Before the modern age there was no such thing as geopolitical nations. A casual survey of ancient and medieval history will reveal that groups of people congregate and call themselves tribes. A monarchical system of government will arise but it usually means subduing or leading a group of tribes. But fast forward to modern times nations arose from the ashes of colonialism. Yet, even with these changes one thing remained, unilateralism, the idea that each his own. If this policy was strictly observed then Africa will be no more as it would have been overwhelmed by a terrible AIDS pandemic. It is a good thing that the United States extended a helping hand when the Bush Administration created the President’s Emergency Plan for AIDS Relief or PEPFAR. But the $15 billion included in the PEPFAR will never be enough to save the said Africans, the government and their people must work hand in hand to ensure that AIDS/HIV will not control their lives.
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Overview of U.S. AID
In the 20th century the world has seen the emergence of independent nations. The modern age has produced ideas regarding freedom and liberty. The colonial masters could not do anything but to relent and agreed to give independence to their former colonies. But with freedom comes responsibility. It is also during this time that unilateralism, the idea that each nation should govern independently without the assistance and interference of other nations is emerged as the best path to ensure self-governance. This is understandable considering that for many centuries these colonies were governed with an iron hand and they need to be given the free hand to rule. The only problem with this arrangement is that when these newly independent nations encountered problems there is no one to pull them out of the rut.
As a result many of the newly independent nations experienced growth pains especially when it comes to eradicating poverty and corruption. Many are well aware that if these twin evils are present in a particular country then one could also expect related problems such as poor infrastructure and the limited services provided by the government. The transport system is in disarray and the bureaucratic red tape can easily suffocate businesses from becoming strong and competitive. But one of the most important sectors that usually get hit with incompetent management is the health sector. There are not enough hospitals and clinics. But adding to the problem is the lack of health workers in the areas where they are most needed.
At the height of the Cold War between Democracy and Communism, the Free World whose major members are the United States, Great Britain, France, and Germany was in conflict with the Sino-Soviet Bloc whose major members include the former USSR, China, and North Korea. In this new type of war the United States realized that it could not win the battle of ideology if U.S. will not take the initiative in helping fledgling democracies and strengthen their resolve to fend off the advances of communist ideas. This means that the United States had to funnel money into these small countries so that the economy will not collapse and prevent the emergence of left-wing groups.
But even in the 1980s the United States was not sold out to the idea of showing all out support to nations needing help. According to one author, “At the beginning of the 1980s, programs to promote democracy abroad was an insignificant part of U.S. foreign aid” (Carothers, 29). The unilateralism doctrine is in effect. Still the U.S. government could not afford to be found guilty of doing nothing while watching the world slowly turn to Communism. Thus, the former president Ronald Reagan embarked on a new method to combat the Soviets. Reagan’s advisers believed that, “…the U.S. government should fight back in the war of ideas with a substantial program of international activities to promote democracy as an ideology” (Carothers, 30). Instead of sending in troops he opted to send aid. During his watch the U.S. government began to become active in promoting democracy through economic means.
In ancient times and even in the Medieval Ages, the human race has fallen victims to terrible plagues that claimed million of lives. The most widely known epidemics are those connected to the Black Death or Bubonic plague, as well as the equally devastating effects of Tuberculosis and other communicable diseases. The discovery of vaccination and the subsequent improvements in healthcare prevented the spread of deadly germs that could have easily wiped out a fraction of the world’s population. Thus, in the 20th century one is scarcely terrified with the words TB, leprosy or even small pox. It seems that humanity has emerged triumphant over fast spreading deadly diseases.
But in the latter part of the last century, the world was stunned with the discovery of a new lethal virus. The Human Immunodeficiency Virus or HIV; it is unlike any other virus or pathogen because it could not be tamed, so to speak. This means that the usual method of inoculating the person with a weaker virus to condition the immune defense system to combat the stronger strain that may infect the individual in the future does not work against HIV. Moreover, the HIV virus does not attack the usual targets; in this case it attacks the white blood cells of the body. Since white blood cells are the major component in the immune system, wiping out white blood cells will mean that the patient will be susceptible to various diseases that in normal conditions are actually not deadly.
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Combining the two factors – the absence of vaccines and the mode of attack – created a super virus that has no known cure and having very lethal effects. The only good thing about the HIV virus is that it is not as transferable as the flu virus, meaning a person sitting next to an infected patient will not develop symptoms of the disease. But this is hardly good news because the mode of infection ensures that many people will get infected in the long run. This is because the HIV virus can be transmitted through sexual intercourse, sharing of hypodermic needles, blood transfusion, and during pregnancies the infected mother can transmit the virus to her unborn child.
