Monday, December 14, 2009

Obama Seen Failing AIDS Test

Obama Seen Failing AIDS Test

Former President George W. Bush was roundly criticized for most of his foreign policy efforts, even by conservative Republicans. However, the one area for which he has been widely praised is for his Africa policy. His efforts to reduce conflict, educate youth (especially girls) and treat disease were lionized, even by liberal Democrats who otherwise opposed his policies. Many Africanists said Bush had raised the bar for U.S. policy toward Africa. Now some are saying President Barack Obama is failing to meet the challenge of meeting and exceeding Bush Africa policy, especially when it comes to dealing with HIV-AIDS.

When President Bush launched the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, he initiated the country’s largest international health initiative devoted to a single disease. More than US$18 billion had been devoted to AIDS-related programs by the time Bush left office, and Congress last year approved a five-year extension and an increase in funding to US$ 48 billion.

Now the Obama Administration is proposing a five-year plan aimed at diverting attention from largely treatment to capacity building to allow AIDS programming to be integrated into African government health systems so that those governments can “oversee, manage and eventually finance these programs.” Instead of providing more and more anti-retroviral (ARV) drugs for AIDS victims at cost of as much as US$2,000 a year, the Obama plan would shift the focus to providing water filters, oral rehydration packets and generic antibiotics.

Under the Bush program, about 500,000 AIDS victims a year were added to the rolls of ARV recipients. Under the Obama plan, only 320,000 AIDS victims will be added each year. A coalition of AIDS activists last week accused the President of failing “to fulfill his commitments to wage an aggressive battle against global AIDS,” and the coalition gave the President a “D+” for his performance to date. The deans and presidents of three dozens medical and public health schools previously urged President Obama to accelerate PEPFAR, but he approved a plan to decelerate and begin the process of devolving responsibility to African governments.

This strategy is consistent with Obama’s overall stance of holding African governments accountable. However, in this case that may be a good long term goal, but in the short run there are too many obstacles to its success. The brain drain has leached thousands of medical professions from African countries to higher-paying jobs with better equipment and supplies in Western countries. African health care systems are too often understaffed and poorly resourced. African health ministries too often lack the best health care professionals still available. In the case of South Africa under former President Thabo Mbeki, decisions were made by non-medical officials based on junk science to avoid facing the true horror of AIDS in Africa.

Africa, particularly the sub-Saharan region, is more significantly affected by HIS-AIDS than any other region of the world, with an estimated 22.4 million people living with the disease. That total represents about two-thirds of all people living with AIDS in the world. Last year, about 1.4 million sub-Saharan African died of AIDS, and 1.9 million new cases of AIDS infection were recorded. Since the beginning of the epidemic, more than 14 million African children lost one or both parents to AIDS. The average life expectancy in Africa today is 47 years; without AIDS, it is estimated that it would be 62 years.

President Obama is said to want to remove the emergency from PEPFAR, but while the rate of AIDS infection seems to be slowing, far too many Africans still are adversely affected by the disease to ease up on addressing it as aggressively as possible. Last year, 390,000 children were infected with HIV, either during pregnancy, through childbirth or from breastfeeding. It will take time for Obama’s strategy to bear fruit. Meanwhile, many more children will contract HIV before their mothers can be affected by prevention efforts or will not have the benefit of medicines such as neviropine to prevent contracting the disease while being born.

It is understandable that President Obama, the African American son of a Kenyan professor, would not want to be known solely as the “African President,” but the Administration’s vague policy toward Africa, and its apparent turnaround on AIDS policy, risks putting him in the position of being worse for Africa than George Bush, who came into office with no ties or known affinity for the continent and achieved more than all his predecessors. That would be a truly sad irony.

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