The Real Story About Bush, HIV/AIDS and Africa
The thin thread – the pretext – for offering George W. Bush what was originally entitled an “Improving The Human Condition Award”, now referred to as `a Global Service’ award (by the University of Denver) – is his supposed work to fight AIDs in Africa.
By emphasizing Bush’s Africa anti-AIDS campaign, most recent explanation for this award, the Korbel School is not doing anything original. A look at the mainstream American media over the past months – starting in the early Spring – suggests nothing short of a coordinated media campaign to reshape Bush’s image. But in many ways, this “re-branding George W. Bush campaign” is worse than trying to put lipstick on a pig—it’s more like putting a Freddy Krueger mask on a pig. It makes the pig look worse.
It has included virtually the entire news media, from newsprint to television and tended to sing the same song: that Bush made a major contribution to fighting AIDS in Africa through PERFAR, an initiative begun in early 2003 – in fact, just before the Bush Administration launched its war against Iraq. Add glowing comments from the likes of Bono, Elton John and Matt Damon (his `I would kiss George W. Bush on the mouth for his AIDS work‘ tops the list) to spit shine the image. Bush’s evangelical supporters – a key element to his constituency – chipped in as well. What stands out about this campaign – check any source – is the nearly complete absence of any remarks critical of the PERFAR program.
This Bush image remake culminated in the opening of the Bush Presidential Library in Texas where the former President, Christian fundamentist and cocaine sniffer got bipartisan kudos from Republicans and Democrats alike. It is not only the University of Denver’s administration that is touting Bush’s supposed contribution to countering AIDS in Africa. As one might suspect given Bush’s record on “improving the human condition”, there is much less here than meets the eye.
In many ways, Bush’s AIDS work is more an example of how not to conduct a foreign aid program, than how to do it. Take away the AIDS initiative and all that is left is the wars in Afghanistan, Iraq, the use of torture, intensification of secret special forces operations, helping to promote the collapse of the US and global economies.
The U.S. governmental program to fight HIV/AIDS is formally known as the President’s Emergency Plan For AIDS Relief (PEPFAR). From the outset, PEPFAR has been run out of the Department of State’s Office of U.S. Global AIDS Coordinator (OGAC). The project works through many other U.S. government agencies (US AID, etc). PEPFAR, according to its own reports, has given anti-retroviral drugs –according to 2013 GAO report to 5.1 million people, more than half of these in low or middle income countries, many of them in Africa. In recent years PEPFAR has shifted emphasis to training in-country specialists to take over the programs. The program has somewhat expanded under Obama.
But what sounds good in the press is not necessarily so in fact.
At best, the results have been mixed. A great deal of money has been spent on the program since its inception with questionable, limited – often exaggerated results and few serious follow up studies. From the outset the program has been plagued with criticisms – some of them serious; do the critiques of the program outweigh the benefits? At the same time there is another issue: how much really has George W. Bush contributed to the shaping and the implementation of the program, if at all?
If PEPFAR has some serious shortcomings, still, its accomplishments cannot be entirely written off. It is almost as if some good has come from the program in spite of itself. As a recent GAO report on PEPFAR notes: “our recent reports have concluded that PEPFAR has helped partner countries expand treatment programs and increase program efficiency and effectiveness” The same report hints at some of PEPFAR’s problems: “However we found that the OGAC has not yet established a common set of indicators to monitor the results of PEPFAR’s efforts to improve the quality of treatment programs.” (p.14) “Also problems of in-country inventory controls and record keeping’ – ie – waste, theft, corruption.
Some of the success is due to the program’s change in policy, its ability to purchase generic ARV drugs. When Bush was in office, PEPFAR was little more than yet another boom for U.S. pharmaceuticals as the program required that the drugs be purchased from the pharmaceuticals holding patents, It was the shift to generics, encouraged according to some sources by Bill Clinton, has led to a significant extension of the program and $1 billion savings over a five year period. As a result, the cost per patient has gone dropped some 400% from 2005-2011 and many more people have been treated.
Among the more serious criticisms of PEPFAR is the way the program is implemented in Uganda. At the heart of the program is what is referred to as the ABC approach, an acronym for `abstention, be faithful, use a condom’ – a touching, Christian fundamentalist inspired, but almost entirely irrelevant way of treating AIDS. The program is not run out of the United Nations nor organizations like the World Health Organization, but is run bilaterally between the United States and the target nations involved.
