The legacy of former President George W. Bush is seen as an ominous cloud rather than a beam of sunshine, especially due to the number of Americans who continually blame President Bush for many of their woes or current state of lament hardship. Regardless of your opinion concerning the former President’s legacy, President Bush does have some positive marks. In 2003, President George W. Bush initiated the greatest effort to combat any disease in history. This noble effort by the United States sought out to provide aid and relief to those suffering from the epidemic HIV/AIDS in regions with scarce or insufficient resources.
The initiative was titled “PEPFAR” (President’s Emergency Plan for AIDS Relief), and carried a cost of $15 billion dollars over the course of five years (2003-2008). The multibillion dollar commitment made by the United States sought to attack the AIDS epidemic that has been marching throughout Africa, and regions of the world. PEPFAR’s first phase began to establish care and treatment programs, providing necessary resources to dull or alleviate the devastating effects AIDS has been causing those infected with the disease.
However, PEPFAR’s real success was seen in expanding PEPFAR beyond care and treatment, into HIV prevention as well. During this early stage of PEPFAR, care and treatment were provided to over 10 million people, with 4 million of whom being orphans or children considered vulnerable. (Washington Post: 2009). In addition, prevention methods of mother-to-child treatment services were provided during approximately 16 million pregnancies. In order to sufficiently combat HIV/AIDS, a necessary sense of urgency, determination, time and effort must be applied to attack the HIV/AIDS epidemic.
An approach that expands prevention programs as well as care and treatment programs is essential in establishing sufficient efforts to HIV/AIDS prevention as we look to find, and sustain control over this epidemic. For PEPFAR to move forward, building upon its successes is important. However, a concentrated focus on promoting programs in regions such as Africa are most pertinent to established sustained progress for a brighter future. “It is my hope, that together, we can move closer to the day when we eliminate this disease from the face of the earth.
” (President Obama: 2009). PEPFAR has targeted various areas across the globe such as Vietnam, Haiti, Guyana and twelve sub-Saharan nations in Africa. In 2008, marking the end of the Bush administration, as well as the beginning of the Obama administration, more than 2 million men, women and children have received ART (antiretroviral treatment). Due to these efforts, approximately 240,000 infants were born free of an HIV infection. (Washington Post: 2009). In any aspect of life, it is always easier to dwell on success and overlook perceived failures.
In fact, spending too much time discussing and focusing on the success of PEPFAR is exactly what may open the doors for additional failure. Roger England from “The British Medical Journal”, points out that providers for AIDS relief, with the United States being the largest, “…. imposes its own priorities, plans and reporting requirements, thus massively increasing the administrative burden on countries. ” (English: 2007). Roger England is quick to point out the palpable aspect of a larger government (e.
g. The United States Government) acting as a burden to the smaller governmental administrations. As too much intervention in another nation’s administration and administrative problems is a distinct criticism, I hardly see it in a negative light. Not only is the largest concentrated effort being made by the United States to combat and prevent HIV/AIDS, but a lack of administrative success in these previously mentioned areas, such as sub-Saharan Africa, must take a portion of the blame as well.
The United States, along with its significantly larger wallet, may not have stepped in to provide funding, aid or relief if an AIDS devastated nation had been developing, progressing and working extremely diligently to combat the disease themselves. Of course, these regions afflicted by the AIDS pandemic are regions where providing the type of help PEPFAR provides isn’t entirely possible, mainly due to lack of development, economic growth as well as a smaller economy.
Aside from the previous basic criticism from Roger English, another common perceived fault lies in the delicate situation revolving around the amount of funding necessary, and the toughness of the HIV/AIDS disease in and of itself. AIDS is very expensive to combat or control. Methods of prevention through abortions, condoms, birth control as well as the high volume of various drugs required to depress the disease enough to live a relatively normal life is very expensive.
This in part, is why methods of prevention are so vital to PEPFAR’s potential success, simply because the best way to combat HIV/AIDS is to prevent infections from occurring. Furthermore, treating or providing care to an individual already infected is far more costly due to the drug remedies required. Addition to this issue, there are many ideological disagreements between the United States and the nations where PEPFAR is implemented.
