The Orbis

Issue date: 12/10/08 Section: News/Features

President and Mrs. Bush stand in front of a giant red ribbon commemorating World AIDS Day.

President Bush's overall legacy may be controversial, but one product of his presidency has garnered significant praise from both sides of the aisle. Thanks to the President's Emergency Plan for AIDS Relief (PEPFAR), Bush has been able to fundamentally change American and global thinking about the scale of international health funding.

Announced in early 2003, PEPFAR aimed to treat two million people, prevent seven million new infections, and support HIV/AIDS care for 10 million people. PEPFAR especially focused on fifteen countries (twelve of which are in sub-Saharan Africa) with the most troubling HIV/AIDS statistics. The plan has already committed $19 billion to HIV/AIDS prevention & treatment, making it the largest international health initiative directed towards a single disease.

So far, PEPFAR has granted life-saving antiretroviral treatment to 2.1 million people and has prevented nearly 240,000 babies from acquiring HIV via mother-to-child transmission. In some cases, the effects have been transformational. In Rwanda, only four percent of AIDS patients received drugs in 2003. Within four years, that statistic shot up to 92 percent. In Uganda, the number of people receiving treatment has increased by 100,000 while over 1.5 million more people receive HIV testing annually.

Of course, PEPFAR has not been devoid of its share of controversy. When the plan was first passed, President Bush favored the use of costly brand-name medications instead of generic drugs, even going so far as to block use of the inexpensive option. Since then, the Food and Drug Administration has approved a generic antiretroviral drug, but PEPFAR has continued to purchase mostly brand-name drugs - an approach that increases the profits of pharmaceutical companies but fails to make the best use of the plan's money. In addition, the program does not fund needle exchange programs for drug addicts, barring promotion of a proven prevention approach.

The biggest criticism by far, however, has been PEPFAR's dogged insistence on the abstinence-only approach to prevention. There is no consensus that such programs, which are often administered by faith-based groups and de-emphasize the use of condoms, are successful in halting the spread of HIV. The scientific consensus is that comprehensive prevention programs promoting abstinence along with partner fidelity and condom use are the best means of reducing transmission. Ignoring such evidence, PEPFAR has required that 20 percent of all its funds go toward prevention and 33 percent of all its prevention funds promote abstinence-only programs, an approach deplored by Democrats, AIDS activists, and health workers alike.

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