Amidst a constant stream of poor and destructive 2003 decisions, George W. Bush did something that should be considered his crowning achievement (unless you’re a billionaire or esteemed magnate of the military-industrial complex or Both!). In fact, it might be the only substantial and positive contribution he made to the planet before picking up a mirror and a paintbrush. However, chronic boobery aside, he deserves to be lauded.
10 years ago, the United States expanded on Bill Clinton’s global initiative to combat HIV/AIDS, when on March 27th, 2003, President Bush signed the US’ President’s Emergency Plan for AIDS Relief, better known by its acronym PEPFAR.
At the time that PEPFAR was conceived of and then established during the George W. Bush administration, the world was witnessing first-hand the destruction of an entire generation of individuals in the prime years of their lives and the reversal of remarkable health and development gains, particularly in sub-Saharan Africa and to a lesser extent in other developing nations. Rates of new HIV infections were rising rapidly, and hospitals, communities, and families were often too under-resourced and overwhelmed to cope with the enormity of this burden. At that time in 2003, despite the availability of life-saving antiretroviral therapy (ART) in most countries in the developed world, in southern Africa and other regions of the developing world, an HIV diagnosis meant a virtual death sentence, since few had access to such drugs.
This is a notable issue. Many government officials balked at providing wide-scale treatment, and wanted to instead focus solely on prevention. One US government official said that Africans wouldn’t be able to take their medication consistently because “they didn’t have watches.” The seemingly arbitrary differences in pharmaceutical pricing of ARTs were also a hang-up. However, they persevered.
Today, as we mark the 10th anniversary of PEPFAR, the situation has changed dramatically. Plummeting life expectancy rates in much of Africa have been reversed; HIV-infected, but healthy, fathers and mothers who are receiving therapy are able to return to work, care for their families, and spur economic development. Doctors, nurses, and community health workers, who once had little to offer their patients beyond a more dignified death, are delivering life-saving ART to millions of people. AIDS-related mortality has declined by more than 26 percent since its peak in 2005. Where despair once cut a devastating swath through so many communities and countries, hope has been renewed.
With regard to the prevention of HIV infection, globally, in the decade since PEPFAR began, new HIV infections have declined by nearly 19 percent. Between 2009 and 2011, new HIV infections among children, still an important component of the epidemic in many southern African countries and other regions in the developing world, declined by 24 percent globally, compared to a 23 percent decline in the previous six years. Not only is progress happening, but its pace is accelerating.
PEPFAR is not perfect. In its early days, too many resources were pushed towards abstinence-only programs. There are issues with family planning and contraception access as well. Condom distribution is part of the program, but that’s it. Still, look at the numbers below:
PEPFAR now estimates that it has provided life-saving treatment for more than 5.1 million people—a number that is set to go up and likely exceed the 6 million target set for the end of 2013. In 2012 alone, it also provided treatment for 750,000 HIV-positive women to help prevent the transmission of HIV to their babies and support and care for more than 5 million orphans and vulnerable children.
The term “American Exceptionalism” makes me cringe, but if we’re looking for true examples of high-minded ideals, isn’t this it? A bipartisan achievement that brought together names like Durbin, Santorum, Pelosi and Isakson in order to assist in saving a generation of people from deadly disease. When conservatives scoff about ‘soft power,’ or the relatively small amount of money spent on foreign aid, they do so derisively – decimating the discourse and dehumanizing those this country has helped. Isn’t this the type of undertaking the richest and most powerful country in the world should pursue?
PEPFAR has also been a common cause of three US Presidents: President Bush, whose steadfast political leadership was critical in PEPFAR’s early years; President Obama, who has expanded treatment and prevention targets; and President Clinton, who has championed the program since leaving office.
Here’s to another 10 years of growth, program improvements, and ultimately saving more lives.