It's Time to Fix Bush's AIDS Policy

The President's Emergency Plan for AIDS Relief (PEPFAR) is moving toward a cloture vote in the Senate, a vote that will determine whether the $50 billion reauthorization lives or dies. That same life or death question applies to millions of people in Africa, and comparing actual life or death in Africa to the political legacy of President Bush, as many people see PEPFAR as his greatest achievement, is appalling. Doubly so when the politicians and mainstream media refuse to demand fixes to PEPFAR's problems. Like the rest of President Bush's legacy, PEPFAR, as successful as it has been in part, is a go-it-alone strategy that has alienated much of the rest of the world's public health community.

The reality is this: as successful as PEPFAR has been getting life-saving treatment to nearly two million people, it has failed to slow the infection rate because it has been hampered by unnecessary ideological restrictions. For every two people who receive treatment, five are newly infected with HIV, according to a letter from leading public health advocates circulating on Capitol Hill.

The current legislation will not change that.

At that rate of infection, fiscal conservatives like Sen. Jon Kyl (R-AZ) are right to question the amount of money being spent and if it makes sense, because unless you stem the infection rate, no matter how many people get treated there will always be more than twice as many who don't. Unless the bill is fixed to eliminate ideological provisions, touted by Sen. Tom Coburn (R-OK) that have hampered PEPFAR's prevention efforts in its first five years, and promise more of the same if the current bill passes, PEPFAR will not be as successful in fighting HIV in Africa as it could be.

Unfortunately, that is not the heart of Sen. Kyl's objections. He and other fiscally-conservative Republicans who've been blocking the bill have taken some heat in editorials recently for standing in the way of "the greatest foreign policy achievement since the Marshall Plan," according to PEPFAR supporters quoted in a Wall Street Journal editorial. Given the continued infection rates and failure to address PEPFAR's flaws to turn the tide, the comparison to the Marshall Plan could only be accurate if Europe were still in shambles.

The Las Vegas Sun writes,

A small group of Republican senators, though, is spoiling the momentum by arguing that the legislation costs too much and includes money for unrelated poverty programs.

Poverty is indeed related to the spread of HIV and anyone who doesn't get that yet isn't paying attention. Poverty is at the heart of why prevention efforts are so challenging and must be changed, and why putting treatment ahead of prevention is the proverbial cart-before-horse problem. They must work together, and only prevention can ultimatley lessen the burden of treatment.

We should all celebrate the two million lives with us today that otherwise would not be because of PEPFAR treatment. The stark realities of those lives are documented beautifully in a special exhibition, Access to Life, at the Corcoran Gallery in Washington, DC, sponsored by The Global Fund on AIDS. The photos tell the story of people from every imaginable walk of life, mostly women, often young, always on the margins -- who because of treatment are alive today, working, raising families, educating others about HIV/AIDS.

Every Member of Congress should be forced to visit this exhibit before voting on PEPFAR, because as much as it speaks to the life-saving power of treatment, the exhibition also speaks truth about the need to set ideology aside in favor of reality-based education and prevention efforts, now. Had ideology not stood in our way for the first 25 years of the AIDS pandemic, many of these people might never have been infected in the first place. Prevention is and always will be the key to fighting HIV.