Obama stops thinking positive

A year on from his inauguration, the president stands accused of reneging on inspiring campaign prom

Once, no one wanted to talk about Aids. Now the global pandemic commands $14bn a year, roughly half of all spending on health worldwide. The single most important contributor to Aids funding is the US President's Emergency Plan for Aids Relief, or Pepfar for short.

Launched by George W Bush in 2003, Pepfar is the largest financial commitment ever made by any nation to combat a single disease. It wields a budget of $6.7bn for 2010 alone, and claims to have succeeded in putting more than 2.4 million people on antiretroviral therapy, particularly in its "focus" countries (primarily in sub-Saharan Africa). This includes some double-counting with the other major provider of antiretrovirals, the Global Fund to Fight Aids, Tuberculosis and Malaria, but the scope is impressive nonetheless.

The tentative optimism needs to be put in context. There are still 33.4 million people with HIV, and, as access to antiretrovirals improves, the number living with the virus continues to climb. Moreover, Aids-related illnesses remain a major cause of death globally, claiming two million lives a year. Initiatives such as Pepfar may have provided life-saving drugs to many, but some global health advocates feel that such organisations are at times more accountable to themselves than to the people enrolled on their programmes. And their sheer scale can disrupt the local health systems of small African countries.

Under Bush, Pepfar faced more criticism than most. Its initial refusal to purchase and disperse cheaper, generic antiretrovirals, in preference for only drugs approved by the US Food and Drug Administration, delayed the roll-out of life-saving medicines and demonstrated an unseemly interest in extending the market for overpriced (and usually US-manufactured) drugs. Equally controversial was the Bush-era insistence that a third of the money slated for reducing HIV infection be spent on promoting social values, including abstinence, delay of sexual debut and partner reduction. Such policies are straight out of the Republican book of morals. A focus on monogamy has little value as a preventive tool in countries such as Thailand, where the main mode of transmission is now between married partners.

Self-selective choice

With the election of Barack Obama a year ago, hopes were high that much of this would change for the better and that Pepfar might become a more positive standard-bearer in the global fight against HIV and Aids.

The new president was quick to repeal the most controversial of Bush's global health policies: the "global gag rule" - an outright refusal to fund any organisation that offered (or even provided information about) abortion. And with the appointment of the new US global Aids co-ordinator, Eric Goosby, the emphasis at Pepfar soon began to fall less on the "emergency" response and more on sustaining existing programmes. Sustainability is important to avoid the emergence of drug resistance, which can render antiretrovirals ineffective.

However, some activists argue that such talk merely disguises the harsh reality of funding cuts. As early as May last year (when his budget plans for 2010 exposed a $1.5bn shortfall in Pepfar funding), they were arguing that the new president had reneged on his campaign promises on Aids.
Since then, Obama has not responded convincingly to their concerns. His new five-year Aids plan, released at the end of 2009, is silent on the extent to which Pepfar intends to address concerns about the ongoing lack of transparency in its funding. This worries global health advocates, who wonder if the strategic interests of the US, rather than the health needs of people in its programmes, may be determining Pepfar's choice of which Aids programmes to fund and where. Addressing these problems will be difficult, but it is essential that Obama should do so sooner rather than later. For all the importance of treatment, it remains the case that, for every two people being put on antiretrovirals, a further five are being infected.

There are, however, systemic as well as political problems to overcome. Pepfar allocates a great deal of funding on the basis of evidence it receives from Aids programmes already in operation. But according to Vinh-Kim Nguyen, a doctor and social scientist with the University of Montreal's department of social and preventive medicine, such evidence of the efficacy of particular interventions can be self-selecting. Organisations promoting treatment interventions (rather than, say, simple prevention or safe sex) find it much easier to get hold of supporting data, because much of the data is taken from individuals already enrolled on programmes being evaluated. Anyone else is excluded, so there is little countervailing evidence (it's hard to provide data on a person not yet infected). But that also makes it difficult to know whether treatment-only approaches to HIV and Aids are always the most effective.

This should not be taken as an argument for scaling back antiretroviral provision, but it makes it much trickier to gauge how, when and where treatment would be more effective than a less costly alternative.

Social complications

The underlying problem with Obama's Pepfar is that - for all the lip-service Goosby has paid in recent months - it is not fully engaging with the constellation of problems associated with HIV and Aids: vulnerability to infection, impoverishment, disempowerment of women, stigmatisation and a persistent Aids denialism, to name a few. These are social issues that are not always easily quantified, and are often the consequence of relative inequality as much as outright poverty.

