Certainly, I thought, the same must be happening in the low-income world. With all the worldwide attention on AIDS, and all the hand-wringing and speeches, surely the donor world was gearing up to help the impoverished world to fight this terrifying epidemic. But once again, my presumptions were wrong. Attaran and I went to work on the donor figures, and once again we were blown away by what we found. Could it really be right that the world was giving just $70 million to all of Africa to fight AIDS? Was this even conceivable? As we started circulating these data there was no statement of correction or complaint from the donors. These estimates were, stunningly, the right numbers, and soon afterward Attaran and I published them in one of Britain's leading medical journals, The Lancet.
Over and over again, I saw the difference between spin and reality in how the world community faced AIDS and malaria. At one point, for example, an IMF official published a letter in the Financial Times noting that health and education spending in poor countries with IMF programs was actually up 2.8 percent per year between 1985 and 1996. The fact is, however, that although the IMF was correct in a strictly technical sense, health spending was disastrously, indeed shockingly, low in African countries with IMF programs. In most cases, public health spending in 1996 was below $10, so the increase had been from almost nothing to almost nothing. I was initially amazed that the IMF would play such tricks with the public, but I came to realize that the Fund had no special feel for these numbers. The IMF management and staff know very little about public health, and have traditionally paid almost no attention to whether health spending in their client countries was $10 or $100 or $1,000 or more per person (as it was for the rich countries that dominate the Executive Board of the institution).
Around the same time, I made a speech noting that the World Bank had made no grants or loans during 1995-2000 for controlling AIDS in Africa. A bank spokesman attacked me vigorously. "You don't know what you're talking about. We had several program countries with AIDS programs." "That can't be, I've checked, and I did not find a single loan." Again, they were technically correct, in a way that utterly distorted the truth. There were probably a few dozen countries where AIDS was mentioned in a sentence or maybe a paragraph, in a loan for the health sector. The AIDS component was usually tiny, perhaps a few million dollars over several years. Up to the year 2000, these minimal efforts never even contemplated the use of antiretroviral drugs to treat AIDS.
In the late 1990s, in the wake of my public spats with the IMF over their mismanagement of the 1997-98 East Asian financial crisis, I went on the warpath with the international financial community over AIDS and malaria. I called for an end to the international community's gross negligence regarding the diseases ravaging Africa. I complained that the IMF and World Bank had been in Africa for decades, but had remained blind to the most basic realities there, and to the growing human and economic catastrophe.