So, a while back I mentioned that some of the towns and regions of Namibia were having their names changed. Well, I came across this little clip discussing it, which I found interesting. And yes, part of the issue was the colonial past (and it's not surprising that al Jazeera would focus on that element). It was also a tourism thing, highlighting local populations to encourage tourists to visit these places. Of course, there are many who found the changes silly. Several people I work with commented that after a lifetime of calling it "Luderitz," calling it "ǃNamiǂNûs" is just going to feel very weird. Same thing with calling the "Caprivi" region the Zambezi Region. I have gone into this discussion already, so I'll just end by pointing out that Namibia seems to be dealing with the same kind of issues many states in the US (especially in the South) have to deal with post Civil War: finding the balance between remembering history (which cannot simply be swept under the rug, since it is part of what this country is) and not wanting to honor those guilty of being brutal to the native population.
Computer classes have started up again, and a month in, my learners are still having trouble saving, can't comprehend the difference between the highlighter and changing the font color in Word, or the fact that missing a class does not mean I "must" give them extra time to complete an assignment. It's going slower than last time, and while I understand that these people had never used a computer before the class, the number of times I've had to go over "left and right" and "top and bottom" with a group of adults does not makes me super optimistic. Then again, there were times I felt this way about my previous class, and most of them would have likely passed the course, had any of them submitted their final exams to be scored. So, I guess we'll see.
I took part in a recent program regarding HIV and healthy sex practices. While it resulted in very interesting discussions which highlighted the difference between Namibian and Western cultures (especially in regard to gender equality), there were also some frustrating moments, trying to explain to the women that there is no situation (unless their lives are under threat, maybe) that they should feel obligated to have sex. Interestingly, it was actually the men who tended more towards feeling it's okay for a woman to say "no". Grace and I are talking about a larger program on this discussion, but it was really interesting to get the different perspective on sexual norms, even if I maybe feel they are not particularly healthy (in regards to HIV and youth fertility).
Wednesday, October 16, 2013
Wednesday, October 2, 2013
PEPFAR: Bush's Overlooked Legacy
Okay, a short disclaimer: This article does contain content of a political nature. It expresses an opinion of the person writing it, and in no way reflects on the attitudes of Peace Corps, the US Government, or the country of Namibia. My opinions are my own, the conclusions are my own, unless otherwise cited. No, this is not a rant. This is not meant to be partisan. I'm a) covering my tail and b) making sure nobody else gets in trouble over technicalities. While politics play a role, they are not the focus, I am merely acknowledging a personal bias here.
A president's legacy is an interesting thing. I saw an article recently that suggested a possible peace with Iran could be President Obama's lasting legacy. The more obvious legacies will be that he is our first non-white president and Obamacare. His impacts on the wars in Iraq and Afghanistan will certainly be part of any legacy, I believe, as will his efforts to further equal rights for homosexuals. Security issues and the NSA spying, Benghazi, and other things yet to be seen may also be part. Depending on party affiliation, he's either a good president or the most evil, unpatriotic, socialist, Kenyan to ever grace the office. For the most part, a president's legacy is a subjective thing, depending on how it impacted you directly and who you voted for.
A president's legacy is an interesting thing. I saw an article recently that suggested a possible peace with Iran could be President Obama's lasting legacy. The more obvious legacies will be that he is our first non-white president and Obamacare. His impacts on the wars in Iraq and Afghanistan will certainly be part of any legacy, I believe, as will his efforts to further equal rights for homosexuals. Security issues and the NSA spying, Benghazi, and other things yet to be seen may also be part. Depending on party affiliation, he's either a good president or the most evil, unpatriotic, socialist, Kenyan to ever grace the office. For the most part, a president's legacy is a subjective thing, depending on how it impacted you directly and who you voted for.
A number of people remember the Bush presidency as an awful time, marked with the collapse of the economy, mishandling of Katrina, the War on Terror, etc. Others remember his term as the "good ol' days." Again, this is all subjective. However, one legacy he leaves behind is PEPFAR, and as far as I'm concerned, it's one of the most objectively good things he did in office. It's also something a lot of people don't know much about.
