Aids in Africa

By Chris McGreal, Guardian, UK

It may be the shining moment of George Bush's rule, but he rarely talks about it.

Over the past five years, the President's Emergency Plan for Aids Relief (Pepfar) has saved close to two million lives by providing antiretroviral drugs to HIV-positive Africans. It has helped ensure 240,000 babies are born without the virus by giving their mothers drugs to prevent them passing it on at birth.

The programme supports nearly 10 million people affected by Aids, such as children living with HIV-positive parents, with food, housing and education.

Yet the initiative has gone largely unnoticed outside its core focus, sub-Saharan Africa.

The key to the programme is its vast budget. It began with $15bn for the first five years. Pepfar was renewed in July with its spending more than tripled to $48bn the bulk of it earmarked for Aids in Africa.

The vast sums spent by Pepfar have meant that its impact has been felt far beyond those with HIV. Doctors say the programme is rejuvenating health systems by training nurses, buying equipment and building clinics that deal with more than the pandemic.

Dr Francois Venter, head of the HIV Clinicians Society in South Africa, is one of a number of Aids doctors who is almost disbelieving in his praise of Bush.

He said: "I look at all the blood this man has on his hands in Iraq and I can't quite believe myself but I would say it's a bold experiment from the last people in the world I would expect to do it, and it is saving a lot of lives. You give these tablets to people and they resurrect themselves. To intervene on such a scale and make such a difference is huge."

Bush agreed to confront the growing Aids crisis under pressure from his then secretary of state, Colin Powell, who warned that the disease threatened to wipe out a large part of the working age population of some African countries. He saw that as a national security issue. The CIA agreed.

Bush was also lobbied by Christian evangelicals with close ties to Africa and some conservative Republican senators who said they were ashamed that more was not being done.

Washington liberals quibbled over a legal requirement for discussion of abstinence alongside monogamy and condoms in educating people about Aids, but that was only a tiny portion of the overall programme and largely dismissed as irrelevant by medical staff on the ground.

There was also criticism of the use of religious organisations to deliver care, but some aid workers noted that churches in Africa are among the institutions most capable of delivery.

Chris McGreal, Guardian, UK, January 17, 2009