There is still one more feature of the HIV virus that helped in creating the current pandemic in Africa and in other parts of the world. When a person is infected with the HIV virus, he or she can still lead a normal life for months or even years without knowing that the HIV virus is already present in the system. This means that the infected person can continue to lead a promiscuous lifestyle, engage in unsafe sex, donate blood, and if a drug addict will have no qualms in sharing hypodermic needles with fellow addicts. In the process the HIV virus is passed from one person to another. Thus, a group of people can be infected by one person and everyone knows nothing about the imminent danger they face. When the HIV virus succeeds in destroying the person’s white blood cells, the immune system is compromised giving rise to a condition called Acquired Immunodeficiency Syndrome or AIDS.
In 2000, a joint United Nations Program better known as UNAIDS, reported that the virus has already claimed 17 million African lives (Copson, 43). Aside from that there are more than 25 million Africans who are already infected and 3.8 million infections had occurred during the same year (Copson, 43). In a survey of sixteen African countries at least 10 percent of the adult population aged fifteen to forty five was HIV positive where a 35.8 percent rate of infection was recorded in Botswana and 19.9 percent in South Africa (Copson, 43). It is hard to look at these figures and not feel a sense of foreboding that the African continent will soon implode. Something has to be done about the African crisis.
Exacerbating the Problems
Based on the above-mentioned factors aiding in the spread of the virus, it can also be argued that knowledge about HIV as well as prevention measures are the best way to limit the spread of the disease. On the other hand the lack of knowledge and access to a reliable healthcare system means that there will be no early warning mechanism that could alert the infected patient that he or she has the HIV virus and therefore make adjustments in behavior, protecting the people around the HIV carrier. The lack of resources is more acute in Third World Countries, particularly in the relatively new nations of Africa.
The African continent is one of the worst hit with the HIV virus. Sub-Saharan Africa has all the ingredients required for a pandemic to occur: 1) large number of people; 2) large groups separated by vast tracts of land; 3) lack of efficient transport system; 4) lack of efficient communication system; and 5) governments riddle with corruption. As a result, “Communities across the continent are experiencing a day-to-day decline in their standard of living, reduced capacities for personal and social achievements, an increasingly uncertain future, and diminished capacity to maintain what has been secured over past decades…” (Poku, 1). The overall picture is indeed bleak.
Combining these together one can find a region in the planet where one infected individual can travel through different places and infect many without them knowing what hit them. There is no flow of information from the top to the bottom because there is no means to transmit it, no TV networks and no Internet connections in most places. If medical support is needed the great distance between key cities and rural areas can be a difficult problem to overcome.
The main impact of the epidemic is seen in the high number of deaths. But there is more; it is not only the old and the sickly who fell victim to the virus, but the truth is this, “…HIV/AIDS is killing people in the prime of their working lives (typically those between 15-49) This has the effect of sharply reducing life expectancy, eroding the labor force and destroying intergenerational socio-cultural capital formation” (Poku, 9). In other words HIV/AIDS is like having an ongoing civil war but the only difference is that the enemy is unseen.
Responses to the Epidemic
There are three major groups who had been found to provide help and support to Africans ravished by the AIDS epidemic. These groups are: 1) donor governments; 2) non-governmental organizations; and 3) African governments. The primary goal of these groups is to reduce the number of HIV infections through prevention programs. The secondary goal is to treat those who are beginning to show symptoms of the disease. Finally the third goal is to ameliorate the damage done by the virus to individuals, families, societies and economies (Wusu, 24). Hitting two birds with one stone, the typical program is not only geared to treat infected patients but also aims to inform the public with regards to the nature of the killer virus. When it comes to prevention, some programs provide information regarding condom use.
One of the most significant programs so far is the one involving the giving of free HIV test each time Africans get to visit a medical center. The said tests coupled with AIDS awareness programs will ensure that Africans will always be on their toes, always on the ready when it comes to fighting the HIV/AIDS epidemic. But these programs coupled with the giving of antiretroviral medications to those who are seriously ill will easily drain the resources of the aforementioned groups.
According to UNAIDS the funding gap remains and in a report entitled Acceleration Against AIDS in Africa and it contains the following:
- An estimated $8 billion will be needed to fight the AIDS epidemic in 2004.
- Of the said amount, $6 billion will be provided by various sources including donors, the Global Fund, African governments, and African households; yet still.
- The funding gap will widen in 2005 (Wusu, 25).
The UNAIDS report made it very clear that in order to solve Africa’s health problems something has to be done beyond the usual funding methods. It can be surmised from the report that the United Nation’s UNAIDS committee has a fair understanding of where the money will be coming and how much. And they are saying that even the best efforts will fall short because the need is so great. Somebody has to make the necessary sacrifices in order to bridge the funding gap. The United States was expected to do more but it is fair to say that no one was able to anticipate what the Bush administration tried to do next.
