President George W. Bush this week visited Africa to highlight the United States? role in helping to prevent the spread of HIV/AIDS. The President?s Emergency Plan for HIV/AIDS Relief - also known as PEPFAR ? is credited with saving thousands of lives in Africa, by giving medicines, care and treatment to HIV-positive people. But while Africans laud Mr. Bush and his fellow Americans for providing billions of dollars towards anti-HIV/AIDS initiatives, PEPFAR is facing several challenges in the U.S. itself as the program comes up for renewal in Congress.  VOA?s Darren Taylor reports on President Bush?s efforts to combat the epidemic as his leadership approaches an end. 

PEPFAR remains the largest international health initiative ever undertaken by one nation to address an infectious disease, and some analysts say it?ll provide Mr. Bush with a far more positive legacy than that of his actions in Iraq, for example. 

Some have also described President Bush as the American leader who has done the most to assist the continent to emerge from the mire of poverty and disease.  They specifically praise his economic help to Africa in the form of the African Growth and Opportunity Act, as well as PEPFAR.

Even before he?d left for Africa, Mr. Bush began emphasizing the United States? support for the continent.  

?It is in our moral interests that we help a brother and sister who?s dying of AIDS. And in helping that soul, it really helps ourselves. America?s generosity has been prevalent throughout the decades. And every time America reaches out to help a struggling soul, we find that we?re a better nation for it,? he told a group of African journalists.   

According to the respected British health charity AVERT, about 1.7 million people in sub-Saharan Africa ? the region in the world that?s worst-affected by the AIDS epidemic - were infected with HIV last year. AVERT says AIDS killed an estimated 1.6 million people in the region in 2007. The charity adds that 22.5 million people in sub-Saharan Africa were living with HIV/AIDS at the end of the last year.

Even critics of PEPFAR praise President Bush for providing life-enhancing medicines to HIV-positive individuals. 

Dr. Tom Kenyon, chief medical officer at the U.S. State Department?s office that coordinates PEPFAR, points out that in 2003, when Mr. Bush kick-started the plan, only 50,000 HIV-positive people in sub-Saharan Africa had access to anti-retroviral drugs.  But thanks to PEPFAR, says Kenyon, there are now almost 1.4 million people in the region receiving the life-prolonging medication.

Dr. Paul Zeitz, of the Global AIDS Alliance based in Washington D.C. that coordinates groups combating the pandemic around the world, says PEPFAR deserves both criticism and compliments.

?There have been some historic accomplishments through it, and the president should be given credit for that - for example on expanding access to AIDS treatment. But it?s a mixed legacy because even in that, he could have done more sooner,? Zeitz states.   

He does, however, credit President Bush with increasing ?programming on the battle to support the orphans and vulnerable children that have been left behind (in Africa). He?s made some first really important steps to provide U.S. assistance for orphans. But much more needs to be done, and we are hoping that he?ll set the stage for a bipartisan (Republican and Democratic) commitment to expand the U.S. approach going forward.? 

Mr. Bush wants the U.S. Congress to give PEPFAR another 30 billion dollars to fight AIDS. But Zeitz and other critics say this is not enough. They say 50 billion dollars is needed to make a real dent in the epidemic over the next five years.

?We?re disappointed with the way that President Bush is leaving his legacy. He?s calling for a flat-lining of HIV/AIDS spending going forward, when we really need to ramp up the spending, to really continue to build on some of the progress that has been made, and to win the battle against AIDS,? says Zeitz. 

?A flat-lining of the budget is not acceptable. Also he?s proposed a significant cut in U.S. funding to the Global Fund to fight AIDS, TB and Malaria - a forty percent cut. We?re very disappointed by that approach of the administration.?

The Global Health Council, which describes itself as the ?world?s largest membership alliance dedicated to saving lives by improving health throughout the world,? said in a recent press release that Mr. Bush?s final budget request proposed only a nominal boost to funding for PEPFAR.

?This small increase will mean that programs in the focus countries supported by PEPFAR will not be able to increase the number of people accessing prevention, care and treatment for HIV/AIDS,? the Council warned.

President Bush has acknowledged that PEPFAR is ?not enough. It?s just a beginning.? But, with more than 40 million people around the world infected with HIV or living with AIDS, the crisis shows no sign of easing significantly ? despite PEPFAR?s notable prevention and treatment achievements. 

Some Democrats also want to reduce funding to the PEPFAR component that places heavy emphasis on instructing people not to have sex before marriage as a primary method of stopping the spread of the disease. Although they say they?re in favor of abstinence instruction, they argue that more money should be given to other PEPFAR programs that they consider to be more successful in preventing HIV infection, such as those that encourage condom use. 

Zeitz, though, is hoping that the in-fighting on Capitol Hill surrounding PEPFAR will soon end.

?There?s this very strong centrist, bipartisan coalition that understands the importance and the critical value of President Bush?s initiative and know that most of what has happened through the initiative has had a positive effect and that we need to fix the policies that haven?t been right on, and then continue to ramp up the funding.?

Mr. Bush has called on U.S. policymakers to ?stop the squabbling? and to renew PEPFAR?s funding as soon as possible.

?PEPFAR is working. It is a balanced program. It is an ABC program ? abstinence, be faithful and condoms. It is a program that?s been proven effective,? he says.

Zeitz says PEPFAR, though, should place less emphasis on ?moralizing? and using religious organizations to spread messages about HIV/AIDS in Africa. He argues that PEPFAR should use science, not religion, to fight HIV/AIDS. 

But Kenyon defends the Plan?s use of religious groups. 

?The faith based organizations have been?. the unsung heroes in all of this. They?re out there in the communities where other organizations - and often governments - are not. They have remarkable commitment and perseverance in addressing the epidemic?. In some countries, (they provide) up to 40, 50 per cent of health care services?.?    

He acknowledges that PEPFAR is not perfect, and that perhaps its greatest success has been the provision of medicines to people that otherwise would probably have died.

?We still realize we have a long way to go. To get this (life-prolonging medicine) out beyond the hospitals (in the cities) to the health centers and clinics in the villages is another leap that we?re working on with (focus) countries, to make these more accessible to people ? particularly in the rural areas,? Kenyon says.