So, a few question that I should probably address. First of all, most of you might be wondering what is PEPFAR (I mean really, not just the basics) and what has it done. Then, you might ask what PEPFAR as accomplished? I'll give a quick answer now: quite a bit. Ok, so if it's been successful, why haven't we heard about it? And, spoiler alert, the answer will be my opinion, since a real, objective answer would be impossible to give. And finally, why am I writing about this, rather than myself or Namibia? So, let us begin.
It's a lot easier to criticize a house for being ugly than it is to fix it up. It's a lot easier to talk about how awful it is that people are dying of HIV/AIDS. George W. Bush didn't just talk about how awful it was. After talking with people who knew what they were talking about, his administration established PEPFAR.
What is PEPFAR? In 2003, President Bush launched the President's Emergency Plan for AIDS Relief, largely as a response to major issue of AIDS around the world. It pledged roughly $15 billion to fight HIV/AIDS from 2003-2008. Renewed under and expanded by Obama, it as donated billions of dollars to fighting HIV/AIDS, TB, and malaria, and has been credited with saving over 1.1 million African lives in 10 years. And yes, Namibia is one of the countries that as benefited greatly from it, as I will talk about later. Originally, there 15 focus countries, mostly in Africa, though the program as moved away from this.
(Map of PEPFAR World Activities)
https://hiu.state.gov/Products/Worldwide_PepfarPlans_2012July19_HIU_U568.pdf
USAID, HHS, the CDC, OGAC (Office of the Global AIDS Coordinator, housed in the Department of State), Peace Corps, and several other departments and agencies have been part of the implementation process. And yes, as you probably guessed, this list answers, at least in part, the "why am I writing about this" thing. It focuses on prevention, treatment, and care for those living with HIV, through education, contraception, ART (antiretroviral therapy), counseling, etc. I could throw around terms like "OVCs," or "PLVHA," or "Out of School Youths" as target groups, or the ABC method of prevention, or PMTCT. Or, I can assume you are all intelligent/capable of using Google. I'm going to go with the latter, since it's less work for me.
So, in short, that's what it is (see links later for more info).
Okay, well, what have been the results? Well, here are some numbers from PEPFAR's website:
http://www.mercurynews.com/breakingnews/ci_12087859
http://www.eurekalert.org/pub_releases/2009-04/sumc-ssf040209.php
Yeah, it's been good. No, it hasn't been cheap, but it as saved lives.
Okay, Jay, we get it. You really like PEPFAR, and it's been fairly successful. So, why is it not more well known? Well, reader, there are a few reason. And no, none of them will completely answer the question, since there is no single answer. There are, instead, several factors which I feel play a role. I will expand on them shortly. One of the most commonly cited ones is politics. One I put more stock in is the main problem with foreign aid: it helps people "over there" rather than "here," so we don't directly see the impact. Another factor is context. Let's face it, the wars in Iraq and Afghanistan pretty much consumed all of our foreign policy attention during the Bush years. Everything else was kind of just drowned out. On top of that, the economy collapsed, and we were more worried about people here who were suffering. Beyond that, the handling of Katrina tends to dominate any discussion about how Bush handled disasters. And, finally, most of the impact is long-term, so it didn't really show up while he was still in office (in fact, we have yet to see the full impact). There are also some criticisms of the program itself, some valid, some (in my opinion) just people being selfish and shortsighted.
Here is one take on the issue: http://www.huffingtonpost.com/anthony-amore/googling-pepfar_b_3934705.html. Now, Amore's take starts off good, talking about how more people know about Miley Cyrus twerking than about a program that's spent billions to save lives. However, he pretty much kills any validity in his article when he talks about "Hollywood elite" and blames "the Left," as if they make up one group. This brings us to the first issue. Politics absolutely play a massive role. After all, we're talking about a 21st century US President, so any legacy is going to be based on political views, and the Democrats certainly had a lot to gain from not publicizing it, since the fewer people who know about it, the fewer people who would have something nice to say about Bush. Of course, this simplistic analysis ignores the fact that the program as been continued and expanded, to a degree (more on that later), by the Obama administration.
