As the AIDS Bureaucracy Cashes In, the Prospect of a Cure Dims

Tragically, avant-garde thinking on AIDS is returning to where it was two decades ago: No pesky disease should get in the way of sexual liberation. That was the overwhelming message, and it's a killer. In the words of Abner Mason, a member of the Presidential Advisory Council on HIV and AIDS, who was appalled by what he witnessed in Bangkok: "They think they're defending a lifestyle. But actually, they're creating a death-style."

But now there's a new twist: The creation of a permanent, self-perpetuating AIDS bureaucracy that has a vested interest in maintaining the disease but little interest in curing it. For every case of AIDS today, somebody -- usually a middleman of the type well represented in Bangkok -- gets money.

The world now spends about $4.7 billion a year on AIDS. About two-thirds of that comes from the U.S. And both governments and nongovernmental organizations have figured out that if they make enough noise, they can get even more for AIDS treatment. President Bush has pledged to spend an additional $15 billion over five years, and John Kerry has pledged to double that.

And of course, any number of big-name foundations -- Bill Gates, Bill Clinton, Elton John -- are writing checks too. Thus has "Big AIDS" -- the network of caregivers, consciousness-raisers and, of course, condom distributors -- become a big business. Five million people contracted HIV last year -- and as for the next 5 million, they're worth billions too, according to a grim dollars-for-dying formula.

In this new environment, when funding streams correlate with victim streams, the vision of a cure as a goal yields instead to perpetuation as a goal.

And if perma-funding for the dying becomes the new "mode of production" -- that is, a lucrative career path for the press-savvy and the politics-connected -- then a legitimating superstructure of ideology will emerge. Indeed, I heard it articulated by Gregg Gonsalves of the Gay Men's Health Crisis in New York City, who told fellow activists in Bangkok that the key to fighting the AIDS epidemic was "documenting the work of the community, tapping into the community, acknowledging the work of communities."

As for science? It seems that people power is more important than laboratory power. Amid all this well-funded sound and fury, the AIDS virus survives. Unimpeded by vaccines, unthreatened by eradicating medicine, it is free to continue striking, infecting and -- following what scientists know as a Darwinian inevitability -- mutating into newer and more lethal forms.

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James P. Pinkerton is a fellow at the New America Foundation in Washington.