Man of the World: The Further Endeavors of Bill Clinton (19 page)

He apologized in passing for the shortcomings of his own administration, confessing that he had been wrong to oppose needle exchange—allowing heroin addicts to turn in old “works” for new, uninfected syringes, a practice shown to reduce that vector of spreading HIV. And then he cast aside his own administration’s defense of pharmaceutical patents, urging the drug companies to make more and better deals to reduce prices in developing countries—and failing that, he said, those countries should be allowed and encouraged to purchase cheaper generic drugs from India and Brazil.

“Developing countries have to work out how much they can pay and send the rest of us the bill for the difference,” he went on, urging the United States to lead the world in appropriating billions of additional dollars toward a global fund of at least $10 billion for treatment.

“Before the year is out,” he vowed, “I will go to Africa and India to
lend visibility and support” to the battle against AIDS, to seek “more money, more action, and more understanding. I pledge that in every speech I make and in every meeting I have, I will raise this and I ask you both to hold me accountable to that pledge and to tell me what more I can do.”

Introducing Mandela, Clinton intoned, “Only very rarely does the world respect someone as much as we love and respect him.” Then he listened as his old friend told the crowd that everyone suffering from HIV and AIDS should receive treatment, “no matter where they live or whether they can afford to pay.” Standing beside the iconic South African, Clinton seemed to endorse his position—at once the most radical and the most practical proposal to begin to reverse the pandemic, before a wave of death engulfed the future.

When the applause subsided, the two former presidents walked hand in hand to a backstage room where their aides and associates waited. As Magaziner stood listening, Mandela turned to Clinton and said, “You told me that you would do something for Africa when you left office.” He paused. “This is what you should do, focus on AIDS.”

That dramatic encounter, like hearing the voice of God, later became the source of a legend that Clinton had commenced his work against AIDS at Mandela’s command—a wonderful story, if not precisely accurate. Already Clinton and Magaziner had decided to begin working on what they then called the “AIDS Project.” But there was no denying that the direct injunction from Mandela deeply impressed both of them.

Or as Magaziner later put it, “In my mind, that was that.”

Within two days after their return from Barcelona, Magaziner quickly drafted a six-page memo to Clinton and Maggie Williams titled “AIDS Project—Next Steps.” The first three pages again outlined the scope of the problem—six million people in need of treatment within the next twelve to twenty-four months, 37 million more infected with HIV across the world who would need treatment soon, and another 50 million-plus projected to join the infected ranks in years to come “if current trends continue”—and what Clinton could do to reverse the crisis.

What fitted the former president to play a “unique role,” Magaziner
argued, was his status as “probably the most credible and recognizable global leader in the world today. He has credibility in most parts of the developing world as well as in the developed world, a rarity for an American leader. . . . I say this not to flatter him. I have known him too long and have been through too much grief in his service that I have no need to nor interest in flattering him.

“I say these things because they are true and because they give him an ability to play a unique role in this struggle. He has the trust of many of the leaders of developing countries that are confronting this crisis and he has the credibility to mobilize resources in the developed world in support of efforts to help the developing countries confront the issue.”

He even seemed to suggest that the most radical AIDS activists would be receptive to a Clinton intervention, if that meant more than just talk. Recalling the events of the previous few days, he reminded Clinton that “the world AIDS conference audience was a skeptical one who had been hostile to many speakers during the week. Yet the reception for President Clinton was enthusiastic. Even some of the radical activists I talked with after his speech valued the fact that he was expressing a willingness to help. Some expressed the wish that he had done more on issues like needle exchange and drug-company patents while he was in office. And some were still skeptical about whether he would back his words with real actions. But all were still appreciative and hopeful that he would provide leadership for the movement.”

World leaders and U.N. officials alike, he wrote, “recognize the value of what [Clinton] could bring, and they want to associate their activities with him as much as possible.”

