Tag: africa

Obama's Global Health Initiative

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Though PEPFAR under Bush certainly made progress in the prevention and treatment of HIV/AIDS, it is important to remember that epidemics such as these do not exist in a vacuum.  Rather, the cycle of poverty and illness is one that is self-sustaining, and aid efforts must focus relief on both sides of the equation.

The Obama administration has recognized this and developed something called the Global Health Initiative, which “adopts a more integrated approach to fighting diseases, improving health, and strengthening health systems.”  Obama’s 2010 budget brings continued awareness to broader global health issues such as child and maternal health, family planning, neglected tropical diseases, and HIV/AIDS.

Obama’s statement says, “the budget invests $63 billion cumulatively over six years (2009-2014) for global health programs. PEPFAR… will constitute more than 70 percent of global health funding.”

It seems that Bush’s plans neglected an important part of global health and poverty: family planning.  Family planning is a difficult topic in much of Africa, where a man’s wealth is measured partly by the size of his family.

Condoms are associated with STDs and with infidelity, so they are very rarely used within a marriage for family planning. Other family planning techniques, such as birth control pills and contraceptive injections, are being promoted.

Another issue that must be addressed is that there is also still some opposition within African governments to the family planning measures.

It is absolutely vital to look at the AIDS crisis in the greater sphere of global health.  Hopefully policymakers will continue to take this into consideration when they decide how aid money is spent.

Porche, a Furman student, with an AIDS orphan during Furman's study abroad program to Namibia, South Africa, and Botswana.
Porche Warren, a Furman student, with an AIDS orphan in Namibia. (Photo taken by Liz Lineback.)

Listen Listen to an interview with a Furman student about her own experiences learning about AIDS while in Africa.

View a slideshow of images showing materials brought back from Porche’s trip to Namibia, South Africa, and Botswana.


PEPFAR's Future Plans

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Though they were not the biggest focus under the Bush administration, condom programs are vital to the AIDS prevention efforts of PEPFAR.
Though they were not the biggest focus under the Bush administration, condom programs are vital to the AIDS prevention efforts of PEPFAR. (All photos taken by Liz Lineback.)

My last few posts have focused on PEPFAR’s past, for it is vital to understand an initiative’s history before realizing its next steps.  It is only through analyzing strengths and weaknesses that policymakers can create the best plan for the future.  Thus, PEPFAR was reauthorized by Congress in July 2008 to provide $48 billion in funds from FY 2009 to FY 2013.

According to the PEPFAR website, “as PEPFAR works to build upon its successes, it will focus on transitioning from an emergency response to promoting sustainable country programs.”

The goals for PEPFAR’s future are as follows:

  • Transition from an emergency response to promotion of sustainable country programs.
  • Strengthen partner government capacity to lead the response to this epidemic and other health demands.
  • Expand prevention, care, and treatment in both concentrated and generalized epidemics.
  • Integrate and coordinate HIV/AIDS programs with broader global health and development programs to maximize impact on health systems.

While these goals are lofty, these trying economics times are making foreign aid promises harder and harder to keep.  Furthermore, limited funding is creating rifts between those who think the focus should be on prevention and those who want to focus on treatment.

Some claim, “while treatment of HIV/AIDS has gained funding support, funding of prevention has lagged behind.”  Bill Gates, founder of the philanthropic Gates Foundation, said, “The harsh mathematics of this epidemic prove that prevention is essential to expanding treatment, and that stressing treatment without paying adequate attention to prevention is simply unsustainable.”

While distribution of funds is never an uncomplicated task, it is certainly an important one for Obama to keep in mind as PEPFAR progresses.  In my next post I will update you on more of Obama’s developments.

The ABCs of AIDS Prevention

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Sex ed posters
Posters in Africa promoting AIDS prevention through abstinence

While Bush’s AIDS initiative undoubtedly made great strides in the 12 African target countries, PEPFAR did not come without stipulations.

The foundation of PEPFAR’s prevention programs is ABC—Abstain, Be faithful, and use Condoms.  Of the 20% of PEPFAR funds allocated for prevention programs, one third of the money must be spent on abstinence until marriage programs.  However, some say that for every dollar that was spent on condom programs, two were spent on abstinence and faithfulness programs.  It is often thought that ABC was the order of importance assigned, with abstinence given the most funding and condoms the least.

Furthermore, organizations that receive PEPFAR funds are forced to sign documents saying that they will oppose sex workers and abortion.  While this ideal is ethically steadfast, this causes organizations to turn their backs on those who need the most outreach and support.  It is for this reason that Brazil refused funds marked with this clause.