Elena Ghanotakis, Susannah Mayhew and Charlotte Watts from “The Oxford Journal” claim, “A number of PEPFAR-South Africa’s positions (e. g. on condoms and abortion) stand in contradiction to South Africa’s own laws.
While PEPFAR-South Africa officials are adamant that PEPFAR addresses the GBV-HIV link, it does not form an explicit strategic goal and there are no indicators for this work. ”(Ghanotakis, Mayhew, Watts:2009). Aside from the economic concern of committing 15 billion dollars to a cause in the AIDS disease that has shown far fewer strides in terms of a cure in comparison to a disease such as cancer, it has devastated life expectancy rates, infant mortality rates, mortality rates, etc. in nations such as Haiti or Vietnam, but mainly sub-Saharan Africa.
Statistics from the “Population Reference Bureau” show infant mortality rates in Vietnam sitting at 16 per 1,000 live births, Haiti with 59 per 1,000, Guyana with 38 per 1,000 as well as sub-Saharan nations in Africa showing equally poor, or worse rates. In this paper, I will focus on Zimbabwe, a nation especially devastated by the HIV/AIDS pandemic. Zimbabwe has an infant mortality rate of 57. 8. While Guyana, Vietnam and Haiti seemingly are less inflicted in terms of infant mortality rates, they also rank better than Zimbabwe in life expectancy as well.
For example the life expectancies for Guyana, Haiti and Vietnam are as follows: Guyana: 70(both sexes), 73(females), 67(males); Haiti: 62(both sexes), 64(females), 61(males); Vietnam: 73(both sexes), 76(females), 70(males). These numbers are far better than Zimbabwe, where life expectancy rates are as poor as 46 for both sexes, with 45 and 46 years of age for females, and males. In addition, Zimbabwe has a mortality rate of 15 deaths annually per 1,000 total population. When compared to the other nations the United States is funding, these numbers are fairly worse: Vietnam: 7, Haiti: 9, Guyana: 6.
As seen by this data, sub-Saharan Africa is seemingly more devastated by the HIV/AIDS epidemic in comparison to nations such Vietnam, Guyana or Haiti. This should cause one to bring up the economic aspect of PEPFAR, and what type of financial investment this will turn out to be. Meaning, to fight a difficult disease such as HIV/AIDS requires a very large investment into treatment/care programs, supplying birth control methods such as condoms, birth control or abortions, ART (antiretroviral treatment), promotion and extreme effort towards preventing HIV and so on.
Since antiretroviral drugs for numbing down HIV/AIDS are very costly, it seems unrealistic to me to provide such a high amount of expensive drugs on such a broad level, especially when the outcome of these efforts through PEPFAR is uncertain. Furthermore, Vietnam and Guyana both statistically rank far better than even Haiti in some regards, and much better than sub-Saharan African nations. Which begs me to ask how desperately Vietnam, Guyana or Haiti truly are for so much of our direct funding and treatment. Especially when other AIDS relief agencies are out there.
To stem off of the antiretroviral treatment aspect of PEPFAR, Eugene Robinson from “Real Clear Politics” is intelligent to mention that “When the drugs are taken haphazardly, the virus mutates and becomes resistant. Therefore, this reasoning went, trying to administer antiretroviral treatment in poor African countries might actually be worse than doing nothing at all. ”(Robinson: 2012). This is incredibly important to understand, because while the antiretroviral drugs are essential to kick back HIV/AIDS to the point where HIV prevention can begin to be a larger scale focus.
While PEPFAR is seen as a positive mark for President Bush, there are many complications ranging from the amount of spending, the effectiveness of the treatment as well as the ideological differences and disagreements. Especially in a nation like Zimbabwe, where a corrupt government has allowed the nation to treat women horribly and has seen an increase in migration out of Zimbabwe because employment is scarce (despite 6% economic growth in 2011: Population Reference Bureau). To pour salt in Zimbabwe’s wounds, HIV/AIDS has been marching through sub-Saharan Africa devastating the social, demographic backbone of Zimbabwe.
