When asked what Bush accomplished during his eight years in office, many people point out that he was responsible for putting together a comprehensive AIDS program for Africa. In an article called, “An Unlikely Champion,” found in the January 15, 2009 edition of Nature (available only to subscribers online), the authors discuss the good and the not so good about the Bush AIDS program. That program was called the U.S. President’s Emergency Plan for AIDS Relief (“PEPFAR”).
First of all, the good. PEPFAR put more than 2 million HIV-positive people on anti-retroviral treatments since the beginning of the program (in 2003). By 2008, PEPFAR prevented infection of 240,000 babies born to HIV-infected mothers. It also provided healthcare for 9.7 million people.
On the other hand, PEPFAR “has also been highly controversial because of stipulations on how its funds should be spent.” When conservative lawmakers enacted PEPFAR, they required 20% of the money to be spent on abstinence education programs. They require organizations receiving PEPFAR money to pledge their opposition to prostitution, which ruled out the option of trying to “reach out to sex workers.” Further, none of the PEPFAR money could go to any groups that supported abortion under Bush’s “gag” rule (which he enacted on his very first day in office).
This article quotes several activists who were suspicious that “PEPFAR was little more than a ploy to curry favor for the United States abroad after its internationally unpopular invasion of Iraq.” Administrative problems existed as well. Randall Tobias was the first head of PEPFAR. He resigned after he was linked to a prostitution ring. Tobias, “a former chief executive of the pharmaceutical company Eli Lilly, had publicly questioned the effectiveness of condoms and the reliability of generic drugs.”
The World Health Organization was one of many organizations that were critical of the effectiveness of “abstinence only programs in developing countries.” Speaking of Uganda, critics claim that the PEPFAR funded organizations “compelled the groups to place too much focus on abstinence and too little on condoms, helping to trigger a resurgence of the epidemic.” PEPFAR officials respond that they distributed “more than 2 billion condoms.” Another criticism of PEPFAR was that PEPFAR focused only on AIDS, neglecting equally important parts of the health care system, such as childhood vaccinations. PEPFAR was also criticized for purchasing mostly expensive brand-name drugs rather than generic pharmaceuticals.
What will the future bring?
Whoever takes over, observers anticipate that the program will improve under the Obama administration, and that many of the problematic aspects, such as the prostitution pledge and the anti-family-planning bent, will be eliminated.