The fact is, foreign aid polls bad. The people it helps aren't the ones paying taxes or voting in the elections. Many people don't like the idea of our money going to help people "over there" when we have so many problems in our own country. There is also the question of whether the money's been worth it, since 10 years later, HIV still exists. Shouldn't people's own governments be taking over by now? Well, actually, they are. PEPFAR funding has been reduced. http://www.huffingtonpost.com/chris-collins/pepfar-cuts-hiv-aids_b_3101250.html. No, this is not about the deficit. PEPFAR (and all money going towards foreign aid health initiatives) make up less than 1% of spending. As the article points out, the focus is less on a billateral solution, where the US gives them money and tells them how to fix the AIDS problem. It's turning more towards a structure whereby money is used to get the spread of HIV/AIDS under control and help countries work to reduce the rates, and then have them take over, with the help of international organizations, NGOs, and the UN. Rather trying to help these countries, the focus is shifting more towards helping them help themselves, or (to use the buzzword of the development community) "capacity building." PEPFAR has been criticized for hurting local health structures, with health workers in PEPFAR-funded programs making several times what similar workers in non-PEPFAR-funded health institutions. Foreign aid is just unpopular, though. Sure, there are disagreements about it from a "what's the best way to do it" standpoint, but many people just think we should cut it. In fact, it's one of the most common suggestions for things we should cut as par of the budget crisis (http://www.people-press.org/2013/02/22/as-sequester-deadline-looms-little-support-for-cutting-most-programs). Of course, anyone who suggests this doesn't know what they're talking about, since all foreign aid comes to not only less of the GDP than the average American thinks, but even less than the amount they would be fine with spending on it (http://www.cgdev.org/blog/lies-damn-lies-and-surveys-about-foreign-aid, http://www.worldpublicopinion.org/pipa/articles/brunitedstatescanadara/670.php). Not only that, but foreign aid leads to people being more supportive of the US, which lowers the risks of them attacking us.
Beyond that is the context. There were far bigger issues facing Americans. If you look at any article regarding PEPFAR and scan the comments sections (and I would recommend not wasting any time doing that), you will see things along the line of "great, so he helped people over there, but look at how he messed up with Katrina and saddled our country with 2 massive wars." Bush's "failures" tend to drown out any positives, which is a shame. Even articles praising him make reference to it being in contrast to his general legacy (http://www.foreignpolicy.com/articles/2013/02/14/what_george_w_bush_did_right?page=0,0). But, if you ask the people being helped, however, this isn't in contrast to his legacy; in many parts of Africa and in countries with high HIV, this IS his legacy (http://news.bbc.co.uk/2/hi/africa/7831460.stm). Sure, many Africans were excited about America having a president who looks like them, and CNN/al Jazeera/BBC have made them aware of his less positive moments. But, in the end, he's done a lot of good (http://www.huffingtonpost.com/ambassador-eric-goosby-md/through-pepfar-support-on_b_3461660.html, http://www.huffingtonpost.com/ambassador-eric-goosby-md/pepfar-tenth-anniversary_b_3325863.html). By the way, sorry for all the links, but I feel it adds more if I make it clear that these aren't just my own opinions/anecdotes. I realize some are repetitive, but it was easier than trying to transfer this from Word with them as links, rather than as footnotes (sorry, MLA fans).
And, of course, there are valid criticisms of the program itself. I already mentioned one, that being the impact it has on local health systems. It's also been criticized for creating a dependency in countries receiving the funds, though, as I mentioned, that is part of why the focus has shifted away from bilateral strategies. There are also those who say by reducing the transmission rates of HIV, we essentially make "high risk behaviors" safer (http://www.aids.org/topics/harm-reduction-and-hiv/). While that's true, when you make them safer, they become less high risk, so the statement is somewhat contradictory, in my opinion. Of course, reducing the likelihood of contracting HIV doesn't change the fact that when you have sex without a condom, you run the risk of other STIs or pregnancy, which should (and is) emphasized with the education aspects of PEPFAR. PEPFAR has also been criticized for working so heavily with FBOs, who, sometimes, make adherence to their faith a condition for being helped (something I personally think is wrong, but since they're willing to help where others won't, unless they're willing to pick up the slack, I don't think people who criticize PEPFAR for working with FBOs have much of a leg to stand on). Funding has been criticized (by this, I mean there are people who say we should be spending more). However, one of the biggest criticisms (and the one I most agree with) has been some of the requirements. A certain percentage (this has varied slightly, but was originally mandated at 1/3) of funds must go towards "abstinence only" education. While it's true that abstinence is the only 100% effective way to stop the spread of HIV, it's also unrealistic (just look in the US and the numbers between states that teach abstinence only sex ed as opposed to those who teach real sex ed). And, in fact, this has lead to a reduction in the effectiveness of encouraging condom use. PEPFAR funds also cannot go toward needle-exchange programs, which is one of the more effective methods of stopping the spread. Are IV drugs good? No. Should they be encouraged? No. But needle exchanges don't encourage them, they simply recognize that these people are going to do drugs either way, so lets help them do it without spreading HIV (sorry for the rant). PEPFAR also requires all organizations to sign an anti-prostitution pledge in order to receive funding. This has resulted in criticism since sex workers are, arguably, one of the groups most at risk for HIV. There are also issues with drug companies and the cost of the meds.