I would say change is not only needed in Zimbabwe, but PEPFAR’s approach as well. PEPFAR provides HIV/AIDS relief to Vietnam, Haiti, Guyana and twelve sub-Saharan nations in Africa. I don’t blame people for criticizing PEPFAR, after all, everyone is entitled to their opinions. However, the noble effort towards justice in knowing AIDS isn’t devastating lives would be a blessing for the nations whose populations have experienced lives that have been halted by HIV/AIDS. With that said, I feel that the phases or goals of PEPFAR need refinement.
So I would advocate a little bit of policy change. Currently, PEPFAR provides relief to a broad range of nations from Vietnam to Haiti and so on. Furthermore, nations like Vietnam don’t experience nearly as bad HIV/AIDS related rates, statistically speaking. Sub-Saharan nations in Africa see far worse infant mortality rates, life expectancy rates, death rates, etc. Since PEPFAR provides funding on such a broad scale, I think going forward it needs to become a more concentrated effort.
Meaning, PEPFAR should seek out other AIDS relief programs to coordinate certain relief goals, who to fund, how much to fund a given nation, what does the population in a certain area require so far as prevention or treatment, and how much that will cost, etc. If PEPFAR can expand by integrating with other relief agencies, HIV/AIDS treatment and prevention efforts can globally increase on a more effective scale. The data provided from the “Population Reference Bureau” shows that Vietnam, Guyana and Haiti are fairly better off in some regards when compared to a nation like Zimbabwe, or the other eleven African nations funded by PEPFAR.
Therefore, Vietnam, Guyana and Haiti should be promoting the progression from treatment into a focus on prevention phase. Simultaneously, funding should slowly be reduced over the next few years in accordance with each nation’s respective improvements. If PEPFAR integrates with other agencies, PEPFAR can focus more of President Bush’s 15 billion dollar investment in the most HIV/AIDS infected areas. For instance, a nation such as Zimbabwe is far more devastated, and requires more of PEPFAR’s direct attention.
The populations in these diseased inflicted areas desperately need to free themselves from the grip of HIV/AIDS. At the same time, economic growth in sub-Saharan African is proving to be a potential investor happy area from an Americans view. Therefore, integration with other agencies would allow the United States’ PEPFAR program to mainly focus on sub-Saharan Africa. The area most devastated by AIDS, and the most investor friendly potential in the future as well.
Potential progress in beating AIDS in sub-Saharan Africa will lead to a more positive outlook on life for citizens there. If this hypothetical ever becomes a reality, the United States would deserve a big thank you. At the same time, progress in the communities within these nations demographically, will catch up to fast growing pace of the sub-Saharan economy. If HIV/AIDS can progress step by step to being all but eliminated, it will greatly change the social atmosphere of the region.
Although, a country like Zimbabwe has an incredibly corrupt government, likely making it a place one would not want to invest in, even if my hypothetical success story I previously stated came to fruition. PEPFAR’s approach needs to aim at not only effectiveness, but the cost of providing relief. A focus on wearing condoms should take center stage. With such ideological differences between the United States and who we fund through PEPFAR, condoms will not only be the cheapest prevention method, but the most ideologically agreeable when compared to birth control pills, or abortion.
With such a culture clash between the United States and the nations we aim to provide HIV/AIDS relief for, it is pointless to try to induce one side to budge on a social, cultural matter. Adapting to the most socially agreeable stance in prevention or treatment is essential if real progress is to be made.
References: 1. English, Roger. 2007. “Dangers of Disease Specific Aids Programmes. ” British Medical Journal, Vol. 335-No. 7619. 2. Salaam-Blyther, Tiaji. 2007. “PEPFAR: From Emergency to Sustainability. ” CRS Report for Congress. 3. Robinson, Eugene. 2012.
“Bush and His Open Heart. ” Real Clear Politics. http://www. realclearpolitics. com/articles/2012/07/27/bush_and_his_open_heart_114924. html 4. Ghanotakis, Elena; Susannah Mayhew, Charlotte Watts. “Tackling HIV and gender-based violence in South Africa: how has PEPFAR responded and what are the implications for implementing organizations? ” Health Policy Journal Links: 1. Population Reference Bureau: http://www. prb. org/DataFinder/Topic/Rankings. aspx? ind=4 2. PEPFAR. gov: * http://www. pepfar. gov/strategy/document/133244. htm * http://www. pepfar. gov/.