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[afro-nets] Progress being made in fight against AIDS in Africa

  • From: "Leela McCullough" <leela@healthnet.org>
  • Date: Wed, 23 Aug 2006 12:55:03 -0400

Progress being made in fight against AIDS in Africa

By John Donnelly, August 20, 2006
The Boston Globe

Copied as fair use.

And now for the good news

Progress is being made in the fight against AIDS in Africa, thanks in no small part to the president's aid program. But that's not what some people want to hear.

FIVE YEARS AGO, in Jos, Nigeria, a city on the country's central plateau, Dr. John Idoko regularly made rounds in a hospital packed with people dying from AIDS because they couldn't pay for the antiretroviral drugs necessary to keep them alive. Three years ago, as the price of the drugs plummeted, the Nigerian doctor was able to deliver the life-extending medication to 700 patients-until his government's supply ran out for several months.

Today, the change for the better is astonishing: Idoko now treats nearly 6,000 HIV-positive patients. He has expanded his clinic three times in five years, and his waiting room once again is too crowded. ``Now, we are eyeing an abandoned building nearby," he said last week, chuckling.

The major reason for Idoko's success is the Bush administration's AIDS program, which in the last three years has sent billions of dollars to Africa and helped save the lives of hundreds of thousands of people. When I moved to Africa three years ago, the President's Emergency Plan for AIDS Relief, or PEPFAR, was just getting off the ground. As I return to Washington this month, the $15 billion program is just hitting its stride, and many Africans believe it has become the single most effective initiative in fighting the deadly scourge.

``The greatest impact in HIV prevention and treatment in Africa is PEPFAR-there's nothing that compares," Idoko said.

Only you wouldn't know it in America-or Canada, or Europe, for that matter-given the tenor of the AIDS debate in Washington and the nature of the international media coverage.

That debate was on full view last week at the International AIDS Conference in Toronto, which ended Thursday. While the AIDS epidemic in Africa is as urgent a crisis as it ever was-an estimated 24 million are infected on the continent and as many as 2 million died last year from AIDS-related illnesses-there are now at least some hopeful signs, though few activists in Toronto wanted to give the United States any of the credit. Indeed, the politically polarized bickering, according to those in Washington AIDS policy circles, could have effects far beyond the Beltway, threatening to impede national and international funding for AIDS programs.
. . .

One telling moment in Toronto came last Sunday when Bill Gates, whose foundation has spent billions on global health in recent years, praised PEPFAR, prompting a chorus of boos from the audience. Earlier, Stephen Lewis, the passionate United Nations special envoy on AIDS in Africa, said that the Bush administration's push for abstinence programs as part of its ABC policy-which calls for abstinence until marriage, being faithful to one's partner, and failing that, using condoms-amounts to ``incipient neocolonialism."

For three years, a wide range of AIDS activists, including Lewis, have been hammering at what they perceive as faults of the US AIDS program, creating the perception that the program is riddled with trouble. They have criticized the administration for funneling its billions into PEPFAR rather than the Global Fund to Fight AIDS, Tuberculosis, and Malaria, another new initiative based in Geneva. They have claimed that the US-funded treatment programs were moving far too slowly. They have questioned the wisdom of the US preference for funding faith-based groups, and have complained that Congress's mandate to spend one-third of all money targeted for prevention on abstinence programs is excessive and counterproductive.

The last issue, abstinence, as Lewis's remarks in Toronto attest, is now the rallying cry against the US program-even though US officials say that just 7 percent of its money goes to programs that try to persuade young people to avoid sex until marriage. No AIDS expert is against abstinence education, but people differ sharply over how much money should be spent on it, and who should determine the mix of messages.

``We all believe in abstinence programming," said Paul Zeitz of the Global AIDS Alliance, a Washington-based AIDS advocacy group that has been one of the Bush administration's strongest critics. ``Our issue is that local leaders in Africa should determine the local funding."

AIDS policy has become so divisive in Washington that an independent mediator, Search for Common Ground, a Belgium-based group with offices in Washington, took the initiative to step in last September as a kind of referee, searching for a ``common front" in the response to the disease. After three meetings involving representatives from 30 private groups-ranging from the Global AIDS Alliance to several large faith-based groups that are now big recipients of US AIDS money-participants concluded ``there was more common ground among them than people realize," but not enough to write a consensus statement, according to a five-page report by the organization. Last month, the mediation effort was abandoned.

Carole Frampton, senior facilitator at Search for Common Ground, said the outcome revealed the gulf between what was happening in sub-Saharan Africa and what was being said in Washington.

``What was encouraging was to see that there is a lot of collaboration [happening] on the ground in Africa," Frampton said in a phone interview. ``We didn't see that level of collaboration in Washington."
. . .

In Africa, the kind of polarized debate that dominates Washington policy circles is rarely heard. Among those working on US-funded AIDS programs, there's a sense of energy and optimism and a belief that they are making history. Every week, faith-based and secular groups, encouraged and funded by US AIDS specialists, are finding new ways to treat people, prevent new infections, and care for the ill.

Pragmatism rules. Two years ago in the southwestern African nation of Namibia, Lucy Steinitz, a Jewish Brandeis graduate who was then the head of Catholic AIDS Action, told me that US officials sought out faith-based groups because of common sense: Churches were running many of the country's hospitals and clinics already. The same is the case in many African countries.

``Civil society is only just beginning to emerge in Namibia. So what's left? Church is it. I have a lot of skeptical friends back in the US about the funding of faith-based groups, but it works here," she said.

That kind of pragmatism can be seen in other US-funded efforts: new collaborations in which traditional healers are referring patients to South African medical doctors; in Kenya, the support of a drug distribution system that can fill any order in the country within five days; and in Uganda, door-to-door surveys during which people are tested for HIV in the privacy of their homes.

But the impact of the US programs, and other funders' programs, will in great part rest on whether they can find a comprehensive approach to cut down on new infections.

Some US AIDS coordinators in Africa grumble about the spending requirement on abstinence programs. In Washington, US officials have given waivers to some countries to spend less money on abstinence programs, allowing the continuation of effective existing efforts to distribute condoms to truck drivers and reaching out to men to try to change sexual behavior.

In Nigeria, Idoko said that more money should be spent in all areas of prevention, especially in the education of young people.

``It's not that people in Africa are having more sex than anywhere else, it's just that sex in the West is a lot safer because of the information they have and because of the technology that is available," Idoko said. ``For many Africans, buying a pack of condoms is a huge problem. Many don't have enough money."

Even though the US programs are saving lives, many more are being lost by the day. It is hard to comprehend the emotional and physical loss in faraway Washington, or even at the Toronto AIDS conference. But in any African village, everyone feels it. That's why the breakdown of efforts such as Search for Common Ground seems so tragic to many.

Last month, in the town of Livingstone, Zambia, my driver, Jefferson Phiri, and I were stuck in one of the town's daily funeral processions. For 20 minutes, we inched along. The dead man was a local police officer; no one was talking about the cause of death.

``People don't live too long here," Phiri said. ``I'm 34. I'm an old man. I have 15 friends dead already. Fifteen! Our situation is an emergency."
John Donnelly is a Globe reporter and the former Africa bureau chief. E-mail donnelly@globe.com.

C Copyright 2006 The New York Times Company

Leela McCullough, Ed.D.
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