The memo outlined three distinct roles for Clinton: promoting and expanding the new International AIDS Trust, pulling together a group of world leaders to speak out and raise awareness—especially in places like South and Central Asia, Eastern Europe, Russia, and “possibly even China,” where entire societies as well as political leaders remained in denial about the crisis; raising funds from the public, through the foundation in cooperation with other organizations; and, most important by far, “rolling out treatment programs around the world that will save lives.”

A massive effort to promote treatment in developing countries was the crux of the program that Magaziner hoped Clinton could launch.
He had accepted Paul Farmer’s critique of the emphasis on prevention insisted upon by Western governments, public health agencies, and academic experts, describing the focus on prevention as “easier politically,” because most AIDS victims were seen as “homosexuals, drug addicts, sex workers, or poor Black people in remote corners of Africa,” which made them “not a priority for many middle class and rich people in the developed world.”

Of course Clinton should advocate and promote prevention wherever he went, Magaziner acknowledged—but successful prevention was much more difficult without treatment.

“And where both you and I hang our moral hats, all human life is valuable and all of the victims of this disease deserve our help in any event. Letting people die when they can be saved is simply wrong.”

No matter how large a program Clinton and Magaziner envisioned, it would be impossible to begin at scale. But they would have to begin somewhere—and the most promising opportunity appeared to be in the Caribbean, a region close to the United States both in proximity and political disposition. Despite the rapidly mounting rate of HIV/AIDS infection among the island nations, they had so far received little attention from Western donors and aid organizations. But under Douglas’s leadership, the Caribbean states had banded together to negotiate a preliminary agreement with major drug companies to make medicine available at reduced prices. As Douglas had told Clinton in Barcelona, what they still lacked was the funding and systems to deliver treatment on a mass scale.

Eager to get moving, Magaziner already had followed up with Douglas. Within the next week or two, he suggested, the foundation might send a small team to meet with Caribbean leaders in Basseterre, the capital of St. Kitts and Nevis, to establish a working group on the ground. Over the coming months, their first goal should be to create a detailed “business plan,” with very specific budgets and schedules for each Caribbean country to implement credible treatment and prevention programs. With such a plan in hand, Magaziner believed, Clinton could approach major donor governments with the assurance that their money would not be squandered.

To Clinton’
s delight, the Caribbean initiative jumped to a very rapid start. At Magaziner’s instigation, he and Williams had traveled down to St. Kitts to meet with Douglas at the end of July. During their discussions, Douglas had urged them to get in touch with Perry Christie, the new prime minister of the Bahamas, who was trying to provide AIDS treatment to afflicted Bahamians by purchasing cheaper generic drugs—but the cost was still far too high to care for more than a small fraction of the islands’ infected population. After his first conversation with the Bahamian health authorities, Magaziner excitedly phoned Clinton in New York.

“You’re not going to believe this,” he told the former president. “The government here is treating about one-sixth of the people who need it, or maybe less. But they’re paying $3,500 [annual cost per patient] for this $500 medicine.”

Clinton was flabbergasted. “Why?” he asked.

“The market is so disorganized,” said Magaziner, “they’re going through two different agents, and both are taking huge markups, and that plus the transportation cost is getting them to $3,500 per.” The next day, Magaziner was on the phone with the generic manufacturers in India, dropping Clinton’s name to persuade them to sell the medicines directly to the Bahamas government—and obtaining a price cut, during the program’s first week, from $3,500 to $500.

“So overnight, for the same amount of money,” Clinton later recalled, “they could treat—not quite seven times, because there are other costs, but six times as many people for the same amount of money.” He was, as he would put it, tickled.

Once the relationship between the foundation and the Caribbean states was established in July, Magaziner embarked on a series of long trips to Africa, returning to the same places he had visited the previous spring. As he promised Clinton, he had put up a million dollars of his own money and persuaded David Sainsbury, the British supermarket magnate and philanthropist, to put in another million. With that funding in hand, he was able to tell the African leaders that Clinton had established a program that would help them. Before the end of August, he had secured agreements with the governments of Mozambique, Tanzania, and Rwanda to join with Clinton in bringing AIDS treatment to their citizens in need.

