No matter how drawn-out, or how dreadful, the global AIDS pandemic turns out to be, those of us who have covered the story from San Francisco will always have a unique perspective. It was here, in a world center of an emerging culture of gay liberation, that the virus first signaled what it was capable of doing to a community.

When we write about sub-Saharan rates of HIV infection to describe the double-digit prevalence rates found in Zimbabwe or Botswana today, the numbers do not yet approach the disastrous percentages recorded among gay men in the Castro neighborhood of our city in the early 1980’s. The San Francisco AIDS experience has also demonstrated how human ingenuity, paired with political will, can contain a disease that now threatens entire populations of underdeveloped nations.

Yet, two decades into this scourge, the story of AIDS is anything but a tale of human triumph. The ghastly fact that AIDS has claimed more than 19,000 lives in San Francisco is becoming just a footnote to the larger story of a global calamity where the sick and dying are measured in the tens of millions and where the political stability of entire nations is at stake.

A Local Story Becomes Global

A profound local story has been eclipsed by one of international stature. This changed circumstance does not bode well for the quality of American coverage of the current AIDS epidemic. My fear is that just as the crafty AIDS virus evolves to sidestep the drugs, vaccines, antibodies and other components of the immune system, the epidemic is slipping from the grip of those who covered it well as a homegrown tale. Most reporters and news organizations are ill-equipped to write about this disease and its health issues on a global scale. I count myself among the culpable.

No doubt, the world is a smaller place in the era of the Internet. Yet in all but a select few media organizations, international coverage is a poor cousin to domestic news. Terrorism and the prospect of conflict in Korea and the Middle East have invigorated international reportage, but resources scraped together for a bureau in Baghdad are likely to drain the budgets that might otherwise serve AIDS coverage in Africa, India and China. America might be capable of fighting a twofront war, but I am not certain that the American press can handle a third front, the global war on AIDS.

Publishers assume, with some justification, that demand is limited for stories that don’t happen on Main Street. Editors are allotting their prime real estate to the stories that marketing consultants and focus groups say their target audiences desire. The appetite for international AIDS stories exists, but it is limited not only by America’s cultural myopia but also by the quality of the international product that limited news budgets can afford.

Too often, the global AIDS disaster is relegated to semiannual statistical updates from UNAIDS, or the biannual reports from International AIDS Conferences. The worst global pandemic since the Black Death of the Middle Ages receives less media attention than a World Cup soccer match. No doubt, some of the international AIDS coverage has been brilliant. Pulitzer Prizewinners Laurie Garrett (with Newsday) and Mark Schoofs (then writing for The Village Voice) have shown us how it can be done. And Elizabeth Rosenthal’s dispatches for The New York Times from China have alerted the world about the looming AIDS crisis in Asia.

That there are bright lights in the field should not distract us from the larger problem afflicting AIDS reporting. International stories, by their very nature, are more difficult and expensive to report. Some of the barriers are obvious, others less so. As news organizations shrink their foreign bureaus, staff resources in those bureaus might be restricted to coverage of political changes, conflict, commerce and the occasional plane crash. These days, it is the rare news organization that can afford a roving foreign correspondent, let alone a globetrotting AIDS reporter. The pool of experienced AIDS reporters is limited, and there are few among us that can break away regularly for international stories.

Difficulties in Reporting the Global AIDS Story

Reporters might be able to find outside support for the coverage of AIDS. The Kaiser Family Foundation, for example, offers paid fellowships for coverage of a wide variety of health policy stories. I was able to travel to South Africa, Uganda, Kenya and Zimbabwe through a Kaiser grant in 2000, although the San Francisco Chronicle, at the time, would not accept stories partly underwritten by an outside organization. I sold pieces instead to

Travel costs, language barriers, time zone differences, poor electronic communications, harsh conditions, and even physical danger make international reporting inherently more challenging. Yet none of these barriers has stopped the best of our profession from covering apocalyptic international stories: wars, revolutions, famines and natural disasters. AIDS is perhaps best described as a slow-moving natural catastrophe.

And therein lies the problem that has dogged AIDS coverage almost from the beginning. We journalists are great at covering the fast-breaking story, the new scientific discovery, sudden tragedy. Slow viruses and chronic wasting diseases do not play into our strengths as storytellers. As dramatic and important as the AIDS epic may be, it is a 20- year-old horror movie in which, at times, it seems that only the names of the victims are changing.

The most critical international AIDS story of our time—the bid to bring affordable versions of antiretroviral drugs to the Third World—is unfortunately mired in the nuance of intellectual property law, global trading protocols, and the obfuscation of diplomatic prose. Critical decisions are reached behind closed doors by diplomats in remote locales such as Doha, Qatar and Phoenix, Mauritius.

