George Bush is brave: Embarking on a publicised HIV & AIDS safari through Tanzania, Zambia and Ethiopia on World AIDS Day?
Yes, the $15 billion President’s Emergency Plan for AIDS Relief (PEPFAR) he began in office achieved some dazzling results – ten times more Africans are thought to be on anti-retrovirals now, than when the programme began, and the fund helped set an incredibly high bench mark for giving. However, Bush’s HIV & AIDS work is far from being the untarnished legacy of his presidency, as he seems to believe.
In fact, George W’s conservatism cost lives. PEPFAR began with a heavy emphasis on abstinence: an approach based on faith, rather than evidence. In order to receive funding, programmes had to stress abstaining from sex, to the detriment of other means of HIV prevention. Uganda was once the golden girl of HIV prevention, for dramatically reducing infection rates from 15 per cent in the early 1990s to 5 per cent in 2001, via a comprehensive, condom-inclusive approach. After an enforced abstinence focus, activists saw HIV rates increase.
Bush also introduced the “anti-prostitution pledge”, which required all organisations in receipt of US HIV & AIDS funds to explicitly condemn prostitution and trafficking. How could aid groups establish trust with sex workers, encourage condom use, and promote human rights, when they had publicly denounced them, and when they also ran the risk of being perceived as “promoting prostitution”? Some of the most at-risk groups in society, whom health workers were desperate to reach, were instead driven underground.
Beyond PEPFAR, Bush was guilty of shoehorning a division between HIV prevention and reproductive health. Whilst in power, he re-introduced the global gag rule (since rescinded by Obama), which cut US funding to international family planning organisations if they mentioned abortion as a choice. As experts will tell you, holistic family planning services are at the heart of HIV prevention and treatment. Across Africa, organisations who would not condone the global gag rule, lost funding, closed rural outreach centres, cut their condom distribution, and scaled back HIV prevention, testing and treatment work.
The countries Bush is to visit on his tour – Tanzania, Ethiopia and Zambia – suffered as badly as any others under his policies. Tanzanian clinics lost funding and vital staff. In Zambia, the only organisation that operated reproductive health clinics lost nearly 40 per cent of its employees. In Ethiopia, the withdrawal of US contraceptives worsened an already serious shortage of supplies, and was linked to an increase in HIV infection rates among young woman aged 15-24.
So, yes, Bush should be proud of expanding access to life-saving HIV drugs. Making ARV treatment a reality in Africa is a remarkable achievement, with amazing results, that would have been almost unthinkable a decade ago. Bush should also be recognised for his new plans to provide screening and treatment for cervical cancer at existing HIV clinics. However, the might of US investment in HIV prevention and treatment could have achieved so much more during his time in office. Bush was ideologically beholden to evangelical conservatism, making at-risk groups more vulnerable, and causing unnecessary deaths in the process.
Times and policies have now changed. However, in the current economic climate, where HIV & AIDS workers are facing cuts from every direction, some of the effects of Bush’s legacy will take years to repair.
Alan Smith is the COO of Interact Worldwide, Plan UK's sister charity. Interact is a UK-based international Sexual and Reproductive Health and Rights charity.