WASHINGTON — This is a moment for all Americans to be proud of the single best thing George W. Bush did as president: launching an initiative to combat AIDS in Africa that has saved millions of lives.
All week, more than 20,000 delegates from around the world have been attending the 19th International AIDS Conference here in Washington. They look like any other group of conventioneers, laden with satchels and garlanded with name tags. But some of these men women would be dead if not for Bush’s foresight and compassion.
Those are not words I frequently use to describe Bush or his presidency. But credit and praise must be given where they are due, and Bush’s accomplishment — the President’s Emergency Plan for AIDS Relief, or PEPFAR — deserves accolades. It is a reminder that the United States can still be both great and good.
When the Bush administration inaugurated the program in 2003, fewer than 50,000 HIV-infected people on the African continent were receiving the antiretroviral drugs that keep the virus in check and halt the progression toward full-blown AIDS. By the time Bush left office, the number had increased to nearly 2 million. Today, the United States is directly supporting antiretroviral treatment for more than 4 million men, women and children in Africa.
This is an amazing accomplishment, especially because it wasn’t supposed to be possible.
Before PEPFAR, the conventional wisdom was that the drug treatment regimens that had been saving lives in developed countries would not work in Africa. Poor, uneducated people in communities lacking even the most basic infrastructure could not be expected to take the right pill at the right time every day. When the drugs are taken haphazardly, the virus mutates and becomes resistant. Therefore, this reasoning went, trying to administer antiretroviral treatment in poor African countries might actually be worse than doing nothing at all.
The Bush administration rejected these arguments, which turned out to be categorically wrong.
Africans are every bit as diligent about taking their HIV medications as Americans or other Westerners. While there has been a “modest, contained and not alarming” rise in resistance to one class of drugs, according to a World Health Organization researcher who presented a study at this week’s AIDS conference, scientists no longer envision a nightmare scenario in which drug-resistant strains of the virus run rampant.
According to a survey by the charity Doctors Without Borders, 11 African countries — including some of the hardest-hit by the epidemic — are providing antiretroviral drug treatment to well over half of their citizens infected with HIV. Treatment not only extends the patient’s life but also decreases the likelihood that he or she will pass the virus to an uninfected person. The end of the AIDS epidemic is not yet in sight. But it is no longer unimaginable.
Bush’s initial multibillion-dollar commitment to PEPFAR was not really justifiable on grounds of national security, except perhaps in the broadest possible sense. The administration was motivated instead by altruism. It was the right thing to do.
So far, the United States has spent about $46 billion through the program. President Obama has been sharply criticized for proposing a cut of nearly 12 percent in PEPFAR funding for the 2013 fiscal year. Administration officials say they are actually just shifting money to complementary programs, and that overall HIV/AIDS funding will rise to an all-time high. Advocates for the PEPFAR program argue that any way you look at it, fewer dollars will ultimately mean fewer people receiving life-saving drugs — and, potentially, more new infections.
The Obama administration has a point when it complains that at a time when the U.S. economy is struggling, it is only reasonable to expect other wealthy countries to bear more of the cost of providing antiretroviral treatment in Africa. Administration officials also have a point when they note that under Bush, the biennial international AIDS conference could not even have been held in Washington — because HIV-positive individuals were denied visas to enter the country. Obama ended this discriminatory policy during his first year in office.
But if Africa is gaining ground against AIDS, history will note that it was Bush, more than any other individual, who turned the tide. The man who called himself the Decider will be held accountable for a host of calamitous decisions. But for opening his heart to Africa, he deserves nothing but gratitude and praise.
Eugene Robinson is a Washington Post columnist. His email address is firstname.lastname@example.org.