Clinton was scheduled to visit Africa in September, including his second visit to Rwanda since leaving the White House. He considered the Rwandan genocide—which had occurred on his watch without significant intervention from the West—to be the most damning stain on his presidency, far worse than impeachment. He had told Magaziner that the small Central African state must be among the very first that they brought into the program.

In late September, Clinton alighted in Kigali, Rwanda, with a pair of celebrities in tow—Oscar-winning actor Kevin Spacey, one of Clinton’s closest Hollywood friends, and comic Chris Tucker, with whom he had recently gotten acquainted. Nothing helped to raise American awareness of a social problem, as Clinton well knew, like famous entertainers urging them to pay attention.

It was Spacey’s first trip to Africa, but he wasn’t shy about telling reporters why he was there. “HIV/AIDS is the single most important issue facing the world today,” he said at an AIDS treatment center the trio visited. “If we don’t begin to tackle this one, then it doesn’t much matter what else we try to do, because we are going to be faced with a devastating plague that would wipe out generations.” While Spacey talked, Clinton waded into a crowd of patients, embracing them and shaking hands. He was thrilled to find that the Rwandans, far from shunning or blaming him, were greeting him joyously.

At the presidential palace in Kigali, with Magaziner standing beside him and Band nearby, Clinton signed a “memorandum of understanding” with President Paul Kagame, outlining the steps to be taken by the government of Rwanda and the Clinton Foundation in a new program of treatment and prevention. A few days later, he signed a similar MOU with Prime Minister Pascoal Mocumbi at an AIDS counseling and testing facility in Maputo, the Mozambican capital, where the foundation planned to begin treatment.

Those ceremonies marked the end of a weeklong sojourn through Africa, during which Clinton and his party enjoyed the convenience and comfort of free transportation aboard a Boeing 727 aircraft owned by Jeffrey Epstein. A wealthy new friend of Clinton, Epstein was a tall, graying bachelor in his late forties, who had risen from teaching at the Dalton School to overseeing $15 billion in assets for investors like Leslie Wexner, chairman of The Limited.

Clinton’s
staff knew little about him, except that he seemed to be acquainted with everyone in Manhattan and Palm Beach, liked to “collect” outstanding scientists and political figures, and was sometimes willing to spend millions of dollars on their projects. He joined the trip to Africa but remained mostly in the background; although he usually shunned publicity, his sudden appearance alongside the former president began to draw the attention of magazines like
New York
and
Vanity Fair
—which both assigned profiles of the reclusive Epstein soon after the Clinton entourage returned. (In June 2008, after a highly publicized, two-year police investigation in Palm Beach, Epstein pleaded guilty to a single count of soliciting prostitution from an underage girl. He served thirteen months in jail and is a registered sex offender.)

During that fall, as Magaziner began to recruit volunteers and partners, Clinton met in his office with a group of AIDS experts and activists to discuss what would be known as the Clinton HIV/AIDS Initiative, or CHAI (which happens to be the Hebrew word for “life”). The tone was friendly, not hostile, but the more outspoken AIDS leaders wanted to test the intentions of the former president. They refused to pose for any pictures—their way of letting him know that they wanted no part in any photo-op announcements.

Perhaps to answer such concerns—and to introduce CHAI as a new, leading force against the scourge of AIDS—Clinton published an op-ed in the
New York Times
on December 1, his second since leaving the White House. Titled “AIDS Is Not a Death Sentence,” the 1,200-word essay outlined the true grim dimensions of the pandemic, briskly rebutted the excuses for prevention over treatment, and declared that “historians of the future” would judge human civilization’s failure to treat its victims as “medieval, like bloodletting.”

The only moral and practical way forward, he declared, was a worldwide effort by governments, citizens, and international organizations to provide proper care and medicine to all the pandemic’s victims. Letting everyone know that the disease need not be fatal would reduce the associated stigma and discrimination, encourage widespread testing, and enable prevention and education to succeed. Only then would the world have a chance to escape the worst consequences of a global plague.