I was struck, during the 14th International AIDS Conference in Barcelona, with the passion of former President Bill Clinton, as he spoke of the need for the West to bring cheap drugs to the developing world. His view was echoed by former South African President Nelson Mandela, and former Canadian Prime Minister Kim Campbell, and former Indian Prime Minister Inder Kumar Gujral, and former Tanzanian President Ali Hassan Mwinyi. What a nice thing it would have been, had all these former global leaders the courage of their convictions when they could have done something about it.

Lacking the resources of The Wall Street Journal or The New York Times, I’ve had to pick my spots in the international AIDS story. Like any of us, I try to keep up with the pack and find stories others are overlooking. My first frontpage story about the movement to bring down the cost of AIDS drugs in Africa was printed in May 1999.

I’ve been drawn to stories I feel are underreported, such as the strong association between lack of male circumcision and high prevalence rates of HIV. If this simple, low-cost, one-time, and permanent medical intervention reduces HIV risk by 50 percent or more, as some studies suggest, the world ought to know about it. There is also intriguing evidence that widespread re-use of hypodermic needles, washed in buckets of tepid water, might be a far more significant factor in the spread of AIDS in Africa than previously recognized.

I’m fascinated by the progress achieved in deconstructing the AIDS virus and the hunt for new and better therapies. But the technical fix for the AIDS epidemic has the look and feel of the nuclear fusion solution to our energy woes—the answer is forever just a decade or so away. The steps that brought this epidemic under control in San Francisco are well known, but in the Third World they are grossly underutilized: condoms, clean needles, prevention education and marketing, treatment of venereal diseases, HIV testing, and treatment with triple-combination antiretroviral drug therapy. By ignoring international patents and producing its own AIDS drugs, Brazil is an example of a country that has contained a potentially explosive epidemic and demonstrated that a treatment strategy can work for an impoverished population.

The Politics of AIDS

AIDS has always been a highly political story, and its political dimensions have only grown as the story goes global. But the level of international coverage, like the global response to the epidemic itself, is inadequate for the task at hand. Secretary of State Colin Powell said in November that the AIDS pandemic was “the biggest problem we have on the face of the earth today,” yet the gap between rhetoric and reality appears wider than ever.

Three years after Pearl Harbor, American troops were poised on the border of Nazi Germany, Japan was in retreat, and the Manhattan Project was months away from its test of the atomic bomb. In the nearly three years since the Durban AIDS conference, when the prospect of cheap AIDS drugs was first widely publicized to the world, 95 percent of those who might benefit from such therapies still have no access to them. The path to widespread distribution of generic antiretroviral drugs is littered with American-led objections and obstruction.

It is a story that has been widely reported, but seldom on the front pages of our papers. It is a political story, but political editors love horse races, not snail’s paces. It seems to be that this slow-killing virus, which preys on the human penchant for denial, also exploits our short attention spans. The AIDS story is chronic, slow moving, and subtle. We favor the acute, the dramatic, and spectacular.

The Global Fund to Fight AIDS, Tuberculosis and Malaria has a goal of raising $10 billion a year, to scale-up AIDS prevention and treatment in the developing world. But pledges to the fledgling fund are but $2.2 billion. The program is in danger of running out of cash. The Bush administration pledge to this fund remains $500 million, even as the President announced his intent to devote $15 billion during the next five years to fight AIDS in Africa and the Caribbean. But even that intention wasn’t in evidence in the budget he submitted to Congress; instead of the two billion he pledged for next year, the Global Health Council analysis indicated a funding request for a bit more than one billion.

Meanwhile, America has cut its aid to family planning programs that have any link to abortion, and Africa is undergoing a condom shortage. Worldwide, donor nations are providing fewer condoms than in 1990, and the U.S. latex contribution has been cut in half. HIV rates are soaring in India and China, the two most populous nations on earth. The fastest growing population of the HIV-infected is in the states of the former Soviet Union. Twenty million people have died of AIDS since the disease was first discovered there in 1981. There are an estimated 40 million currently infected by HIV, and forecasts are for 68 million deaths by 2020. Yet how many people know this is happening there? Given the press coverage of this preventable human tragedy, far fewer know than should.

Powell might be right. AIDS might be the biggest problem facing the world today. Yet where does this epidemic rate among the Bush administration’s priorities? Where does it rate among the priorities of our newsrooms? The world’s biggest problems should be journalism’s biggest stories. By that standard, we are all falling down on the job.

Sabin Russell is medical reporter for the San Francisco Chronicle, where he has worked for 16 years. He covers medical science and health policy. He has written about HIV for more than a decade from both San Francisco and sub-Saharan Africa.

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