time.com
Monday, Feb. 18, 2008
Laura Bush's African AIDS Crusade
By Alice Park
President and Mrs. Bush are traveling in Africa to visit a handful of countries receiving U.S. aid through the President's Emergency Plan for AIDS Relief (PEPFAR), a five-year, $15 billion relief program launched in 2003 to provide HIV treatment in lower-income countries with high rates of infection. Since its inception, PEPFAR has distributed antiretroviral (ARV) AIDS drugs to 1.5 million people, and, through its prevention efforts, has also contributed to a slowing of the spread of the disease.
Despite its successes, however, the program has its share of critics, who take issue with the stipulation that one-third of PEPFAR's prevention funding go to programs that promote abstinence before marriage and target safe-sex messages at high-risk groups such as sex workers and IV drug users, instead of the general, sexually active young population. PEPFAR comes up for reauthorization this year — President Bush has asked Congress to renew it for another five years, at $30 billion. Before leaving for Africa, First Lady Laura Bush talked to TIME's Alice Park about PEPFAR's goals, successes and controversies.
TIME: What are the goals of this trip?
Bush: This will be my fifth trip to Africa since George has been President. This will be my second trip with him to Africa since 2001. We'll be visiting PEPFAR sites, and programs supported by the President's emergency plan, we will be visiting Malaria Initiative sites, handing out insecticide-treated bed nets and really just looking at all of the different programs in Africa that are supported by the United States, both by U.S. taxpayers through the appropriations from the Congress, and of course by a number of NGOs [non-governmental organizations] that are on the ground, faith-based and other community based groups that are either founded by Americans or where Americans are volunteering.
The goals are the same ones we have every time. One major goal, or I hope one really good result of the trip, will be that PEPFAR will be reauthorized with more money, like the President has asked. It has been very, very successful, and we know how many people are on treatment now — many more than when we started with PEPFAR.
Since PEPFAR was launched in 2003, there has been an increased appreciation for how important prevention programs are, to go hand in hand with treatment programs. What have been some of the ways that PEPFAR has incorporated or enhanced that message?
Well, there are two major ways. One of them is mother-to-child-transmission, which can be prevented. If mothers are taking certain antiretroviral drugs when they are pregnant, their children are less likely to be born with HIV, HIV-positive or AIDS. There is also a treatment for babies [and] young toddlers that can help them to not have AIDS. That's a very important part. Most children in Africa who do have AIDS got it at birth from their mothers. If we can have an AIDS-free generation of children who are born HIV-free, then we will be really making a big step. And that's possible because mother-to-child-transmission can be prevented.
Another part of the prevention is the "ABC" part that really started in Uganda — Abstinence, Be faithful and use a Condom. All three of those are very important for prevention. Abstinence prevents HIV 100% of the time. If you're faithful and monogamous with someone who is either HIV-free or you know has HIV and always use condoms, then you can also prevent the spread of HIV.
ABC has been one of the controversial elements of PEPFAR in some respects because of the definition that PEPFAR uses for ABC. Some critics point out that it carries some faith-based imperatives, and feel that PEPFAR's message might be getting diluted a bit. How do you respond to those criticisms?
All three parts of ABC are very, very important. Obviously, they are important for good sexual health everywhere to avoid STDs [sexually transmitted diseases] of all kinds. This [ABC program] came from Africa, this was what Uganda wanted to do. We adopted the program, which started in Africa. That's important as well; it's not the United States government telling people what to do in Africa. Rather it's a program started by Africans. We know all three parts of ABC work.
I also think it's really important to have an abstinence piece for girls, who, a lot of times, especially with gender issues like there are across many parts of the world, think they have to comply with men. We want to get the message out to girls that they don't have to, that they can be abstinent, and to protect themselves.
Why does PEPFAR focus primarily on the high-risk groups — such as sex workers, discordant couples in which one partner is positive, and the other is not, and drug users — rather than on the more general message that other groups have used on the young population in general?
I wouldn't say that. I would say that PEPFAR focuses on all groups that are susceptible — from babies, for mother-to-child transmission, to young children. I visited schools all over Africa and on every one of my visits the schools themselves have big signs and posters painted on their walls about a friend is still a friend, even if they are HIV positive, to address the stigma problem of HIV... I would say PEPFAR focuses on every group that is vulnerable to contracting HIV/AIDS. We also work with every country on their plan, and what is right for their people.
What do you hope the legacy of PEPFAR will be? I hope it will be millions of saved lives. I hope it will be an HIV-free generation, children who don't get HIV at birth. And many, many more people on ARVs so they can live a positive life even if they are HIV-positive. And I think that is what we are already seeing. We are seeing huge increases in the number of people on ARVs. What we want to see with it, of course, is a large decrease in the number of new infections.
What do you think it will take for Congress to reauthorize PEPFAR? Do you see any barriers or issues?
I feel very confident that the American Congress wants PEPFAR to be reauthorized. I think that will happen. I certainly hope so.
