Five Years Later: Judging Bush's AIDS Initiative
Smallman, Shawn
NACLA REPORT ON THE AMERICAS report: hiv/aids Five Years Later: Judging Bush’s AIDS Initiative in January 2003, president george w. Bush announced his plan to ask Congress for $15...
...Key states in Asia (Myanmar and Cambodia), as well as in Africa (Democratic Republic of the Congo and Zimbabwe), proved less capable...
...First, the virus arrived in Latin America later than in Central and Eastern Africa, where the first cases appeared in the 1960s, which allowed more time for Latin American governments to clean up the blood supply, educate the public, and create a plan...
...funds...
...One argument might be that Latin America has not experienced the level of sustained warfare that many African nations have...
...in são paulo i visited a support group for people who had difficulty sticking to their regimen of Hiv medications...
...Despite these efforts, costs still remain high, and only Costa Rica currently provides such medications to all HIV-positive citizens...
...conservatives, most notoriously ronald reagan, studiously avoided referring to Hiv—after the millennium, conservative leaders seized upon Hiv, particularly its appalling impact in africa, as a key issue...
...The Economist has called pepFar the key positive foreign policy of Bush’s presidency...
...Yet, with the exception of Haiti, Guyana, and perhaps Honduras, it has been spared a generalized epidemic...
...Second, one has to consider the role of migration, a key force in driving the spread of HIV all over the world...
...A careful study of repatriated Contra soldiers found only a handful infected with the virus...
...As the work of Andrew Price-Smith has shown, stronger states are more effectively able to address the spread of HIV.13 Even relatively poor nations, like Cuba, were generally able to create a plan to mobilize their public health infrastructure and educate their people...
...nor do many sex workers face realistic options...
...I would suggest that Latin America has escaped a generalized epidemic of HIV in most countries for four reasons...
...Furthermore, monogamy and fidelity are not an issue for married women or babies who become infected...
...He had most likely infected her because he cheated on her after their marriage...
...Most of the funds (70%) are expended on care and treatment, while 10% is spent on supporting aids orphans and affected children, and 20% on prevention, of which at least one third must be spent on abstinence training (and two thirds on combined abstinence-fidelity education...
...religious groups to impose their views on other nations by means of their financial and political power...
...a truly hemispheric initiative is needed...
...Young, poorly educated men and women on their way to the United States pass through a series of transit points throughout Central America where they are vulnerable to exploitation...
...the sense of anger was perhaps best captured in the words of pedro Chequer, the director of Brazil’s aids program and the chairman of the national commission that turned down the u.s...
...Called the president’s emergency plan for aids relief (pepFar), Bush’s initiative sped through Congress and is now five years old...
...by providing medications to more than 1 million Hiv-positive africans, the magazine suggests, the program has served both humanitarian and propaganda purposes, with the majority of africans still viewing the united states positively as a result.2 the pepFar agency points to its efforts over the last five years to “build partnerships” by strengthening the capacity of more than 2,000 local organizations in africa.3 given these achievements, how could the program be controversial...
...From 1983, when the Argentine military government collapsed, to 1990, when Pinochet left power in Chile, one authoritarian regime after another fell to popular protest and political exhaustion (though there were exceptions: Peru under Fujimori, Mexico until 2000...
...one woman had been living with Hiv for years and was now on her own, because her husband had died of aids...
...to the Brazilian leaders—who have had great success in containing Hiv, largely by reaching out to marginalized groups like sex workers and drug addicts—this requirement seemed illogical...
...the program was slow to adopt generic drugs, but in the lastfewyearstherehasbeenadramaticshift,sothatgenerics now account for the majority of the drugs provided.1 overall, the program has unquestionably helped to increase the number of Hiv-positive people who receive medication...
...Her voice shook with anger as she talked about the man who had infected her, who was the same man with whom she had lost her virginity...
...Lastly, the virus arrived in Latin America just as sweeping political changes came to the region...
...in short, critics have charge that politics rather than science drives u.s...
...Still, the danger remains that without precautions a similar disaster may be repeated in Mexico and Central America...
...Because these transit points are documented, an outreach effort in these areas could have a broad impact.12 Given this migratory context, no country in this region can fight the epidemic in isolation...
...On the surface, it might seem that the lower level of poverty in Latin America, compared with Africa, might explain why the region has been more successful in facing HIV...
...JULY/AUGUST 2008 From the start, Honduras’s epidemic focused on the two main cities of San Pedro Sula and Tegucigalpa, while the regions that hosted U.S...
...First, it might be good to exclude some hypotheses that seem insufficient...
...as the Brazilian experience has shown, effective anti-aids policy must integrally link prevention and treatment, rather than favor one over the other...