In sub-Saharan Africa, women aged between 15 and 24 are more than three times as likely as their male counterparts to be HIV-positive; in the United States, the prevalence of HIV among African-American males in the District of Columbia ranks alongside that of some of the worst-affected countries. The only consistent feature linking sub-epidemics among injecting drug users in the former Soviet republics, men who have sex with men in Asia and heterosexual women in sub-Saharan Africa is the way that HIV can be seen, in each case, to cut along and reinforce pre-existing socio-economic divides.

With funding for many global health initiatives likely to decline in the current economic climate, there is concern that these underlying causes of vulnerability will be pushed further to the margins in a drive for greater statistical accountability and savings in initiatives such as Pepfar. Pledges to the Global Fund are down. The lives of those who have already been enrolled on antiretroviral programmes in settings where there continues to be a lack of development in local health systems will be put at risk. So, too, will the lives of many more people as yet uninfected.

Simon Reid-Henry is director of the Centre for Global Security and Development at Queen Mary, University of London

DC doubles up as infection capital

A report published in March 2009 revealed that more than 3 per cent of the population of the District of Columbia - Washington, DC - is infected with Aids or HIV. This makes the area the most severely affected in the United States. According to Shannon Hader, director of the district's HIV/Aids administration, such rates are "on a par with Uganda and some parts of Kenya . . . higher than in West Africa".

Following another report - issued in 2007 - that aimed to emphasise the unsettling reality of what was called a modern epidemic, the 2009 document showed a 22 per cent increase in the number of cases of the illness (currently estimated at roughly 15,120).

Worse still, health professionals observed, the latest figures are based on those who agreed to be tested; as such, the actual number is likely to be far higher than the report suggests. And the rate is "on the rise", claims Hader, due to the widening scope of the condition. Once mainly affecting men who have sex with men, HIV/Aids is now a health risk for people of every age, race and sex.

The US government has been criticised for failing to confront the crisis effectively. Critics note how policies that prevent the use of public funds for social programmes such as needle exchanges have led to an increase in the rate at which drug users are being infected by the virus.

Others suggest that the key to tackling the crisis is open discussion, to break down the taboos surrounding HIV and Aids.

Harriet O'Brien

This article first appeared in the 01 February 2010 issue of the New Statesman, Unforgiven

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The strange death of boozy Britain: why are young people drinking less?

Ditching alcohol for work.

Whenever horrific tales of the drunken escapades of the youth are reported, one photo reliably gets wheeled out: "bench girl", a young woman lying passed out on a public bench above bottles of booze in Bristol. The image is in urgent need of updating: it is now a decade old. Britain has spent that time moving away from booze.

Individual alcohol consumption in Britain has declined sharply. In 2013, the average person over 15 consumed 9.4 litres of alcohol, 19 per cent less than 2004. As with drugs, the decline in use among the young is particularly notable: the proportion of young adults who are teetotal increased by 40 per cent between 2005 and 2013. But decreased drinking is not only apparent among the young fogeys: 80 per cent of adults are making some effort to drink less, according to a new study by consumer trends agency Future Foundation. No wonder that half of all nightclubs have closed in the last decade. Pubs are also closing down: there are 13 per cent fewer pubs in the UK than in 2002. 

People are too busy vying to get ahead at work to indulge in drinking. A combination of the recession, globalisation and technology has combined to make the work of work more competitive than ever: bad news for alcohol companies. “The cost-benefit analysis for people of going out and getting hammered starts to go out of favour,” says Will Seymour of Future Foundation.

Vincent Dignan is the founder of Magnific, a company that helps tech start-ups. He identifies ditching regular boozing as a turning point in his career. “I noticed a trend of other entrepreneurs drinking three, four or five times a week at different events, while their companies went nowhere,” he says. “I realised I couldn't be just another British guy getting pissed and being mildly hungover while trying to scale a website to a million visitors a month. I feel I have a very slight edge on everyone else. While they're sleeping in, I'm working.” Dignan now only drinks occasionally; he went three months without having a drop of alcohol earlier in the year.

But the decline in booze consumption isn’t only about people becoming more work-driven. There have never been more alternate ways to be entertained than resorting to the bottle. The rise of digital TV, BBC iPlayer and Netflix means most people means that most people have almost limitless choice about what to watch.

Some social lives have also partly migrated online. In many ways this is an unfortunate development, but one upshot has been to reduce alcohol intake. “You don’t need to drink to hang out online,” says Dr James Nicholls, the author of The Politics of Alcohol who now works for Alcohol Concern. 

