The Washington Post

Bush AIDS policies shadow Obama in Africa

As President Obama’s motorcade pulled up on Sunday to a community health center run by Archbishop Desmond Tutu in this picturesque coastal city, people on the streets held signs that read “Thanks PEPFAR.” It was a reference to the President’s Emergency Plan for AIDS Relief, started by President George W. Bush.

Obama has been widely applauded for distinguishing himself from Bush’s policies, especially in Iraq and Afghanistan. But across this continent, many Africans wish Obama was more like Bush in his social and health policies, particularly in the fight against HIV/AIDS — one of the former president’s signature foreign policy aid programs.

Bush poured billions of dollars into the effort to combat the spread of the disease that once threatened to consume a generation of young Africans, and as Obama has spent two days touring South Africa, the shadow of his predecessor has trailed him.

On Monday, Obama travels to Tanzania, where he could wind up face to face with Bush, whose visit will overlap with Obama’s there the next two days. Bush’s wife, Laura, will participate in a First Ladies Summit hosted by the George W. Bush Foundation, and first lady Michelle Obama also will participate. White House aides suggested Sunday that the two men could appear with each other, although they said no plans have been set. “There may be something. We’ll keep you updated,” deputy national security adviser Ben Rhodes said.

For Obama, the success of Bush’s program has proved a tad awkward, as he has been mindful to praise his predecessor even as he tries to push forward on his administration’s own plans for new programs based on private investment from U.S. businesses. Flying to South Africa from Senegal this weekend, Obama told reporters that Bush “deserves enormous credit” for the fight against HIV/AIDS, acknowledging that the program likely saved millions of lives.

In South Africa, the success was extraordinary. AIDS killed roughly 2.3 million in South Africa — once one of the worst-affected countries in the world — and orphaned about a million children there, according to the United Nations. Today, rates of infection have fallen to 30 percent, and nearly 2 million people are on antiretroviral drugs.

But AIDS advocates on Sunday said that Obama administration budget cuts that have slashed hundreds of millions of dollars from PEPFAR threaten to turn back years of progress in the fight against the AIDS epidemic. Last year, the administration unveiled a budget that reduces AIDS funding globally by roughly $214 million, the first time an American president has reduced the U.S. commitment to fighting the epidemic since it broke out in the 1980s during the Reagan administration.

Since 2010, funding for PEPFAR has fallen 12 percent, putting the program at its lowest funding level since 2007, Chris Collins, director of public policy at the Foundation for AIDS Research, wrote in an April editorial on the Huffington Post Web site. The administration has proposed an additional $50 million cut for 2014.

“Knowing that Africa has many challenges, with fighting AIDS being one of the biggest challenges, we were really expecting President Obama to continue where President Bush had left off,” said Hilary Thulare, country director of the AIDS Healthcare Foundation, a Los Angeles-based nonprofit group that works in 26 countries providing medical care to people with AIDS. “But it’s been a disappointment. Obama is retreating on AIDS and, by this, retreating on Africa.”

Publicly, the Obama administration has vowed to combat AIDS. In November 2011, Secretary of State Hillary Rodham Clinton announced that achieving an AIDS-free generation was a “policy priority.”

Privately, some administration officials bristle at the comparison to Bush, and Obama hinted at the frustration during his conversation with reporters on Air Force One. Spending restraints in the wake of the great recession that swept the globe around the time he took office in 2009 has hampered the administration’s ability to replicate Bush’s huge global aid initiative. “Given the budget constraints, for us to try to get the kind of money that President Bush was able to get out of the Republican House for massively scaled new foreign aid program is very difficult,” the president said Sunday in the discussion with reporters.

White House officials said the president’s trip is designed to treat Africa as a more-equal partner, instead of the traditional donor-
recipient relationship, and that the administration’s plans for PEPFAR fit into that new paradigm. At the Tutu Center on Sunday, Obama said the goal of U.S. policy under his administration is to increase capacity for South Africa and other nations to manage their own programs to fight the disease, rather than rely largely on U.S. funding.

“This center is a wonderful example of that transition,” Obama said. “Because of the wonderful work that’s being done on the ground, because of the partnership between the United States and South Africa, we have the possibility of achieving an AIDS-free generation and making sure everybody in our human family is able to enjoy their lives and raise their families.”

Administration officials note that the decreases in funding for PEPFAR have been made up by increases in funding to multilateral programs that tackle a variety of diseases, including AIDS. But AIDS advocates say such transfers still add up to an overall decline in U.S. government funding to tackle the global AIDS epidemic.

In South Africa, advocates say that U.S. funding cuts have already caused the closure of an AIDS clinic at McCord Hospital, near the city of Durban, earlier this year. The clinic was conducting HIV testing and providing antiretroviral treatments, or ARVs. Its 4,000 patients had to be referred mostly to government-run clinics, where treatment is less certain. “We feel the capacity of the government is not there,” Thulare said.

“I am alive because of the ARVs I received through the PEPFAR funding,” said Monica Nyawo, 37, a counselor at an AIDS clinic near Durban who is HIV positive. “We don’t need people dying now.”

She, like others interviewed, keenly watched Obama as he paid homage to the legacy of ailing anti-apartheid icon Nelson Mandela throughout his South Africa visit. On Sunday, Obama and his family visited Robben Island, where Mandela spent 18 of his 27 years imprisoned by the apartheid regime. “We’re deeply humbled to stand where men of such courage faced down injustice and refused to yield,” Obama wrote in a guest book in the jail’s open air, dirt field, surrounded by high walls and barbed wire.

Thulare said she wished Obama was as inspired by Mandela when it came to fighting AIDS. It was Mandela who is credited with breaking the shame and silence that enveloped the disease in South Africa. After he stepped down from the presidency in 1999, he became a leading AIDS campaigner. “For Mandela, it was another battle,” Thulare said.

Raghavan reported from Johannesburg.

Sudarsan Raghavan has been The Post's Kabul bureau chief since 2014. He was previously based in Nairobi and Baghdad for the Post.
David Nakamura covers the White House. He has previously covered sports, education and city government and reported from Afghanistan, Pakistan and Japan.



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