AIDS is estimated to have killed 25 million people around the world and infected millions more. On May 27 President George W. Bush signed into law a $15 billion emergency plan that aims to prevent and treat AIDS in 12 countries in Africa and two in the Caribbean.
“I’d certainly say this changes the entire environment of addressing AIDS,” says Dr. Nils Daulaire, president of the Global Health Council, a non-profit organization that works to promote better health practices around the world.
“Consider the fact that barely five years ago, the United States was dedicating about $120 million dollars a year, which will be one-thirtieth of what’s going to be going into AIDS in the fiscal year 2004,” he says. “So many people have been discouraged and have said this is impossible, it can’t be done. And really what we’ve seen as practitioners on the front lines is that it’s very doable on a one-on-one basis in terms of getting things done in communities and with individuals, but it’s not done for free.”
Sub-Saharan Africa, where 30 million people are infected with HIV - the virus that causes AIDS, has been especially hard hit by the disease. Cash-strapped African governments have been unable to pay for the lifesaving drug therapy that can prolong the lives of AIDS patients.
Whereas in the West people with AIDS continue to lead productive, relatively healthy lives for years after becoming infected, the disease has wiped out entire families and communities in Africa. Humanitarian aid workers talk of villages where the only survivors are the very old or very young. AIDS strikes adults in their prime, who would normally be farmers, teachers, health care workers. As a result, children are caring for their AIDS-stricken parents or grandparents are raising their orphaned grandchildren.
AIDS activists hope that will change once the President’s plan goes into effect. Holly Burkhalter, U.S. Policy Director for Physicians for Human Rights, says 55% of AIDS Plan funds will go to treating patients, a major shift in both U.S. and international public health policy, which until now focused more on preventing the disease.
“In the past, the United States has not funded really any treatment initiatives whatsoever,” she says. “And indeed, policy makers in both Congress and the executive branch simply wrote off 30 million people with AIDS (in Africa). ‘Well, forget them. The people with AIDS are going to die of AIDS. Our goal isn’t treatment.’ And even to this day you get debates in medical journals and elsewhere about the relative best use of the scarce dollar: should you treat or should you prevent? And that is an unethical debate: you should do both.”
Some AIDS activists and health care workers were upset that socially conservative U.S. lawmakers added some amendments to the bill. Particularly troublesome is a requirement to spend one-third of prevention funds on programs that encourage people to refrain from having sexual relations until they are married.
“There is a question about the abstinence-only programs that are being prioritized for prevention because there’s no scientific evidence that abstinence-only programs actually change behavior or actually reduce HIV transmissions,” says Dr. Paul Zeitz, executive director of the Global AIDS Alliance, a group working to stop the spread of AIDS.
“So we have a significant concern about that,” he says, “and we believe in evidence-based public health programming: meaning we need to invest in programs that we know are going to have a people level impact. In the area of prevention it is scientifically proven that a mixed and balanced approach between promoting abstinence, faithfulness and condom use is the best way to achieve behavior change and reduce transmission. By focusing only on abstinence, there’s no evidence that that actually leads to the kind of behavior changes that we’re seeking.”
“We’ve had condoms distributed in Africa for all of these years and people are still dying, and it’s not solving the problem,” counters Sandy Rios, president of Concerned Women for America, a group that works to bring Biblical teachings into everyday public life. She says the extremely successful Ugandan model of AIDS prevention and its emphasis on abstinence show that this method can work.
“In Uganda there has been incredible success fighting AIDS,” she says. “I mean it is a success story like none other. And they will tell you that a huge part of their success has come from teaching abstinence.”
Debate also continues over how the President chooses to fight the deadly disease. Many AIDS activists, like Holly Burkhalter with Physicians for Human Rights, are concerned that the President is acting unilaterally instead of working through the Swiss-based Global Fund to Fight AIDS.
“This is an area where the United States is the world leader on AIDS,” she says. “We helped develop the fund. Our Health and Human Services Secretary is the Chairman of the Fund. We ought to really be the triumphant figure there, and I think we could make it work if we gave more money, and I think it would be very much in our interest to do so.”
But the Global Health Council’s Dr. Daulaire says President Bush had his own reasons for acting independently.
“When I met with the president last month,” he says, “he was very clear about his reasoning, which was that he was calling for this bill and this level of resources and feels that he will be held accountable by the American taxpayer for the effective use of those monies. My sense was not that there was an opposition to the Global Fund itself but rather a commitment to making sure that the resources are quickly and well used and that there’s accountability in that.”
Concerned Women for America’s Sandy Rios supports the President’s decision to act alone.
“I’m not advocating that we don’t have global help or global cooperation,” she says, “but I think we have proven in this war (in Iraq) that we have the means and the will and the resources and the character to do things well. When we move it out onto the international scene, there’s so much disagreement on values and how to approach, and I think we risk throwing money away by making the coalition too broad."
"Thank God America has the resources to do this," she says. "And I think we have a responsibility as a prosperous nation, and I don’t think we should worry. The other nations can do what they want to do. There’s plenty of need for all of us. We don’t have to go under the same umbrella to get the job done.”
With three million people expected to die this year from AIDS, health care workers say the most important thing is putting the President’s plan into action. Although they applaud the President’s initiative, they are concerned that his budget request for 2004 only asks for $1.7 billion to fight AIDS – or about half of what the new law allows him to spend. They say the challenge now will be for people around the world, including Americans, to hold President Bush accountable for delivering on his pledge to combat AIDS.