...in places like oaxaca, Mexico, a large proportion of new Hiv infections are among housewives, the majority of whom may have had only one sexual partner in their lives...
...and the compassion that has shaped the program needs to be matched by a ruthless dedication to results, whether considering policy options in Haiti or kenya...
...in 2005 i interviewed government and ngo leaders in são paulo, Brazil, where pepFar evoked powerful emotions...
...How, they asked me, can you fight aids if you don’t work with prostitutes...
...But some extremely poor countries in Latin America, like Bolivia and Nicaragua, have low rates of HIV, while some report: hiv/aids wealthier ones, like Argentina, have significantly higher rates...
...S.S...
...A small minority of migrant women fall victim to human traffickers, the sex trade, and demands for transactional sex...
...Central American nations are now collaborating to bring antiretroviral drugs to those who need them...
...4 Critics have also charged that pepFar inappropriately requires that Hiv/aids prevention efforts prioritize abstinence and fidelity training.5 little research in peer-reviewed journals suggests that such training decreases sexual activity among the young, and the example of thailand proves what a solid condom-based Hiv prevention program can do...
...money: “we can’t control [the disease] with principles that are Manichean, theological, fundamentalist, and shiite...
...Third, for all of their weaknesses, most Latin American nations had the state capacity to respond to the epidemic...
...at the time the Brazilian government was considering seeking funds from pepFar (although Brazil is not a focus country), which would have meant signing an “oath” affirming Brazil’s opposition to prostitution...
...Similarly, there is no clear connection between the spread of the virus and poverty or globalization...
...troops had much lower rates...
...Democracy alone is not enough to slow HIV, as South Africa has proved, but most of Latin America saw a proliferation of grassroots activism dedicated to everything from gay rights to women’s issues...
...It is true that one cannot discuss the virus’s course without discussing international political economy, from structural adjustment programs to chronic indebtedness, which hampers the state’s ability to respond to HIV...
...Because abstinence does not protect married women, who need to learn to protect themselves, workers in the field are often infuriated by the suggestion that abstinence education is the key to aids prevention...
...Latin america is home to many of the factors that might lead one to expect HIV to flourish in the region: widespread poverty, gender inequality, hidden male homosexuality, an extensive sex trade, and often imperfect national health care systems...
...it has also cut the rate of mother-to-child transmission, as well as supported people living with Hiv and aids orphans...
...aids policy, pointing to the program’s favoring of treatment over prevention, which would entail engaging with politically difficult issues like teen sex and homosexuality, condom usage and prostitution...
...NACLA REPORT ON THE AMERICAS report: hiv/aids Five Years Later: Judging Bush’s AIDS Initiative in January 2003, president george w. Bush announced his plan to ask Congress for $15 billion to fight the global aidspandemic.incontrasttothe1980sand1990s—when many u.s...
...for many Brazilians, the anti-prostitution requirement reflected the efforts of u.s...
...thanks to widespread, bipartisan support in 2008, pepFar will likely be again funded with $30 billion for the next five years...
...For this reason, many public health officials advocate a more pragmatic approach...
...the process by which the focus countries are selected should be transparent and based on objective criteria...
...Likewise, the location of the Contra camps did not match areas with a high prevalence of HIV...
...if the program, now launching into a second incarnation that is twice its original size, is to be effective, it must be seen in the global south as building upon best practices and scientific knowledge...
...they decided against seeking u.s...
...the program focuses funds on 15 countries (12 african nations, together with guyana, Haiti, and vietnam) although others also receive support...
...Certainly there has been extensive migration from Mexico and Central America to the United States, but migration has been less important than in Southeast Asia and Southern Africa...
...But as we have seen, warfare in some cases has the paradoxical effect of dampening the spread of the virus...
...In the long run, it probably makes sense to consider Central America’s epidemic in the same context as Mexico’s, given these populations’ high rate of mobility...
...Moreover, the region has both the resources and the capacity to continue expanding treatment and care, while also safeguarding human rights...
...But thelargerissuethatdisturbscriticsisthatneitherabstinence nor fidelity is a realistic option for many women becoming infected with the virus...
...An exclusive focus on poverty may in fact distract from other issues that shape the spread of the virus—patriarchy, gender inequality, and racial and economic discrimination...
...In country after country the popular protests of activists, often supported with funds from international NGOs, led to key policy changes, from enforcing human rights provisions to making free treatment available...
...a stress on faithfulness may actually distract these women from the dangers they face...
...For this reason, Honduras’s early experience of the virus remains mysterious, especially given that Nicaragua’s rate has remained extremely low...
...Much of Africa—with the exception of the continent’s southern region—did not have this opportunity...
...In sum, HIV would have had far more devastating consequences if it had not been for the flowering of civil society that accompanied regional democratization...
Vol. 41 • July 2008 • No. 4
