Politics & Policy

What Works

President Bush's approach to AIDS, on the ground in Uganda.

When the President’s Emergency Plan for AIDS Relief (PEPFAR) was launched in 2003, many criticized the United States for taking money away from the Global Fund to Fight AIDS, Tuberculosis, and Malaria–even though the U.S. was, and remains, the Fund’s largest contributor. It was said that PEPFAR was yet another example of American determination to go it alone rather than work with the rest of the international community to tackle the AIDS epidemic. However, during a recent trip to Uganda, I saw that PEPFAR has been a tremendously effective way of dealing with AIDS control.

President Bush deserves credit for his leadership in creating this program, which is literally saving hundreds of thousands of vulnerable Africans–especially young children–from what had previously been certain death.

I led the congressional-delegation trip to Uganda earlier this month to investigate claims that the country had mismanaged funds intended to fight the HIV-AIDS pandemic. In fact, Uganda’s funding was suspended for a time by the Global Fund, and our delegation was told that there were significant management problems. Nevertheless, in addition to the difficulties the Ugandan government had in ensuring complete transparency of its handling of Global Fund monies, the Fund itself had trouble managing the grant to Uganda. It lacked sufficient management ability on the ground to ensure program efficiency and overall effectiveness. Those management issues are now being remedied through oversight by a locally based management company, and the funding has since been restored.

Such mismanagement contrasts sharply with our experience with PEPFAR in Uganda. The U.S. government has a wide array of agencies on the ground managing HIV-AIDS program funds, including the Centers for Disease Control, the National Institutes for Health, and the U.S. Agency for International Development. Program partners include the African Medical and Research Foundation, Children’s AIDS Fund, the AIDS Information Center, and Catholic Relief Services. Only weeks after getting PEPFAR approved, funds went into the field in Uganda and were paying for drug therapy, testing and counseling, and other approaches, including the promotion of abstinence and fidelity in committed relationships.

One of the visits we made in Uganda was to the Bethlehem Medical Center just outside the capital city of Kampala. Eight clients who are receiving antiretroviral (ARV) treatments at the center opened our meeting with a song that expressed their gratitude to the U.S. government. They followed up by expressing their heartfelt appreciation to President Bush, specifically, for having given them and their country hope in overcoming the devastating effects of this dreaded disease. For all of the negative stories we hear about the U.S. image abroad, there is a positive, untold story that is occurring without fanfare: in Uganda and other parts of Africa, they love George W. Bush.

We made several visits to the homes of those infected with HIV/AIDS, both in Kampala and in Bushenyi, a remote region of Uganda. The insecticide-treated mosquito nets and plastic-chlorinated water dispensers we found there may seem like insignificant items when listed on paper, but they are strikingly conspicuous in the humble shelters of those who rely on them for protection from deadly infections.

We met John Roberts, a 28-year old man who was the first person to benefit from the initial program sponsored by PEPFAR. He is a teacher, with a calm demeanor and gentle bright eyes that made us feel extremely welcome. We were told that when he was first given the ARV treatment, his condition was so poor that he looked like a walking skeleton. His CD4 count, the measure of the effectiveness of his immune system, was as low as it could possibly be. Now he is healthy and energetic, leading a fulfilled and productive life.

Before leaving for the visit to Uganda, we heard much criticism of its “ABC” program: Abstinence, Be Faithful, and Condoms. Many of those with whom we met are associated with faith-based organizations that promote only the abstinence and fidelity aspects of the ABC program. A representative of one such organization, the Uganda Youth Forum, said that the youth they serve say the organization is unique because it challenges the youth to be abstinent without compromise. Other organizations that include condom use in their education give only a passing reference to abstinence and fidelity that is then undermined by emphasis on the use of condoms. The representative added that sexually active youth are appreciative when someone finally tells them that they can change their behavior, and they do change their behavior.

I believe the Uganda PEPFAR program is a model for handling HIV-AIDS prevention and treatment using a comprehensive public-private partnership. It should be adopted by other developing nations around the world that are also fighting the AIDS pandemic. While PEPFAR does not replace the Global Fund as a means of fighting AIDS, it has been a more immediately successful way of saving lives. John Roberts and many other victims of AIDS are alive and well today because we decided to create a program that suits our views of how this threat should be addressed, and we got funds into the field quickly.

New Jersey Republican Chris Smith is chairman of the House Subcommittee on Africa, Global Human Rights, and International Operations.


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