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African AIDS Crisis Outlives $15 Billion Bush Initiative
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Venter said the infusion of money from PEPFAR enabled two clinics he helps oversee to offer more drugs to more people by improving the training of nurses, providing medical tests and paying some staff salaries. One of the clinics, Venter said, used to add about 10 people a month to its roster of patients on antiretroviral drugs; now that number exceeds 150.
"That's happened with a lot of effort, and that's largely on account of the PEPFAR program," Venter said.
On prevention, the officials who implement PEPFAR have largely abandoned its most audacious and specific claims. Instead they tabulate how many people, for example, may have heard a radio show on AIDS, without attempting to estimate how many avoided contracting HIV as a result.
They do claim, however, to have helped prevent 157,000 cases of pediatric HIV by assisting programs that have provided antiretroviral drugs to pregnant women. Administration officials rarely mention, however, that they have resisted calls to provide women with contraceptives.
Studies have shown that family planning could avert far more infections than antiretroviral drugs because many women, especially those with HIV, want fewer children. Critics say the restriction, along with PEPFAR's emphasis on untested abstinence programs, exists mainly to win support from conservative congressional Republicans, undermining the full potential of a program that the White House bills as one of the biggest humanitarian ventures in history.
"The same money spent in more evidence-based ways would bring more health and happiness," said Malcolm Potts, former head of Family Health International, a research group that receives significant PEPFAR funding.
But PEPFAR officials have adapted. After initial reluctance, they have begun supporting efforts to offer circumcision services for men, which three major experiments in Africa have shown could slow infection rates by more than 60 percent.
The program has also branched out beyond AIDS, which in most African nations kills fewer people than does malaria, malnutrition or contaminated water. In Rwanda, the 3 percent HIV rate is far lower than in southern African nations. PEPFAR money increasingly is used to improve basic medical services.
Yet the past five years have also shown that the AIDS epidemic can be contained by forces other than U.S. money and political will. Africa's biggest declines in HIV rates during Bush's AIDS initiative have come in Zimbabwe, where economic collapse has coincided with fundamental social change, including a shift toward monogamy and away from more-costly multiple relationships, research there shows.
The changes have come as President Robert Mugabe's ruinous rule has driven away foreign funding. Each of its neighbors -- which all lag behind Zimbabwe in slowing HIV -- are PEPFAR focus countries. Zimbabwe is not.