So, between partisan politics, context, and criticism of the program itself (and an American public increasingly obsessed with gossip and less interested in stuff that actually impacts the world), the program has slipped many people's minds. Which is unfortunate. But, thankfully, the 10th anniversary of PEPFAR has done a little to rectify this.
http://www.washingtonpost.com/opinions/eugene-robinson-george-w-bushs-greatest-legacy--his-battle-against-aids/2012/07/26/gJQAumGKCX_story.html "George W. Bush's greatest legacy" by Eugene Robinson
http://www.washingtonpost.com/opinions/george-w-bush-extend-success-against-aids-to-other-devastating-diseases/2012/07/22/gJQAxs042W_story.html "Extend the success against AIDS to other devastating diseases" by George W. Bush himself, suggesting we use the lessons learned from PEPFAR (arguably the most successful global health initiative) to fight other major diseases around the world.
http://www.washingtonpost.com/opinions/pepfars-glowing-report-card-10-years-later/2013/02/25/1a1c67e4-7ede-11e2-b99e-6baf4ebe42df_story.html "PEPFAR's glowing report card, 10 years later"
http://www.washingtonpost.com/opinions/a-pepfar-for-dc-and-baltimore/2012/07/20/gJQAVbZbyW_story.html "A PEPFAR for DC and Baltimore". Yes, it's been so successful "over there" that people, like Robert C. Gallo, are suggesting using the methods to fight HIV in the US.
And, of course, the many articles I've already included, most of which criticize the lack of articles about PEPFAR. The truth is, the information is out there, people just tend not to care. But that's changing, slowly, as we're seeing just how successful PEPFAR has been.
Ok, Jay, so PEPFAR's helped a lot of people. I get it. But I came here to read about your own experiences, not another story about fighting AIDS in Africa. So, please tell me, Mr. Salus, why exactly did I just read all of that? Well, first of all, as I mentioned before, one of the ways the US government implements PEPFAR programming is through the Peace Corps. My official title is a US Peace Corps Health Extension Volunteer, as part of the Community Health and HIV/AIDS Program. Basically, I'm how Peace Corps does the PEPFAR thing. But it's more than that. Namibia gained independence in 1991. Since 1996, HIV has been the leading cause of death in the country, and was a major cause for the life expectancy in the country dropping from 61 years to 49 between 1991 and 2001. However, between 2006 and 2008, the HIV rate between ages 15-49 dropped from almost 20% to less than 18% of the population. In 2009, the CDC estimated that roughly 13.1% of the adult population was living with HIV/AIDS (http://www.cdc.gov/globalhealth/countries/namibia/pdf/namibia.pdf). PEPFAR has also been directly responsible for an increased access to ART treatment, counseling, and HIV prevention education in Namibia, which has helped reduce the death rate caused by HIV. It's also led to a drastic reduction of mother-to-child transmissions and led to improved care for OVCs and other high risk groups, like out of school youths. In 2011 (the most recent year in which statistics are available), over 98,000 people received ARTs, over 240,000 received counseling and testing, and almost 2,300 infant infections were averted. Just in one year. Meanwhile, the CDC says that in 2011, life expectancy was up to 63 year for women, 62 for men. Here's the take from Wanda L. Nesbitt, US Ambassador to Namibia: http://reliefweb.int/report/namibia/working-namibia-end-aids.
