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How to Build on Success Against AIDS in Africa
Forbes The public and private sectors have achieved remarkable success in Africa in the battle against AIDS, and the question now is: Where do we go from here? I have two answers, but, first, understand the incredible accomplishment of the past decade. Despite the advent of effective anti-retroviral drugs, in 2002 AIDS was running rampant in Africa and other low-income parts of the world. At the time, scholars were predicting the disease would kill 6.5 million people annually. Instead, according to the World AIDS Day Report just issued by UNAIDS , 1.8 million died in 2010 from AIDS-related causes, down from a peak of 2.2 million in 2004. New infections with HIV, the virus that causes AIDS, have fallen to 2.7 million from a high of 3.1 million. In sub-Saharan Africa, the drop is even more dramatic: to 1.9 million from 2.6 million, or 26 percent. The reason for the declines in deaths and infections is clear: the world, led by the United States under President George W. Bush, mobilized to fight the disease. Testing, counseling, and education vastly increased. The number of clinics offering anti-retrovirals (ARVs) jumped from 8,000 in 2007 to 22,000 in 2010. Nearly half of pregnant women are now getting therapies that prevent mother-to-child transmission of HIV. Most dramatically, there are now 6.7 million people receiving ARVs, up from 400,000 in 2003. The number of children on ARVs has risen by a factor of six in just five years. And, in Africa alone, ARV use jumped 20 percent in 2010 alone. This assault on AIDS was spearheaded by the Global Fund to Fight AIDS, Malaria and Tuberculosis and the President’s Emergency Plan for AIDS Relief (PEPFAR). U.S. taxpayers are by far the largest single source of funding for the Global Fund, contributing $6 billion of the $20 billion raised so far. PEPFAR was introduced by President Bush in his State of the Union Address in 2003 and initially funded for five years with $15 billion from U.S. taxpayers. In 2008, Americans renewed their commitment and will spend an additional $39 billion on PEPFAR and the Global Fund through 2013. But money alone does not come close to explaining the success of this effort. It has worked because it was based on a partnership with an intense focus around explicit, measurable results. And it could never have saved millions if private pharmaceutical firms had not developed drugs that stopped the progress of HIV to full-blown AIDS. The success, said Mark Dybul, who formerly headed PEPFAR and is now a fellow at the George W. Bush Institute, “shows the power of partnership, the power of the American people standing with the people of Africa…to tackle their problems.” At the time PEPFAR was started, wrote President Bush yesterday in the Wall Street Journal, “Some were skeptical, particularly about the possibility of treatment. Skepticism is no longer sound.” Still, nearly 2 million people are dying of AIDS, and 53 percent of those who are eligible for treatment are not receiving it. The fight must continue – and at an intense level. That’s not easy at a time of global belt-tightening. Policymakers and publics need to realize that defeating AIDS is not only a humanitarian cause but also a practical one. The successes in the battle against AIDS have helped sub-Saharan Africa become a bright spot in the global economy. The Economist, in its “The World in 2012? publication, projects 5 percent growth in the region for coming year, ranking four African countries among the top 10 nations in the world in its annual forecast. And defeating AIDS is key to ending the violence and political unrest that have plagued Africa. Health makes wealth, and health makes security. Those outcomes are as important to the United States, which can sell goods into African markets and increase its safety through African stability, as they are to Africa. So the first answer to where we go from here is more of the same, and then some. The goal of UNAIDS is “Zero new HIV infections” and “Zero AIDS-related deaths.” That sounds right. The second answer is to build on the AIDS-fighting platform to fight other deadly diseases in developing nations, especially in Africa. The Bush Institute is starting to do just that, in partnership with UNAIDS, PEPFAR, Susan G. Komen for the Cure and founding corporate partners Merck, Becton Dickinson, Bristol-Myers Squibb, QIAGEN, the Caris Foundation, GlaxoSmithKline, and IBM. The U.S. State Department, under Hillary Clinton, has had the foresight to see that the clinics and the systems that PEPFAR has established over the past eight years can be leveraged against non-communicable diseases as well as against AIDS. Americans, Africans, and others who have battled AIDS so successfully in the past decade should not rest on their considerable laurels. It’s time to re-double our efforts against the disease and to build on the powerful disease-fighting platform that’s been created. James K. Glassman is the founding executive director of the George W. Bush Institute in Dallas, Texas. He is a former Under Secretary of State for Public Affairs and Public Diplomacy.