The sheer cost of boozing also puts people off. Although minimum pricing on booze has not been introduced, a series of taxes have made alcohol more expensive, while a ban on below-cost selling was introduced last year. Across the 28 countries of the EU, only Ireland has higher alcohol and tobacco prices than the UK today; in 1998 prices in the UK were only the fourth most expensive in the EU.

Immigration has also contributed to weaning Britain off booze. The decrease in alcohol consumption “is linked partly to demographic trends: the fall is largest in areas with greater ethnic diversity,” Nicholls says. A third of adults in London, where 37 per cent of the population is foreign born, do not drink alcohol at all, easily the highest of any region in Britain.

The alcohol industry is nothing if not resilient. “By lobbying for lower duty rates, ramping up their marketing and developing new products the big producers are doing their best to make sure the last ten years turn out to be a blip rather than a long term change in culture,” Nicholls says.

But whatever alcohol companies do to fight back against the declining popularity of booze, deep changes in British culture have made booze less attractive. Forget the horrific tales of drunken escapades from Magaluf to the Bullingdon Club. The real story is of the strange death of boozy Britain. 

Tim Wigmore is a contributing writer to the New Statesman and the author of Second XI: Cricket In Its Outposts.

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What Jeremy Corbyn can learn from Orwell

Corbyn’s ideas may echo George Orwell’s – but they’d need Orwell’s Britain to work. It’s time Corbyn accepted the British as they are today.

All Labour Party leaderships since 1900 have offered themselves as “new”, but Tony Blair’s succession in 1994 triggered a break with the past so ruthless that the Labour leadership virtually declared war on the party. Now it is party members’ turn and they, for now at any rate, think that real Labour is Jeremy.

To Keir Hardie, real Labour had been a trade union lobby expounding Fellowship. To the Webbs, real Labour was “common ownership” by the best means available. Sidney’s Clause Four (adopted 1918) left open what that might be. In the 1920s, the Christian Socialist R H Tawney stitched Equality into the banner, but during the Depression young intellectuals such as Evan Durbin and Hugh Gaitskell designated Planning as Labour’s modern mission. After the Second World War, Clement Attlee followed the miners (and the London Passenger Transport Board) into Nationalisation. Harold Wilson tried to inject Science and Technology into the mix but everything after that was an attempt to move Labour away from state-regulated markets and in the direction of market-regulated states.

What made the recent leadership contest so alarming was how broken was the intellectual tradition. None of the candidates made anything of a long history of thinking about the relationship between socialism and what the people want. Yvette Cooper wanted to go over the numbers; only they were the wrong numbers. Andy Burnham twisted and turned. Liz Kendall based her bid on two words: “Have me.” Only Jeremy Corbyn seemed to have any kind of Labour narrative to tell and, of course, ever the ­rebel, he was not responsible for any of it. His conference address in Brighton was little more than the notes of a street-corner campaigner to a small crowd.

Given the paucity of thinking, and this being an English party for now, it is only a matter of time before George Orwell is brought in to see how Jeremy measures up. In fact, it’s happened already. Rafael Behr in the Guardian and Nick Cohen in the Spectator both see him as the kind of hard-left intellectual Orwell dreaded, while Charles Cooke in the National Review and Jason Cowley in the New Statesman joined unlikely fashion forces to take a side-look at Jeremy’s dreadful dress sense – to Orwell, a sure sign of a socialist. Cooke thought he looked like a “burned-out geography teacher at a third-rate comprehensive”. Cowley thought he looked like a red-brick university sociology lecturer circa 1978. Fair enough. He does. But there is more. Being a middle-class teetotal vegetarian bicycling socialistic feministic atheistic metropolitan anti-racist republican nice guy, with allotment and “squashily pacifist” leanings to match, clearly puts him in the land of the cranks as described by Orwell in The Road to Wigan Pier (1937) – one of “that dreary tribe of high-minded women and sandal-wearers and bearded fruit-juice drinkers who come flocking towards the smell of ‘progress’ like bluebottles to a dead cat”. And though Corbyn, as “a fully fledged, fully bearded, unabashed socialist” (Huffington Post), might make all true Orwellians twitch, he really made their day when he refused to sing the National Anthem. Orwell cited precisely that (see “The Lion and the Unicorn”, 1941) as an example of the distance between left-wing intellectuals and the people. It seemed that, by standing there, mouth shut, Comrade Corbyn didn’t just cut his wrists, he lay down full length in the coffin and pulled the lid shut.