Look, I realize I'm no expert when it comes to HIV/AIDS. There are plenty of people out there who could've written this post, or even a better one. I'll even admit that one of the reasons I wrote this was that I'm simply afraid I, like many PCVs, will lose the ability to write and speak in real English (as opposed to the Namlish that is slowly taking over). But I also wanted to talk about a topic I feel strongly about. Because I am working in the field of HIV/AIDS and PEPFAR does impact my life directly and because ever since I can remember, I'd seen people on TV talking about AIDS in Africa. I often hear people say how awful it is. While George W. Bush did a lot which I disagreed with, he also established PEPFAR, which has save millions of lives around the world, and I think it's time we all recognized this aspect of his legacy. 10 years later, and we're still seeing progress. Is there work to do? Sure. And I plan to be a part of it. So, I hope you enjoyed this and found it informative.
When AIDS was first discovered, it was a death sentence and a cause for great fear. It's now manageable and treatable. Soon, we might even have a vaccine (http://www.nytimes.com/2013/09/17/science/new-hope-for-hiv-vaccine.html?_r=0). Now, it's just a matter of helping people know the facts about the virus and how to prevent it. I'm writing this as the government shutdown is taking place, so I'll throw in my 2 cents on these negotiations: don't cut a penny of foreign aid, and especially from health initiatives like PEPFAR. It won't be more than a drop in the bucket for the American debt problem, but it will mean lives over here and around the world. "Investment in AIDS will be repaid a thousand-fold in lives saved and communities held together," Dr. Peter Piot, ED of UNAIDS. George W. Bush established PEPFAR. He made the investment. He began fixing the house. And he deserves a lot of thanks for doing so.
So, a few question that I should probably address. First of all, most of you might be wondering what is PEPFAR (I mean really, not just the basics) and what has it done. Then, you might ask what PEPFAR as accomplished? I'll give a quick answer now: quite a bit. Ok, so if it's been successful, why haven't we heard about it? And, spoiler alert, the answer will be my opinion, since a real, objective answer would be impossible to give. And finally, why am I writing about this, rather than myself or Namibia? So, let us begin.
It's a lot easier to criticize a house for being ugly than it is to fix it up. It's a lot easier to talk about how awful it is that people are dying of HIV/AIDS. George W. Bush didn't just talk about how awful it was. After talking with people who knew what they were talking about, his administration established PEPFAR.
What is PEPFAR? In 2003, President Bush launched the President's Emergency Plan for AIDS Relief, largely as a response to major issue of AIDS around the world. It pledged roughly $15 billion to fight HIV/AIDS from 2003-2008. Renewed under and expanded by Obama, it as donated billions of dollars to fighting HIV/AIDS, TB, and malaria, and has been credited with saving over 1.1 million African lives in 10 years. And yes, Namibia is one of the countries that as benefited greatly from it, as I will talk about later. Originally, there 15 focus countries, mostly in Africa, though the program as moved away from this.
(Map of PEPFAR World Activities)
https://hiu.state.gov/Products/Worldwide_PepfarPlans_2012July19_HIU_U568.pdf
USAID, HHS, the CDC, OGAC (Office of the Global AIDS Coordinator, housed in the Department of State), Peace Corps, and several other departments and agencies have been part of the implementation process. And yes, as you probably guessed, this list answers, at least in part, the "why am I writing about this" thing. It focuses on prevention, treatment, and care for those living with HIV, through education, contraception, ART (antiretroviral therapy), counseling, etc. I could throw around terms like "OVCs," or "PLVHA," or "Out of School Youths" as target groups, or the ABC method of prevention, or PMTCT. Or, I can assume you are all intelligent/capable of using Google. I'm going to go with the latter, since it's less work for me.
So, in short, that's what it is (see links later for more info).
