval from the
Food and Drug Administration, they can't be sure that generics are
safe and effective, even though the World Health Organization has
endorsed many of them and AIDS programs around the world use them
with excellent results. It's not a question of science: the drugs
cannot be used in the United States because they would violate
patents, so the F.D.A. never examined them.

Until now. Last week, the F.D.A. approved for overseas use two
Indian-made generic versions of nevirapine, a standard ingredient in
the triple cocktail, and a generic version of efavirenz, another
widely used antiretroviral. That brings the number of approved
generic antiretrovirals to seven. While none are yet in use in
Washington's overseas programs, the approvals will eventually allow
four times as many lives to be saved for the same amount of money.

Also last week, however, the administration was on a moral crusade
that could lead to a significant rise in AIDS cases in Russia, China,
elsewhere in Asia and in the former East bloc. In these places, drug
users who inject are a prime risk group for AIDS, and the gateway
through which the epidemic will spread into the general population.
As many as a third of new AIDS infections outside sub-Saharan Africa
are in drug users; in Russia, Unaids estimates that injecting drug
users are 80 percent of the infected. Needle exchange programs can
help control this part of the epidemic.

But at a Unaids policy meeting this month, a Bush administration
official asked that all references to needle exchange be dropped from
the group's governing policy paper.

Unaids doesn't control much money, but it sets world policy on how to
fight AIDS, and usually operates by consensus to give its
recommendations more force. Although America is virtually alone in
its opposition to needle exchange, its clout as the largest Unaids
donor means it might be able to win a vote this week in the group's
program coordination board. If Unaids could no longer work on needle
exchange, nations would lose a valuable source of technical help. And
a lack of consensus could keep countries from starting needle exchanges.

American law already forbids United States money from financing
needle exchange programs. For Washington to decide that it wants to
stop everyone else from doing that as well is a breathtakingly dangerous step.