PEPFAR there is a typical `top down’ bureaucratic affair with very little interaction with “folks on the ground”, similar in many ways to many World Bank/IMF structural adjustment programs – a lot of sound and fury signifying much less than asserted. As the ABC approach glaringly suggests, PEPFAR is infused with Christian fundamentalist values. In line with their skewed thinking, the program promotes `abstention’, prostitutes and homosexuals are excluded from treatment. Emphasizing abstention tends to focus on individual behavior modification for prevention, – as opposed to structural change, or some kind of hybrid approach or an approach which focuses on prevention.
By excluding those more likely to be affected by HIV/AIDS, PEPFAR is shooting itself in the foot. The results have been – almost predictably – uneven. If HIV/AIDS levels in Uganda did dip in the early years of the program, their levels are once again on the rise. While some groups see (significantly) falling rates of HIV/AIDS prevalence, other groups see rates rising or unchanged (e.g. married women, LGBT community). In a similar vein, there is no real evidence that the credit for declining HIV prevalence where it exists, is as a result of the Bush program.
PEPFAR has also resulted in a number of unintended consequences: the marginalization of groups at high risk for HIV/AIDS (LGBT, prostitutes, IV drug users, etc.); the promulgation of misunderstandings about HIV transmission, prevention and safe sex (condoms); the promulgation of misunderstandings about the causes of HIV/AIDS epidemic (structures and flows matter too! e.g. gender hierarchies, class hierarchies, economic change, migratory flows).
Even if we examine only the most narrow issue at play in the context of the Korbel Award—the Bush record on HIV/AIDS prevention and treatment—Bush’s record of “global service” falls short. In Uganda, the ABC prevention program spread US power and influence, reinforced unjust social divisions, propagated misinformation, all the while actually causing HIV/AIDS infection rates to rise in some cases. Even where HIV/AIDS rates have fallen (for some populations, very considerably), the role of the Bush program in this fall is heavily disputed.
From the Peace Corps in the 1960s to PEPFAR Today – A Never-ending Effort to Reshape The U.S. Foreign Policy Image…
U.S. foreign policy has often had more than one face. For example, in the early 1960s, Presidents Kennedy and Johnson launched the steamroller wars in Indochina, conducted aggressive interventions and C.I.A.-like coups in dozens of Third World countries (Congo, Dominican Republic, Iraq, Cuba, much of Latin America – just to name a few). At the same time that the Kennedy Administration was putting in motion what would become a half a century of counter-insurgency into Third World affairs, it also created the Peace Corps!
It is a mistake to underestimate the public relations importance of the Peace Corps (or now PEPFAR), which soften an otherwise militaristic and essentially greedy reality of U.S. foreign policy. In both the case of the Peace Corps and PEPFAR, the public relations aspect of the campaign has been as important – if not more important – as the actual results. It is not that Peace Corps `did nothing’ to help the countries where its volunteers were sent, but its overall record in terms of aiding development is spotty at best. Furthermore, one notes how few serious, rigorous studies have been done to evaluate Peace Corps’ contribution, effectiveness or lack thereof.
If the Kennedy and Johnson Administrations were dropping napalm and phosphorous bombs all over Vietnam, putting people in tiger cages and executing tens of thousands there based up a `profiling’ program known as the Phoenix Program, in Tunisia (and elsewhere) Peace Corps architects were designing civic centers and reconstructing mosques, training daycare center directors and teaching English in high schools and universities at the same time. Building bridges in one part of the world paralleled blowing them up elsewhere.
The Bush Administration’s policy of `combatting HIV/AIDS’ in the periphery of the global economy while destroying Iraq and Afghanistan is the more recent example of the same policy a half century on. Launching PEPFAR at the same time as he was launching Cruise missiles at Iraqi power stations, bridges and hospitals provided Bush with a veil of respectability that would later come in handy. PEPFAR began in early 2003, right around the time that the Bush Administration launched its war in Iraq which led to the overthrow of Saddam Hussein and the implosion of that country. What was probably the most economically and socially advanced country in the Arab world was reduced to rubble within a decade.
If U.S. forces were bombing bridges in Baghdad and Basra, the U.S. State Department was giving out anti-HIV vaccinations in Uganda and preaching sexual abstinence to locals there. If one counts the civilian casualties from the Iraq war alone, which government U.S. statisticians are careful not to do, the deaths inflicted by the conflict by some counts are more than one million. Another four million out of a population of 22 million were made refugees either within the country or abroad. The casualties inflicted on Afghanistan are similarly tragic. No amount of embellishing – if not inventing – George Bush’s supposed contribution to combating HIV/AIDS can undo that damage. The smudge cannot be erased.
Rob Prince is a lecturer Lecturer in International Studies at the University of Denver.