PEPFAR in Perspective

It’s always easier to cast the first stone instead of building upon lofty, if flawed ideas. I’ve witnessed the phenomenon hundreds of times – everyone’s a critic, and I’m certainly not excluded. It’s a well known fact that I’m passionate about a number of topics, many related to humanitarian efforts. Anyway, I realize that hardly anything is ever perfect – but life is a process that is continually going through revisions. My philosophy is that we should discard ideas that don’t work and stick with the ones that do. So, this is going to be the first post in a series of two – focusing on two great ideas. The first, here, defends PEPFAR, the President’s Emergency Plan for AIDS Relief, and the second, coming soon, for Product (RED).

Since 1981, the first reported cases of acquired immune deficiency syndrome, or AIDS, in Los Angeles, CA have spread across the globe to virtually every populated continent. President Bush has been the first U.S. leader since to address the issue with full force, pledging $15 billion dollars over five years to fight HIV/AIDS with the President’s Emergency Plan for AIDS Relief (PEPFAR). In order to battle the disease effectively, high-risk, resource limited countries across the globe have been targeted through the plan, which has been praised as the largest international health initiative ever undertaken by one nation to address a single disease. Using the 2-7-10 goals, it aims to provide anti-retroviral treatment (ART) to 2 million HIV-infected people in resource-limited settings, to prevent 7 million new infections, and to support care for 10 million people.

The Epidemic

The global pandemic of AIDS affects over 35 million people across the globe, and while there is no cure for the degenerative disease, it is treatable and preventable. These treatments, better known as anti-retrovirals, or ARVs, consist of 2 pills and are readily available in North America and in Europe for the equivalent of 40 cents per day. Unfortunately, these same effective and affordable medicines are not available for much of Sub-Saharan Africa, in which more than 25 million, or 68% of the infected population, is forced to live. For this reason 12 of the 15 focus countries are in Africa, including Botswana, Cote d’Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia. Guyana, Haiti, and Vietnam are the only three on other continents which still make up a significant portion of the infected population.

While the $15 billion is a daunting number that has a significant affect on the crisis, critics say that $50 billion would be a more suitable amount to ensure adequate coverage in each of the 15 countries. Contrary to popular belief, the money is not evenly distributed and is given on an “as needed” basis per country. It is distributed based on prevention, care, and treatment.

On the Ground

PEPFAR has most notably helped pay for not only these ARV’s, but for education and contraceptives, which are integral in stopping the disease at its foundation. The program is structured in an “ABC” format, which was borrowed from a similar Ugandan campaign. ABC stands for abstinence, be faithful, and correct and consistent use of condoms. The initiative has stated that this is, in their opinion, the most reliable and noteworthy approach to eradicating the spread of the disease.

Additionally, the program funds counseling programs in which the currently afflicted can receive support. This is vital, especially in youth and women, because life is difficult even after receiving treatment. In much of Africa, AIDS is still an unmentionable topic that is associated with homosexuality, rape, and poverty. To the dismay of many health officials, the program has abstained from supporting any organization that gives aid to those in marginalized social groups, such as those involved with commercial sex work. Likewise, the taboo – yet effective – practice of safe needle exchange among drug addicts has also been rejected.

President Bush’s support through the program has also helped destroy the stigma set forth by the American population in regards to the disease. AIDS is no longer identified as a “homosexual” disease, and enjoys much of the same following and support that the American Cancer Society has developed over the years. Additionally, interest groups such as the ONE Campaign and international 501(C)3 non-profits like the U.N.’s Global Fund have produced overwhelming support and results in fighting the spread of the disease.

Results

When President Bush announced PEPFAR in 2003, it was estimated that less than 50,000 people were receiving treatment for HIV/AIDS in sub-Saharan Africa. The official reports now suggest that through 2007, in just four years, the plan has provided life saving treatments for nearly 1.73 million individuals worldwide – 1.3 million specifically in the focus countries.

In the same countries, 930,000 individuals on anti-retroviral treatment as a result of direct PEPFAR support are women and girls, while 86,000 are children ages 14 and under. Through prevention strategies, mother-to-child HIV transmission rates have gone down in nearly 12.7 million pregnancies. This has directly helped prevent an estimated 194,000 infant infections. The plan has also supported care for more than 6.6 million, including 2.7 million orphans and vulnerable children, while still supporting over 33 million counseling and testing sessions to date.

By publicizing the audacity of the plan’s work, President Bush attests to mobilizing the American people in one of the greatest humanitarian events in world history – a feat which truly cannot be argued against.

Criticism

There has been, of course, criticism of the program. Other AIDS activist organizations, including the Global AIDS Alliance, state that the plan is riddled with vast conservative, evangelical beliefs which focus on subjectively moral issues opposed to public health. Another significant criticism that has since been resolved is the initial conception that only “brand name” ARVs would be used opposed to generics, which are inconceivably cheaper. With newly accepted procedures, generic ARVs have been used since. PEPFAR Watch, a project of the Center for Health and Gender Equity, is active in the initiative’s on-goings, and has also provided its own suggestions on how PEPFAR can improve.

Several think-tanks such as Foreign Policy in Focus have provided new acronyms to contradict the “ABC’s”, such as “ACTION”, which stands for additional new money, cancellation of international debts, treatment access, infrastructure development, offer preventative measures – now. This has become accepted as the most substantial and widely publicized change yet to be made to the PEPFAR program.

National Opinion

President Bush’s plan is not held without accountability. He reports to Congress at the end of each fiscal year of the program, which has been for the most part enormously successful. While it has enjoyed bipartisan support, there is an undertone of mistaken public opinion.

83% said they support U.S. humanitarian development assistance to other countries, including 86% of Republicans and 80% of Democrats (Interaction). Still, 75% of Americans believe that the United States spends far too much in foreign aid, when in reality it equates to less than 1% of the entire budget. Even smaller is the fraction specified for AIDS relief programs like PEPFAR. When faced with those facts, 33.5% still said the number was too great (Interaction). Because of the discrepancy between groups, support from the public remains widely touch and go.

Since relatively little is known about treatment for the disease, the question of reliability comes into question again. Many argue against giving aid, hoping the infected will simply die out and the problem will be solved. Simply ignoring the problem won’t make it go away – it will only make things worse. The problem is enormous, and giving assistance can be justified simply by the millions suffering worldwide. Relief also strengthens our own national security, ultimately reducing long-term threats of unstable governments and societies. Additionally, as countries grow and recover, they will be introduced back into world economies and become full partners in the age of globalization. Improving upon foreign assistance is simply an effective and morally just way of responding to global crises, which will ultimately improve the lives of countless individuals.

Future Projects

On July 17th, 2008, PEPFAR was re-authorized. The Senate agreed to more than double President Bush’s initial plan, bringing the budget to $48 billion under the next 5 year cycle. By renewing the program, the U.S. will continue striving to meet the United Nation’s proposed Millennium Development Goals (MDGs), which aims to have universal HIV/AIDS treatment for all by 2010. These actions have been praised by numerous organizations and philanthropists, including the prominent Democratic and Republican candidates for the presidency. Both Senator John McCain and Senator Barack Obama have pledged to continue with the program and visit afflicted African countries within their first year of office.

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Ultimately, President Bush’s impact on the global HIV/AIDS community has been substantially recognized with praise both at home and abroad, although the future remains uncertain. The United States is in a unique position, in which the eradication of HIV/AIDS and other major diseases is at hand. History will certainly show just how far the impact of the current government’s actions will reach – the only question that remains is whether or not the country will hold strong and finish what it has started.