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TechnoratiShe says the money would be better spent on strengthening African health care systems rather than focusing on a single disease.
Johanna Hanefeld at the London School of Hygiene and Tropical Medicine says her research in Zambia indicated that the U.N. Global Fund to Fight AIDS, TB and Malaria was more effective in using HIV programs as a lever to improve health care and staff training, rather than scattering cash among many non-governmental groups, faith-based or other.
PEPFAR ambassador Mark Dybul dismisses criticism that the funding is too narrowly focused.
"In Africa you can't tackle development goals unless you tackle HIV/AIDS," he says, citing the devastation wreaked on professions like nursing and teaching.
Besides PEPFAR, Bush has launched a five-year, $1.2 billion initiative to cut malaria deaths in 15 African nations by half.
Dybul also says it is unfair to accuse the U.S. of overemphasizing abstinence because PEPFAR is a major supplier of condoms to the targeted African countries. For instance, PEPFAR figures show 60 million condoms going to Zambia, 40 million to Rwanda, 145 million to Ethiopia in the past five years.
Some critics, like rockers-turned-advocates Bono and Bob Geldof, have become admirers.
"The Bush regime has been divisive ... created bitterness — but not here in Africa. Here, his administration has saved millions of lives," Geldof wrote in Time Magazine as he accompanied Bush on an Africa trip last February.
"The administration and Bush himself deserve a lot more credit than they received for getting this job done," says Josh Ruxin, assistant professor of public health at Columbia University.
Desperately poor Rwanda, where Ruxin runs a health care project, now has more than 100 centers where people can receive AIDS testing, counseling and treatment, up from just two in 2002.
"I am heartbroken overall by the Bush administration," Ruxin said in a telephone interview. "But from my perch here in Rwanda, it is impossible to deny the results and achievements of PEPFAR. Many Rwandans were made Republicans because this was the first administration that has taken an interest and done something here."
Ruxin hopes Obama will learn lessons from PEPFAR's first five years — in particular to end the emphasis on abstinence and start funding groups who work with prostitutes and carry out abortions.
PEPFAR's biggest single success story is the fortyfold increase in the number of Africans receiving life-prolonging medication in the past five years.
Populous countries like Nigeria and Ethiopia are still struggling to increase access to medication. But in Rwanda, 71 percent of those in need of AIDS drugs received them in 2007, up from 1 percent in 2003, and in Namibia the rate shot up to 88 percent, from 1 percent.
AIDS is no longer a death sentence for people like Ndaxu Mungunda, a Namibian diagnosed as HIV positive after the birth of her child. She, her husband and child were given AIDS drugs provided at all major Namibian hospitals, thanks in part to PEPFAR funding which has increased tenfold in the past five years to $109 million.
Four years later, at age 40, she and her husband look forward to something that is by no means a certainty in Africa's AIDS era — a ripe old age.
Jones Mubita, a Zambian policeman, had given up hope for his young daughter, a "mere skeleton" covered in boils when she was hospitalized. With the help of AIDS drugs provided by the U.S. government the child is now back at school, he says, beaming. Continue »
David Ben-Ariel »
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