Okay, well, what have been the results? Well, here are some numbers from PEPFAR's website:
- 5.1 million people received ARTs because of PEPFAR
- 11 million pregnant women received HIV testing and counseling treatment, and is believed to ave prevented 230,000 cases of mother-infant transmissions in 2012
- 15 million people receiving care in 2012
- 5 million OVCs receiving care and support in 2012
- 46.5 million people were tested for HIV in 2012
- As mentioned, an estimated 1.1 MILLION PEOPLE IN AFRICA ALONE DIDN'T DIE FROM HIV/AIDS
- Over 7 million new infections prevented
http://www.mercurynews.com/breakingnews/ci_12087859
http://www.eurekalert.org/pub_releases/2009-04/sumc-ssf040209.php
Yeah, it's been good. No, it hasn't been cheap, but it as saved lives.
Okay, Jay, we get it. You really like PEPFAR, and it's been fairly successful. So, why is it not more well known? Well, reader, there are a few reason. And no, none of them will completely answer the question, since there is no single answer. There are, instead, several factors which I feel play a role. I will expand on them shortly. One of the most commonly cited ones is politics. One I put more stock in is the main problem with foreign aid: it helps people "over there" rather than "here," so we don't directly see the impact. Another factor is context. Let's face it, the wars in Iraq and Afghanistan pretty much consumed all of our foreign policy attention during the Bush years. Everything else was kind of just drowned out. On top of that, the economy collapsed, and we were more worried about people here who were suffering. Beyond that, the handling of Katrina tends to dominate any discussion about how Bush handled disasters. And, finally, most of the impact is long-term, so it didn't really show up while he was still in office (in fact, we have yet to see the full impact). There are also some criticisms of the program itself, some valid, some (in my opinion) just people being selfish and shortsighted.
Here is one take on the issue: http://www.huffingtonpost.com/anthony-amore/googling-pepfar_b_3934705.html. Now, Amore's take starts off good, talking about how more people know about Miley Cyrus twerking than about a program that's spent billions to save lives. However, he pretty much kills any validity in his article when he talks about "Hollywood elite" and blames "the Left," as if they make up one group. This brings us to the first issue. Politics absolutely play a massive role. After all, we're talking about a 21st century US President, so any legacy is going to be based on political views, and the Democrats certainly had a lot to gain from not publicizing it, since the fewer people who know about it, the fewer people who would have something nice to say about Bush. Of course, this simplistic analysis ignores the fact that the program as been continued and expanded, to a degree (more on that later), by the Obama administration.
The fact is, foreign aid polls bad. The people it helps aren't the ones paying taxes or voting in the elections. Many people don't like the idea of our money going to help people "over there" when we have so many problems in our own country. There is also the question of whether the money's been worth it, since 10 years later, HIV still exists. Shouldn't people's own governments be taking over by now? Well, actually, they are. PEPFAR funding has been reduced. http://www.huffingtonpost.com/chris-collins/pepfar-cuts-hiv-aids_b_3101250.html. No, this is not about the deficit. PEPFAR (and all money going towards foreign aid health initiatives) make up less than 1% of spending. As the article points out, the focus is less on a billateral solution, where the US gives them money and tells them how to fix the AIDS problem. It's turning more towards a structure whereby money is used to get the spread of HIV/AIDS under control and help countries work to reduce the rates, and then have them take over, with the help of international organizations, NGOs, and the UN. Rather trying to help these countries, the focus is shifting more towards helping them help themselves, or (to use the buzzword of the development community) "capacity building." PEPFAR has been criticized for hurting local health structures, with health workers in PEPFAR-funded programs making several times what similar workers in non-PEPFAR-funded health institutions. Foreign aid is just unpopular, though. Sure, there are disagreements about it from a "what's the best way to do it" standpoint, but many people just think we should cut it. In fact, it's one of the most common suggestions for things we should cut as par of the budget crisis (http://www.people-press.org/2013/02/22/as-sequester-deadline-looms-little-support-for-cutting-most-programs). Of course, anyone who suggests this doesn't know what they're talking about, since all foreign aid comes to not only less of the GDP than the average American thinks, but even less than the amount they would be fine with spending on it (http://www.cgdev.org/blog/lies-damn-lies-and-surveys-about-foreign-aid, http://www.worldpublicopinion.org/pipa/articles/brunitedstatescanadara/670.php). Not only that, but foreign aid leads to people being more supportive of the US, which lowers the risks of them attacking us.
