Monday, December 1, 2008

Obama, Africa and AIDS

The Iraq war and the human and economic fallout that followed will, now and forever, be the primary legacy of the Bush administration. The estimated $580 billion spent so far in the war's prosecution will have repercussions on American foreign policy and the nation's domestic agenda for years to come. The nearly 4,200 American lives lost in that war will resonate with the families of those who died for longer than that.

History will pick and choose from any number of other disasters that George Bush and his advisers presided over, from a mismanagement of the housing crisis and its spillover into the wider economy, to the tragic debacle of Hurricane Katrina. But there's one area in which the Bush White House has excelled, if only by comparison with previous administrations.

Bush's President's Emergency Plan for AIDS Relief (PEPFAR) have brought AIDS drugs to almost 3 million people in poor countries, more than under any other American president. The program was reauthorized in expanded form by Congress in July.

When Bush launched PEPFAR in 2003, about 50,000 people in Sub-Saharan Africa got anti-retroviral treatment. PEPFAR now supports anti-retroviral treatment for nearly 1.7 million people in the region – and more people around the world, according to The White House.

"The evangelical community raised the awareness of HIV and AIDS to the president," said Rep. Donald M. Payne (N.J.), a ranking Democrat on the House International Relations subcommittee on Africa. "When the Bush administration came in, HIV and AIDS were not an overwhelming priority. Now we have seen a total metamorphosis," Payne told the Post in December 2006.

President-elect Obama thus inherits the responsibility of building on the one global initiative that the Bush administration has, by any reasonable yardstick, gotten mostly right. A lot is riding on what he does, and how soon he does it.

Obama has promised to eliminate obstacles that may have slowed progress of the very program the Bush administration created. He's expressed a commitment to end the Prostitution Loyalty Oath, which requires that U.S. and foreign non-governmental organizations that get U.S. funding must adopt a policy opposing prostitution and sex trafficking.

Obama has backed renewed emphasis on the use of condoms over more ideological approaches stressing abstinence and fidelity. And in October 2007, while still a candidate, he signed a pledge (conditional on winning the presidency) to increase funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria, and to consider creation of a Cabinet-level agency focused on preventing poverty in the developing world.

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As evidence of Obama's intent to "hit the ground running," it's a very good start — or it at least has the potential to be one. The President-elect has promised to make focus on AIDS in Africa one of the centerpieces of his first 100 days in office. But other events, global and domestic, have occurred more recently — developments that could derail Obama's efforts to usher in the changes on the timetable he proposed as a candidate.

The crisis in the domestic economy remains a top-shelf concern; the new president will face a daunting challenge from "day one" to keep his pledge of creating 2.5 million jobs over the next two years. Estimates of the cost of plan to rescue an economy hobbled by a mortgage meltdown begin, conservatively, at $500 billion.

And in recent days a new global hot spot has emerged — re-emerged, really — with the deadly terrorist violence in Mumbai. Those attacks on India's most international city are believed by many to have originated in Pakistan. There's a chance, therefore, that India and Pakistan — longtime antagonists that are now both nuclear powers — may resort to their old combustible relationship, this time with the risk of a nuclear confrontation.

Add these relatively recent developments to an already full plate of issues to be addressed — the Iraq war, the war in Afghanistan, the health-care crisis, the need for dramatic action in defense of the environment, and a rising chorus of voices for efforts toward U.S. energy independence — and it's clear that even the most ambitious timetable vis-à-vis AIDS in Africa could be sidetracked.

Here's hoping that doesn't happen.

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In his World AIDS Day speech on Dec. 1, 2006, two years ago today, Obama framed the issue of AIDS in an undeniably all-inclusive context borrowed from the Biblical book of I Corinthians:

"We are all sick because of AIDS, and we are all tested by this crisis. It is a test not only of our willingness to respond, but of our ability to look past the artificial divisions and debates that have often shaped that response. …

"Neither philanthropist nor scientist; neither government nor church, can solve this problem on their own. AIDS must be an all-hands-on-deck effort." 

As President-elect Obama builds his Cabinet, there's every reason to believe this "all-hands-on-deck" approach will inform his strategy against AIDS in the developing world — despite the potential distractions of flashpoints around the globe.

It's an approach that Obama — not as a senator, not as a candidate, but as the next U.S. president — should revisit, not as an idea but as a reality, not as a promise but as a policy.
Image credit: AIDS ribbon: Wikipedia (Netherlands), republished under GNU Free Documentation License. Map, AIDS infection rates in Africa: Sascha Noyes (2004), republished under GNU Free Documentation License. Map data: UNAIDS.

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