Trouble is, this line of attack not only misrepresents the Labour leader, it misrepresents Orwell. For the great man was not as unflinchingly straight and true as some people think. It is impossible, for instance, to think of Orwell singing “God Save the King”, because he, too, was one of that “dreary tribe” of London lefties, and even when he joined Labour he remained ever the rebel. As for Corbyn, for a start, he is not badly dressed. He just doesn’t look like Chuka or Tristram. He may look like a threadbare schoolteacher, but Orwell was one twice over. Orwell was never a vegetarian or a teetotaller, but, like Corbyn, neither was he interested in fancy food (or drink), he kept an allotment, drove a motorbike, bicycled, cared about the poor, cared about the environment, loathed the empire, came close to pacifism at one point, and opposed war with Germany well past the time when it was reasonable to do so.

In Orwell’s thinking about socialism, for too long his main reference point was the London Marxist left. Not only did he make speeches in favour of revolutions, he took part in one with a gun in his hand. Orwell was far more interested, as Corbyn has been far more interested, in speaking truth to power than in holding office. His loyalty was to the movement, or at least the idea of the movement, not to MPs or the front bench, which he rarely mentioned. There is nothing in Corbyn’s position that would have shocked Orwell and, should they have met, there’d have been much to talk about: belief in public ownership and non-economic values, confidence in the state’s ability to make life better, progressive taxation, national health, state education, social care, anti-socially useless banking, anti-colonialism and a whole lot of other anti-isms besides. It’s hard to be sure what Orwell’s position would have been on Trident and immigration. Not Corbyn’s, I suspect. He was not as alert to feminism as he might have been but equally, few men try to write novels from a woman’s point of view and all Orwellians recognise that Julia is the dark hero of Nineteen Eighty-Four. In truth they are both austere types, not in it for themselves and not on anyone else’s expense account either. Corbyn won the leadership because this shone through from the very beginning. He came across as unaffected and straightforward – much as Orwell tried to be in his writing.

Except, as powerfully expressed in these pages by John Gray, Corbyn’s politics were made for another world. What sort of world would he need? First off, he’d need a regulated labour market: regulated by the state in partnership with a labour movement sensitive to what people wanted and experienced in trying to provide it. He would also need capital controls, a manufacturing base capable of building the new investment with Keynesian payback, an efficient and motivated Inland Revenue, a widespread public-service ethos that sees the country as an asset, not a market, and an overwhelming democratic mandate to get things done. In other words, Corbyn needs Orwell’s Britain – not this one – and at the very least, if he can’t have that, he needs the freedom to act that the European Commission forbids.

There’s another problem. Orwell did not trust left-wing intellectuals and spent half his life trying to work out their motivations as a class who spoke for the people, went in search of the people, and praised the people, but did not know them or believe in them. True, Corbyn says he wants to be open and inclusive, but we know he can’t possibly mean it when he says it will be the party, not him or the PLP, that will decide policy, just as we knew it couldn’t possibly be true when he said he’d turn PMQs into the People’s Question Time. Jeremy hasn’t changed his mind in forty years, appears to have great difficulty (unlike Tony Benn) in fusing socialism to national identity or experience (Hardie, Ben Okri and Maya Angelou were bolted on to his Brighton speech) and seems to think that not being happy with what you are given somehow captures the historic essence of socialism (rather than its opposite).

Granted, not thinking outside the ­circle is an inherent fault of the sectarian left but some of our most prominent left-wing journalists have it, too. Working-class support for nationalisation? Good. Right answer! Working-class opposition to benefit scroungers and further mass immigration? Bad. Wrong answer! Would you like to try again? In his essay “In Defence of Comrade Zilliacus” (1947) Orwell reckoned that left-wing intellectuals saw only what they wanted to see. For all their talk of representing the people, they hated the masses. “What they are frightened of is the prevailing opinion within their own group . . . there is always an orthodoxy, a parrot-cry . . .”

The game is hard and he may go down in a welter of knives, yet Corbyn still has time. He may go on making the same speech – on the benefits of apple pie to apple growers – but at some point he will have to drop the wish-list and get on the side of the British people as they are, and live with that, and build into it. Only the nation state can even begin to do the things he wants to do. The quicker he gets that, the quicker we can see if the latest incarnation of new Labour has a future.

Robert Colls is the author of “George Orwell: English Rebel” (Oxford University Press)

This article first appeared in the 08 October 2015 issue of the New Statesman, Putin vs Isis