Beyond that is the context. There were far bigger issues facing Americans. If you look at any article regarding PEPFAR and scan the comments sections (and I would recommend not wasting any time doing that), you will see things along the line of "great, so he helped people over there, but look at how he messed up with Katrina and saddled our country with 2 massive wars." Bush's "failures" tend to drown out any positives, which is a shame. Even articles praising him make reference to it being in contrast to his general legacy (http://www.foreignpolicy.com/articles/2013/02/14/what_george_w_bush_did_right?page=0,0). But, if you ask the people being helped, however, this isn't in contrast to his legacy; in many parts of Africa and in countries with high HIV, this IS his legacy (http://news.bbc.co.uk/2/hi/africa/7831460.stm). Sure, many Africans were excited about America having a president who looks like them, and CNN/al Jazeera/BBC have made them aware of his less positive moments. But, in the end, he's done a lot of good (http://www.huffingtonpost.com/ambassador-eric-goosby-md/through-pepfar-support-on_b_3461660.html, http://www.huffingtonpost.com/ambassador-eric-goosby-md/pepfar-tenth-anniversary_b_3325863.html). By the way, sorry for all the links, but I feel it adds more if I make it clear that these aren't just my own opinions/anecdotes. I realize some are repetitive, but it was easier than trying to transfer this from Word with them as links, rather than as footnotes (sorry, MLA fans).
And, of course, there are valid criticisms of the program itself. I already mentioned one, that being the impact it has on local health systems. It's also been criticized for creating a dependency in countries receiving the funds, though, as I mentioned, that is part of why the focus has shifted away from bilateral strategies. There are also those who say by reducing the transmission rates of HIV, we essentially make "high risk behaviors" safer (http://www.aids.org/topics/harm-reduction-and-hiv/). While that's true, when you make them safer, they become less high risk, so the statement is somewhat contradictory, in my opinion. Of course, reducing the likelihood of contracting HIV doesn't change the fact that when you have sex without a condom, you run the risk of other STIs or pregnancy, which should (and is) emphasized with the education aspects of PEPFAR. PEPFAR has also been criticized for working so heavily with FBOs, who, sometimes, make adherence to their faith a condition for being helped (something I personally think is wrong, but since they're willing to help where others won't, unless they're willing to pick up the slack, I don't think people who criticize PEPFAR for working with FBOs have much of a leg to stand on). Funding has been criticized (by this, I mean there are people who say we should be spending more). However, one of the biggest criticisms (and the one I most agree with) has been some of the requirements. A certain percentage (this has varied slightly, but was originally mandated at 1/3) of funds must go towards "abstinence only" education. While it's true that abstinence is the only 100% effective way to stop the spread of HIV, it's also unrealistic (just look in the US and the numbers between states that teach abstinence only sex ed as opposed to those who teach real sex ed). And, in fact, this has lead to a reduction in the effectiveness of encouraging condom use. PEPFAR funds also cannot go toward needle-exchange programs, which is one of the more effective methods of stopping the spread. Are IV drugs good? No. Should they be encouraged? No. But needle exchanges don't encourage them, they simply recognize that these people are going to do drugs either way, so lets help them do it without spreading HIV (sorry for the rant). PEPFAR also requires all organizations to sign an anti-prostitution pledge in order to receive funding. This has resulted in criticism since sex workers are, arguably, one of the groups most at risk for HIV. There are also issues with drug companies and the cost of the meds.
So, between partisan politics, context, and criticism of the program itself (and an American public increasingly obsessed with gossip and less interested in stuff that actually impacts the world), the program has slipped many people's minds. Which is unfortunate. But, thankfully, the 10th anniversary of PEPFAR has done a little to rectify this.
http://www.washingtonpost.com/opinions/eugene-robinson-george-w-bushs-greatest-legacy--his-battle-against-aids/2012/07/26/gJQAumGKCX_story.html "George W. Bush's greatest legacy" by Eugene Robinson
http://www.washingtonpost.com/opinions/george-w-bush-extend-success-against-aids-to-other-devastating-diseases/2012/07/22/gJQAxs042W_story.html "Extend the success against AIDS to other devastating diseases" by George W. Bush himself, suggesting we use the lessons learned from PEPFAR (arguably the most successful global health initiative) to fight other major diseases around the world.
http://www.washingtonpost.com/opinions/pepfars-glowing-report-card-10-years-later/2013/02/25/1a1c67e4-7ede-11e2-b99e-6baf4ebe42df_story.html "PEPFAR's glowing report card, 10 years later"
http://www.washingtonpost.com/opinions/a-pepfar-for-dc-and-baltimore/2012/07/20/gJQAVbZbyW_story.html "A PEPFAR for DC and Baltimore". Yes, it's been so successful "over there" that people, like Robert C. Gallo, are suggesting using the methods to fight HIV in the US.
