Disclaimer: I must be honest, I cannot take much credit for many of the words written below- I am a but a mere master of paraphrasing the excellent eloquence of others. I must give credit when credit is due. Thank you John Hopkins School of Public Health for your magazine Zambia in 2005 (thanks Nurain for the magazine- I smiled to myself when I read the article about DPT!)
As a perused through its pages, there was one story that caught my attention and thus, I shall share with all you who love and care about me so much that you read these ramblings of mine—either that or you just have too much time on your hands and read to elude the boredom… but since I’ll never know for sure, I’ll assume the first— makes falling asleep easier at night to think that what I’m doing here actually does matter and that there are people there who actually do care. Distance and time can do funny things to your thoughts sometime… So anyway… back to that magazine article about politics and PEPFAR and you and me…
Michael J. Klag, MD, MPH (of John Hopkins School of Public Health) wrote a compelling piece about his brief visit to Uganda and his experience here. He visited a few HIV outreach clinics during his travels which I found myself relating to within his first few words. At the clinic, he was greeted by a passionate applause— purely based upon the country he represented to them. He was an American. Besides money and materialism and Hollywood, , most Ugandans are convinced that Americans are the most generous people on the face of this earth. Now I know what some of you may be thinking—Americans? Generous? Do those two words go together in the same sentence without any sort of derogatory word between them? Well, I’m here to tell you that according to many, they most certainly do. America is the land of milk and honey—it’s the land of USAID and PEPFAR.
Mr. Klag was greeted with a warm welcome because he stood before all those PLWHA (people living with HIV/AIDS) as a living manifestation of the generosity of the American people. The free ARVs (antiretroviral medications) that are distributed here (and throughout much of Africa) come by ways of PEPFAR (the President’s Emergency Plan for AIDS Relief). PLWHA are living—they’re not dead and thus they clap—or they give you a chicken or a giant yam or offer their eldest son’s hand in marriage in addition to five cows (if you’re me that is). Many Ugandans who are on ARVs are grateful for the medicines that keep them alive—most have had the awful experience of sitting and watching their family and friends die one by one of the disease without they believed there to be no help for—no hope. Before the availability of ARVs, whole villages were devastated in Uganda by the loss of life. Presently, there are more than 25 million people in Africa alone infected with HIV—the epidemic’s toll defies comprehension— mine at least.
Nevertheless, I see hope and this hope I learned during my time here. As I travel to villages and towns I see programs and clinics offering free ARV treatment to the communities which are extending the lives of many- not just prolonging their years but actually improving their quality of those years. And it’s due in part to PEPFAR—it’s the reason why many are still alive today—“each day’s supply of pills is a day of life preserved.”
Okay, now granted if any of you are familiar with this plan of President Bush and you’re at all involved with the healthcare sector, I’m sure you’ll be a bit perplexed by my positive portrayal of PEPFAR. From a public health perspective there are many criticisms which I could highlight—many of the restrictions of the Plan seem ridiculous, the hoops one needs to hop through seem endless (like for instance its emphasis solely on abstinence based programs with neglect evidence-based methods of prevention (like condom distribution— can you say vulnerable populations? I guess the prostitutes and drug users don’t deserve a second chance). (ASIDE: sentence ladened in sarcasm—just want to clarify before you jump to conclusions about me!)
Of course PEPFAR has its flaws and imperfections but I have to say wholeheartedly, it’s one thing President Bush did right. All politics aside, no matter how much you loved or painstakingly endured Bush’s years in office, PEPFAR is making a difference, it’s saving lives. The program is only funded through the year 2008—at the end of this fiscal year all those here in Uganda and throughout the world will kiss their precious life-saving ARVs goodbye. PEPFAR needs to be expanded and improved for sure, but not ended. Americans need to wake up to the reality of the good that can come from a government program and recognize the tremendous effects being seen and felt throughout the world—if not, the Plan may not be renewed. The termination of this program would essentially assign a death sentence of millions.
Of course, we should not overlook the significance of proclaiming prevention methods to communities nor should we lose hope of the development of a vaccine (which still remains elusive). Behavioral interventions (much like what we’re doing at AEGY) must be emphasized with “redoubled vigor and creativity”. The epidemic will never end if each new generation does not learn from the mistakes of the past. Here in Uganda, most cases of HIV are spread through sexual intercourse which means inevitably abstinence and faithfulness are important messages in the prevention strategy (condom use would reduce risk- not prevent it). We need to reduce the spread of HIV in order to reduce the lifelong dependency on expensive ARV medications. Until a cure becomes available, it is our responsibility as fellow human beings to do everything in our power to keep people already infected with HIV alive. PEPFAR (among a few others like UN’s Global Fund to Fight AIDS, Tuberculosis and Malaria) offer our highest hopes.
Yes, controversy surrounds many of U.S.’s world policies but all in all, PEPFAR is one we got mostly right. I agree with Mr. Klag when he concludes, “whatever our politics, we have to send a message that what President Bush has done with PEPFAR is a really good thing. And it cannot be stopped.” Call the White House, write a letter, go march on Washington. I don’t know. Be creative. Let Bush know he did good – at least this one time.