President’s Emergency Plan for Aids Relief
According to one study, the U.S. government was never keen on giving excessive dole outs to Africa but the AIDS pandemic sweeping across the continent necessitated a response (Copson, 42). Pressure from different groups – rising media coverage, pressure for action from Congress, activist organizations, faith0based advocates – finally forced the Federal government to relent (Copson, 42). In 2003, President George W. Bush signed into law the President’s Emergency Plan for Aids Relief. The PEPFAR authorizes the government to release $15 billion for five years 2003-2008. The sizable resources will be used for treatment, care, and prevention programs in Africa.
Treatment uses antiretroviral drugs and care involves mitigating the impact of the dreaded disease. Prevention on the other hand follows the acronym ABC which will be explained as follows:
- Be faithful.
- Use Condoms (Nelson & Williams, 869).
Without a doubt the Christian heritage of the United States was influential in pressuring the government to do something significant. This means that the time has come to make a major step forward. It seems that the Bush administration is willing to make a difference and no longer contented to put a “band-aid” on a gaping wound that is the HIV/AIDS pandemic. In January 28, 2003, in his annual State of the Union address Bush told the members of Congress and top government officials that:
Today, on the continent of Africa, nearly 30 million people have the AIDS virus – including 3 million children under the age of 15. There are whole countries in Africa where more than one-third of the adult population carries the infection. More than 4 million require immediate drug treatment. Yet across that continent, only 50,000 AIDS victims – only 50,000 – are receiving the medicine they need…(Copson, 46).
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Aside from shared Christian values there is another reason why Congress was persuaded to approve such a generous aid. At that time, the United States was conducting a war in the Middle East and they needed to show the world that they know a thing or two about solving the world’s problems aside from sending in troops and stealth bombers. The Bush administration needed the world to know that there is a nice side to U.S. foreign policy (Copson, 46). But the huge budget and the short timeline can backfire. It must be understood that the success of the PEPFAR is not only limited to the success in the prevention and treatment program. Success for PEPFAR means reauthorization in the year 2008. If the U.S. government approves the continuation of the program that act is the real gauge for success.
There were many problem encountered during the implementation of PEPFAR. One of the hurdles toward efficient performance is the controversy surrounding the Bush administration’s concessions to religious groups. The said groups wanted to pressure the African nations to highlight abstinence-until marriage programs, limit condom distribution and discourage prevention services for prostitutes (Copson, 42). The criticisms and controversies that followed PEPFAR prevented it from gaining momentum as quickly as possible.
Aside from the minor controversies, the major issue that could potentially derail PEPFAR and prevent it from being reauthorized, is the issue involving antiretroviral treatments. It has been mentioned prevention and early detection programs play a vital role in eradication the AIDS problem in Africa. But no mater what the experts will say, an effective treatment program specifically a cure for AIDS is still the best way to limit the impact of the HIV virus by eliminating the possibility of one infected person infecting another.
As of the moment there is no known cure for AIDS but there is an alternative that can help patients live longer. This type of drugs is called antiretrovirals or ARVs. This type of drug must be administered through a treatment regimen called HAART or highly active antiretroviral therapy. This treatment method has been known to work well in developed countries, especially the United States (Wusu, 26). Now, based on the preceding discussion, the spread of infection, the acute need for funds and the effectiveness of HAART, the logical step is to funnel massive amounts of money into Africa.
It will only require a very short time to come up with the analysis that PEPFAR can indeed make a major difference in America. But a closer examination of the issues involved will reveal that it is not that simple. Injecting funds into a program will not ensure success, in fact in region like sub-Saharan Africa were corruption and incompetence comes in abundance money is not the magic wand that will make every problem disappear. According to analysts the infusion of money without having the proper apparatus and the proper channels in place will only result in creating highly resistant strains. This will only push the program back to square one. According to one view:
…African supply channels cannot make the drugs consistently available to millions of patients and that regular monitoring of patients by medical personnel is not possible in much of the continent. Monitoring is necessary, they maintain, to deal with side effects and to adjust medications if drug resistance emerges. Many fear that if drugs are taken irregularly, resistant HIV strains will emerge that could cause untreatable infections worldwide… (Wusu, 28).
This is indeed a serious concern. Someone has to ask if PEPFAR can indeed make a difference or will it simply create another monster? If resistant strains will spread worldwide then the problem will totally be out of control. Thus, the $15 billion price tag should lift up the hopes of Africans but they must realize that the work is only halfway done. There are so many things to do before the $3 billion a year package can be used properly without the unnecessary backlash because there are many African nations already tethering on the brink of collapse.