And, of course, the many articles I've already included, most of which criticize the lack of articles about PEPFAR. The truth is, the information is out there, people just tend not to care. But that's changing, slowly, as we're seeing just how successful PEPFAR has been.
Ok, Jay, so PEPFAR's helped a lot of people. I get it. But I came here to read about your own experiences, not another story about fighting AIDS in Africa. So, please tell me, Mr. Salus, why exactly did I just read all of that? Well, first of all, as I mentioned before, one of the ways the US government implements PEPFAR programming is through the Peace Corps. My official title is a US Peace Corps Health Extension Volunteer, as part of the Community Health and HIV/AIDS Program. Basically, I'm how Peace Corps does the PEPFAR thing. But it's more than that. Namibia gained independence in 1991. Since 1996, HIV has been the leading cause of death in the country, and was a major cause for the life expectancy in the country dropping from 61 years to 49 between 1991 and 2001. However, between 2006 and 2008, the HIV rate between ages 15-49 dropped from almost 20% to less than 18% of the population. In 2009, the CDC estimated that roughly 13.1% of the adult population was living with HIV/AIDS (http://www.cdc.gov/globalhealth/countries/namibia/pdf/namibia.pdf). PEPFAR has also been directly responsible for an increased access to ART treatment, counseling, and HIV prevention education in Namibia, which has helped reduce the death rate caused by HIV. It's also led to a drastic reduction of mother-to-child transmissions and led to improved care for OVCs and other high risk groups, like out of school youths. In 2011 (the most recent year in which statistics are available), over 98,000 people received ARTs, over 240,000 received counseling and testing, and almost 2,300 infant infections were averted. Just in one year. Meanwhile, the CDC says that in 2011, life expectancy was up to 63 year for women, 62 for men. Here's the take from Wanda L. Nesbitt, US Ambassador to Namibia: http://reliefweb.int/report/namibia/working-namibia-end-aids.
Look, I realize I'm no expert when it comes to HIV/AIDS. There are plenty of people out there who could've written this post, or even a better one. I'll even admit that one of the reasons I wrote this was that I'm simply afraid I, like many PCVs, will lose the ability to write and speak in real English (as opposed to the Namlish that is slowly taking over). But I also wanted to talk about a topic I feel strongly about. Because I am working in the field of HIV/AIDS and PEPFAR does impact my life directly and because ever since I can remember, I'd seen people on TV talking about AIDS in Africa. I often hear people say how awful it is. While George W. Bush did a lot which I disagreed with, he also established PEPFAR, which has save millions of lives around the world, and I think it's time we all recognized this aspect of his legacy. 10 years later, and we're still seeing progress. Is there work to do? Sure. And I plan to be a part of it. So, I hope you enjoyed this and found it informative.
When AIDS was first discovered, it was a death sentence and a cause for great fear. It's now manageable and treatable. Soon, we might even have a vaccine (http://www.nytimes.com/2013/09/17/science/new-hope-for-hiv-vaccine.html?_r=0). Now, it's just a matter of helping people know the facts about the virus and how to prevent it. I'm writing this as the government shutdown is taking place, so I'll throw in my 2 cents on these negotiations: don't cut a penny of foreign aid, and especially from health initiatives like PEPFAR. It won't be more than a drop in the bucket for the American debt problem, but it will mean lives over here and around the world. "Investment in AIDS will be repaid a thousand-fold in lives saved and communities held together," Dr. Peter Piot, ED of UNAIDS. George W. Bush established PEPFAR. He made the investment. He began fixing the house. And he deserves a lot of thanks for doing so.
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