The abstinence strategy has been widely criticized by those who say that PEPFAR is far too determined by ideology, rather than driven by strategies that are proven to produce the most success. Republican leaders promote abstinence,  having claimed that condom distribution endorses premarital sex. Yet a 2006 study by the World Health Organization found “little evidence of the effectiveness of abstinence-only programs in developing countries.”

One health expert has said, “The directives made in the United States look ridiculous to the world.  It was like, ‘There they go again—being generous on the one hand and then earmarking dictates on the other.’”

While no initiative will be perfect, it is important that future policymakers focus on what is the best for the people they are trying to help, rather than simply pushing their own ideologies and making PEPFAR less effective.

Click here for a slideshow showing AIDS prevention efforts.

Bush's Positive Legacy

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President Bush signing PEPFAR
President Bush signing PEPFAR

There are many who consider the most significant positive legacy of George W. Bush’s eight years as President of the US to be his implementation of PEPFAR: the President’s Emergency Plan for AIDS Relief.  Developed in 2003, the initiative designated $15 billion dollars to be spent on AIDS relief efforts.  $9 billion of this was allocated to 15 focus countries that are most harshly affected by the disease, 12 of which are in sub-Saharan Africa.  The goals of the effort were lofty:

  • Provide treatment to 2 million people with HIV infection
  • Prevent 7 million new HIV cases
  • Provide care to a further 10 million people affected by AIDS

Reporting directly to the Secretary of State, OGAC (the Office of the Global AIDS Coordinator) managed the implementation and realization of the initial “2-7-10 by 2008” goal.

In November of 2008, President Bush announced that both the treatment and the care goals had been met.  Yet prevention of a disease is much harder to gauge because it is difficult to measure a non-event.  For example, the distribution of one condom could be counted as one case of AIDS prevented, when no foreign aid worker can truly know whether or not that condom was used.

PEPFAR has certainly done a lot of good on the African continent, especially in sub-Saharan Africa where AIDS relief is so needed.  Yet Bush’s program was not without stipulations, many of which clashed with traditional African social norms.  Many think that even though PEPFAR has done great things, more significant results could have been achieved.  In my next posts, I will go into more detail about how the PEPFAR funds were divided and allocated.

Treatment or Prevention- What Should We Buy Into?

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Since the AIDS outbreak in the 1980s, people have been scrambling to treat those already infected and prevent further infections.  In Africa, especially, there are major obstacles to overcome.  This could explain why “two-thirds of the world’s 40 million HIV/AIDS cases are in… sub-Saharan Africa… and 72 percent of the 3 million people who died from AIDS in 2006 were Africans” (Bristol).  So how should we as global citizens try to help?  To figure out the solution one must recognize the myriad and endlessly complex obstacles getting in the way:

Obstacles to treatment:

  • Weak health systems— many African countries suffer from a “brain drain,” meaning medical students leave for school then never return to practice medicine

    Antiretroviral pills (ARVs) used to treat AIDS
    Antiretroviral pills (ARVs) used to treat AIDS
  • Lack of medial workers— “Africa… bears 24 percent of the world’s burden of disease but has only 3 percent of the global health workforce and 1 percent of its physicians” (Bristol)
  • Limited funding— most of the people who need antiretroviral (ARV) treatment are not receiving it consistently or even at all
  • Stigma of the disease— AIDS carries with it a harsh stigma, causing many to refuse to recognize it for the deadly disease that it is

Obstacles to prevention:

  • Cultural norms— many social norms stimulate the spread of AIDS, including objection to male circumcision, prevalence of male-dominated culture,  and the tendency of concurrent sexual partners
  • Misinformation & lack of education— myths are widely circulated, such as the belief that having sex with a virgin will cure a man of AIDS
  • No AIDS vaccine in sight— it will be many years until we even begin to see a cure

While there are differing opinions as to the main obstacle, ultimately we must focus on both prevention and treatment to be successful.  So where has the US contributed its funds?  Next time I will focus on some of our government’s efforts in Africa.

The Role of the US in the African HIV/AIDS Crisis

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Namibian orphans, some of whose parents fell victim to AIDS, with their caretaker Meme Maria.
Namibian orphans, some of whose parents fell victim to AIDS, with their caretaker Meme Maria.

My goal is to explore US involvement in alleviating the HIV/AIDS crisis in sub-Saharan Africa.  While participating in a ten-week study abroad program to Namibia, South Africa, and Botswana, I learned first-hand how these countries were affected by AIDS.  My focus will be the efforts of government programs (such as PEPFAR and USAID) to address the crisis, and I will compare the policy changes of these programs with the administration change from Bush to Obama. I will assess the dispensation of monetary aid as well as the success of any relief programs being administered in Africa.  I will reference the websites of the programs and assess news articles critiquing the effectiveness of each. I will also interview Furman faculty who have intimate knowledge of this subject.