CAPE TOWN – In her AIDS-scarred South African township, Sweetness Mzolisa leads a chorus of praise for George W Bush that echoes to the deserts of Namibia, the hills of Rwanda and the villages of Ethiopia.
Like countless Africans, Mzolisa looks forward to Barack Obama becoming America’s first black president on January 20. But – like countless Africans – Mzolisa says she will always be grateful to Bush for his war on AIDS, which has helped to treat more than two million Africans, supported 10 million more, and revitalised the global fight against the disease.
‘It has done a lot for the people of South Africa, for the whole of the African continent,’ says Mzolisa, a feisty mother of seven. ‘It has changed so many people’s lives, saved so many people’s lives.’
Mzolisa (44) was diagnosed with the AIDS virus in 1999 and formed a women’s support group to ‘share the pain’.
In 2004 she received a US grant to set up office in a shipping container and start a soup kitchen from the group’s vegetable garden. She stretches her US$10 000 (about N$100 000) in annual funding to train staff to look after bedridden AIDS victims, feed and clothe orphans, and do stigma-busting work at schools and taxi ranks.
Hundreds of similar small grassroots projects are being funded by the President’s Emergency Plan for AIDS Relief, or PEPFAR, alongside higher-profile charities and big state clinics.
Bush launched the US$15 billion (about N$150 billion) plan in 2003 to expand prevention, treatment and support programmes in 15 hard-hit countries, 12 of them African, which account for more than half the world’s estimated 33 million AIDS infections.
The initiative tied in with a World Health Organisation campaign to put three million people on AIDS drugs by 2005 – a goal it says was reached in 2007.
Congress last year passed legislation more than tripling the budget to US$48 billion (about N$480 billion) over the next five years, with Republicans and Democrats alike hailing the programme as a remarkable success.
But the task remains enormous. Of the more than 1,5 million Africans who died of AIDS in 2007, fewer than one-third had access to treatment, and new infections continued to outstrip those receiving life-prolonging drugs.
In most African countries, life expectancy has dropped dramatically, and only a few, like Botswana, have started to turn the corner again.
And with no end in sight to the global financial crisis, there are fears about whether all the funding approved by Congress will be delivered.
There continue to be detractors who say the US administration should have channelled the money through the UN; that it has placed too much emphasis on faith-based groups and abstinence; that it has trampled on women’s health by shunning anything associated with abortions; that it has concentrated on AIDS treatment at the expense of prevention; and that it has diverted attention away from bigger killers like pneumonia and diarrhoea.
DEVELOPMENT
Johanna Hanefeld at the London School of Hygiene and Tropical Medicine says her research in Zambia indicated that the UN Global Fund to Fight AIDS, TB and Malaria was more effective in using HIV programmes as a lever to improve health care and staff training, rather than scattering cash among many non-governmental groups, faith-based or other.
Mark Dybul, the US global AIDS co-ordinator who is informally known as the PEPFAR ambassador, 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, US$1,2 billion (about N$12 billion) initiative to cut malaria deaths in 15 African nations by half.
Dybul also says it is unfair to accuse the US of over-emphasising 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 in New York.
Desperately poor Rwanda, where Ruxin runs a health care project, now has more than 100 centres where people can receive AIDS testing, counselling 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.’
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 per cent of those in need of AIDS drugs received them in 2007, up from one per cent in 2003, and in Namibia the rate shot up to 88 per cent, from one per cent.
NAMIBIA
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 US$109 million (about N$1 billion).
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 hospitalised. With the help of AIDS drugs provided by the US government the child is now back at school, he says, beaming.
At a 22-bed clinic run by Living Hope, a church-based charity near Cape Town, 85 per cent of patients now survive and only 15 per cent die. A few years ago, it was the opposite, says Pat Ball, a retired teacher from North Carolina, and a volunteer at Living Hope.
The acclaimed mothers2mothers organisation has expanded from about 40 locations around Cape Town to nearly 500 in seven African countries thanks to PEPFAR cash. Its network of more than 1 000 HIV positive women are trained as ‘mentor mothers’ and paid to counsel the newly infected and ensure they and their babies stay healthy.
Thanks to the growing provision of AIDS drugs to pregnant women, few babies in the m2m network are now born with AIDS, says co-founder Gene Falk.
In big South African government clinics, there is palpable optimism that AIDS infected newborns could become history.
In a sunny room furnished with toys and a play kitchen at the Soweto Hospice in Johannesburg, dying children are given a chance to enjoy what remains of their life.
‘We want to give them their childhood back,’ said Louisa Ferreira, director of the nine-bed paediatrics unit funded by PEPFAR. ‘The hospice is not about death. It’s about life.’
PEPFAR says its programmes have helped care for nearly four million orphans and vulnerable children.
GIVING BACK
One of them is Frans Dobola, who at age 13 lost his parents to AIDS. Heartbeat, an organisation helping AIDS orphans with US$750 000 in PEPFAR grants, trained a neighbour to act as his foster mother, provided a daily meal, and an after-school programme.
Dobola (20) now works at Heartbeat, near the South African capital, Pretoria, and dreams of a job in computers. Meanwhile, he grows beets and tomatoes at the after-school centre’s garden and gives poetry and dance lessons.
‘I am givi
ng back to the community what they gave me,’ he says, smiling.
Francois Venter, an outspoken doctor who heads a PEPFAR-funded programme at the University of the Witwatersrand in Johannesburg, says because of its emphasis on measurable targets, ‘PEPFAR is different.’
‘A lot of previous donor projects were touchy-feely, fuzzy,’ says Venter, adding that US funding helped boost the number of South Africans on medication to 700 000.
Supporters and critics alike agree that prevention is the weakest link in global AIDS initiatives.
PEPFAR says its funds have provided drugs to 250 000 pregnant women to prevent them passing on the AIDS virus in the womb. In countries like Uganda, babies born with the AIDS virus still account for 15-25 per cent of new infections and so the increase in therapy to stop mother-to-child transmission offers one of the few rays of hope in an otherwise bleak prevention outlook.
US Ambassador Eric Bost brims with superlatives about the achievements of PEPFAR in South Africa, and believes Bush will be judged more kindly in history than on January 21.
Dybul, the US AIDS co-ordinator who is a specialist in infectious diseases, concurs. ‘It’s the largest international health initiative in history for a single disease,’ he says. ‘In any other circumstances, he (Bush) would be getting a Nobel prize.’
Sweetness Mzolisa, overflowing with energy and enthusiasm, puts it more simply.
‘He’s got heart,’ she declares. ‘He cares about people.’ – Nampa-AP
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