Bush touts African AIDS triumphs

Tuesday President Bush will step off Air Force One into the dry, summer heat of Senegal, one of Africa's oldest democracies and the country with the lowest HIV-infection rate on the continent.

The stop will mark the beginning of a whirlwind, five-day tour during which Mr. Bush will travel to five nations considered, in different ways, Africa's best hopes: Senegal, South Africa, Botswana, Uganda, and Nigeria. Although recent instability in Liberia and increasing international pressure on the US to send peacekeepers there is likely to dominate discussions through the week, Bush's itinerary is intended to highlight the continent's successes.

High on the president's agenda is Africa's AIDS crisis, to which he has pledged $15 billion over the next five years. According to the United Nations, 30 million Africans are HIV-positive, with 3.5 million new infections last year alone. Some 11 million children have been orphaned and at least 3 million infected. Bush says his plan will prevent 11 million new infections, treat 2 million cases, and help care for 10 million orphans.

Three of the countries on the president's itinerary - Uganda, Senegal, and Botswana - are emerging as AIDS-fighting models and examples that the president is likely to look to as he implements his program. Uganda is the first African country to reverse the epidemic by reducing the number of new infections; Senegal has kept its total infection rate near 1 percent; and Botswana, now facing the highest infection rate in the world, is the first country to launch a free, universal drug-access program.

A key force that unites the three countries in their fight against AIDS is political will. The current leaders - Yoweri Museveni of Uganda, Abdoulaye Wade of Senegal, and Festus Mogae of Botswana - have been among the most outspoken on the disease, both in their own countries and abroad.

"I think what's been so important has been the mobilization of the highest political leaders...." says Stephen Lewis, the UN's special envoy for AIDS in Africa. "There are now various leaders on the continent who are talking about AIDS."

On a continent where some countries are facing HIV-infection rates of more than 30 percent, Senegal's modest rate of 1.4 percent is no small achievement.

Senegal was one of the first African countries to aggressively combat the epidemic through a variety of actions. Behavior-modification campaigns were launched encouraging youths to delay their first sexual experiences or to use condoms.Religious leaders from the country's two main faiths, Christianity and Islam, were encouraged to help educate the public. And prostitutes were targeted with safe-sex campaigns and frequently tested for AIDS and other sexually transmitted diseases.

"One reason for our success is political will and early response," says Fatimata Sy, Senegal's country director for Family Health International, a US-funded program. "Since 1986, when we had the first cases, Senegal never denied the problem. That year ... they put in place the national AIDS-control program."

Senegal is not one of the countries specifically targeted for Bush's new AIDS funding, since that money will go to Africa's hardest hit nations, along with parts of the Caribbean. But Mr. Lewis says there is growing consensus that targeting high-risk groups, like Senegal's sex workers, is one of the most effective ways to combat the disease.

Uganda is the country most often associated with stemming the tide of AIDS in Africa.

In the early 1990s, the Great Lakes nation was facing an HIV-infection rate of 14 percent, one of the highest in the region. Today that rate has fallen to around 8 percent, due largely to an aggressive information campaign.

Mr. Museveni, the country's rebel-turned-president, was one of the first African leaders to speak openly about the disease. His administration launched awareness campaigns and the continent's first voluntary counseling and testing centers. Many Ugandans say the government's attention helped change attitudes and, ultimately, behavior.

"One of the things that has helped has been the openness, and that people from the highest level of the political structure, including the president, are talking about AIDS," says Christine Oryema-Lalobo, program manager of the Hope for African Children Initiative in Uganda, sponsored by CARE and five other international humanitarian organizations. "We don't get it right all the time, but at least we're talking about it."

Meanwhile Botswana, with an HIV infection rate estimated at 38 percent, the highest in the world, is an unlikely candidate for AIDS success stories. For a long time, the Southern African nation, like many other countries, ignored the epidemic while cases soared.

But facing the reality that large numbers of Africans, particularly young people of child-bearing age, were HIV-positive, much of the debate on AIDS has shifted from prevention to treatment.

Botswana, a diamond-producing nation with a tiny population, has been the first to offer universal treatment. Last year, it launched the continent's first free antiretroviral program.

"You can't avoid the issue of treatment any more. There are 30 million infected people and a minimum of 6 million who would qualify for treatment," says Mr. Lewis. "What we've also discovered is that treatment not only keeps people alive, it restores hope."

More than 50 percent of the US's new AIDS money - which will go both to the UN's Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria and to 14 of the world's most affected countries - is earmarked for prevention and treatment, including antiretrovirals.

But critics question whether the pledge will be fully funded since the president only asked for about $1.5 billion in next year's budget, rather than the $3 billion that was expected in order to meet his five-year, $15 billion target. They also complain that instead of contributing all the money to the Global Fund, they are complicating things by sending funds directly to the countries.

"They're phasing the money in very slowly and undermining the Global Fund," says Paul Zeitz, head of Global AIDS Alliance, a nonprofit group based in Washington. "There are 25 million people who have already died, 3 million dying each year, and 8,000 a day. You don't go slow. We're already way behind on this."