Botswana's Gains Against AIDS Put U.S. Claims to Test

By Craig Timberg
Washington Post Foreign Service
Friday, July 1, 2005

GABORONE, Botswana -- As global leaders gathered in Davos, Switzerland, for the World Economic Forum in January, officials from President Bush's $15 billion anti-AIDS program issued a news release citing their accomplishments. Nowhere were the numbers more impressive than in Botswana, where 32,839 AIDS patients were receiving life-extending treatment with the help of the U.S. government, they said.

But thousands of miles away in Botswana, the Bush administration's claim provoked frustration and anger among public and private partners that had built Africa's most far-reaching AIDS treatment program, recalled those involved. Although the Bush program had promised millions of dollars of support, no money had yet arrived, they said.

The operations manager of Botswana's treatment program, Segolame Ramotlhwa, called the U.S. figures "a gross misrepresentation of the facts." His boss, Patson Mazonde, who as deputy permanent secretary for health services had overseen the program since its inception in 2002, called the Bush claim "false" but suggested it was merely a mistake.

They agreed on the number of patients in Botswana who had been put on treatment because of the Bush program: zero.

After first defending its figures from the January news release, the Bush administration last month revised them sharply downward. But even the revised numbers remain in dispute. Administration officials announced that 20,000 people in Botswana were receiving "significant support" from U.S. programs for their AIDS treatment. Health officials in Botswana maintained, as they have for months, that no citizen was dependent on U.S. support for treatment, the cost of which has been covered overwhelmingly by the Botswanan government.

The disagreement underscores not only the highly politicized nature of treating AIDS in Africa, where less than 10 percent of the people who need antiretroviral drugs are getting them, but also how rare -- and coveted -- success stories such as those in Botswana remain.

To people receiving the lifesaving medications, the question of who gets the credit may not matter. But for the government of Botswana, the groundbreaking AIDS program is a source of enormous national pride, while for the Bush administration, being able to announce such successes bolsters its claim to having begun to "turn the tide" against AIDS in the developing world.

The dispute essentially comes down to a question of how to define "support." In March, in an annual report on the program, the Bush administration said support could include general "system strengthening" -- a category so broad that it could allow officials to claim to have supported treatment of any AIDS patient who benefited, however indirectly, from U.S. government assistance.

The head of the Bush administration's program in Botswana, Peter H. Kilmarx, from the Centers for Disease Control and Prevention in Atlanta, said in an interview here in May that he was aware of the upset among the Botswanan officials but that the treatment claims fit within U.S. government guidelines. The definition used for measuring support, he said, had broadened to the point that even assistance as trivial as editing a government health official's speeches could allow the Bush program to say it had supported treatment for everyone receiving antiretrovirals from that nation's public health system.

The system "could be abused," Kilmarx said. "But it's not."

The Bush program set its numerical targets even before the legislation creating the program was drafted. In his 2003 State of the Union address, Bush stunned AIDS activists by announcing a $15 billion commitment over five years to fight the disease. The program would soon become what U.S. officials call the largest global health initiative undertaken against a single disease by a single country.

Bush announced that the program would "treat at least 2 million people with life-extending drugs." But over the next year, as administration officials developed the president's promise into a program, they recast the goal. It was not practical, officials say they concluded, for the U.S. government to build clinics, hire doctors and hand out drugs all over the developing world. And officials from the countries targeted for the assistance, including Botswana, made clear that while they wanted help, they believed that their own governments, not the United States, should be distributing the medicine.

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