Surprisingly the difficulty in implementing PEPFAR should not be entirely blamed on Africa. A major stipulation in PEPFAR requires that antiretroviral drugs that will be used in the program must be licensed by the US FDA. On January2005 U.S. Government Accountability Office issued a report saying that, “…the regimen of antiretroviral drugs offered under the PEPFAR is narrower and more costly than the regimen offered by other programs” (Wusu, 31). So if PEPFAR will fail there are two possible scenarios that can occur. The first one is the emergence of resistant strains because the sudden increase of money provided drugs that could not be administered correctly. The second scenario will show a U.S. government spending large sums of money for drugs that can be bought at a cheaper price. In both cases the American tax payers are simply wasting time and money in supporting PEPFAR.
But there are also those who firmly believe that even with the above-mentioned obstacles the best thing to do initiate a chain of events that will lead to eradication the AIDS epidemic is to simply increase funding. In the first eight months of operation PEPFAR was able to achieve the following:
- The Emergency Plan reached 155,000 people and treated them with antiretroviral medication;
- There were 1.2 million women who benefited from services that prevented mother-to-child transmission of HIV;
- There were more than 1.7 million persons who received some form of health care (Nelson & Williams, 869).
It is no longer practical to debate the merits of PEPFAR. First of all it was already approved and made into law. Secondly, it was recently reauthorized and extended the program for five more years from 2009 to 2013. The only thing left to do is to find out the steps needed to ensure the success of the said program. A step into the right direction involves the U.S. FDA. The said agency must continually improve the mechanism it created to ensure the, “…rapid review and licensure of antiretroviral drug combinations allowing the use of cheaper, simpler-to-use, generic drug combinations…” (Nelson & Williams, 869). This will increase the cost-efficiency of the program. The money saved from purchasing drugs can be used instead to improve the delivery channels of the drugs and then upgrade the monitoring systems to prevent the emergence of resistant strains.
There is also a need to shift from the traditional view that the epidemic is due to the unbridled sexual cravings of Africans. As a result, “…the central thrust of prevention programs over the past two decades has been dominated by the advocacy of behavioral modification and the encouragement of condom use” (Poku, 3). Although this remains important one has to understand that there are other factors involves aside from the fact that the epidemic has become more complicated with each passing day. For instance mother can infect the child. There is no behavior modification that can prevent that. What remains is the fact that the child can grow up with full-blown AIDS and the government and the community has to respond to that.
There is no need to elaborate on the need to solve the problem of corruption within sub-Saharan Africa. This is easier said than done. The community leaders as well as the politicians must come to realize that if they will not make a stand against corruption and continually plunder their nations and make millions for themselves then one day they will wake up without a country to rule because majority of the population are already buried six feet under.
On the part of the United States, the success of PEPFAR can only be achieved if support continues. If there is a decline in support then Congress and the American public can easily find loopholes in the program which will then increase the demand for its discontinuation. There must be shift in mindset when it comes to unilateralism and the idea that it is all right to be selfish sometimes to protect the interest of the United States. But as one expert pointed out, the AIDS/HIV epidemic in Africa can become a potential security threat to the U.S. especially if highly resistant strains will spill over the borders of Africa when refugees will be forced to move out from the continent and then settle elsewhere. It will not take long before the virus will eventually land in U.S. It is therefore imperative to contain the epidemic inside Africa.
The United States of America believe in unilateralism. For a nation as big, powerful and as rich as the U.S. the unilateral doctrine makes sense. This means that America can carefully choose the enemy it will fight and choose the problem that it will attempt to solve. If there is a region in the planet that requires rescuing the U.S. government will not immediately drop everything and extend a helping hand. The U.S. government has been known to examine the benefits that it can get from helping others.
This may sound like a harsh criticism for U.S. foreign policy but if other nations will have an open mind they will probably agree that the U.S. government is simply trying to be prudent. After all resources are limited and if the U.S. will come running to save every form of international emergency then time will come when the Federal government will no longer have the means to make significant contributions to world peace and global economic stability.
For many decades the U.S. government find very little incentive in helping Africa. But all of that changed when the U.S. was forced to fight global terrorism. It required very little analysis to realize that if Third World nations are allowed to slip into poverty and hopelessness then it is easier for extremists groups to find fresh recruits to volunteer for their suicide missions. Aside from that it has become apparent that if the U.S. government will not help Africa then no one will because the U.S. is the sole superpower in the world today and it is the only nation to have the clout to do anything of significance in Africa.
Aside from that there are some analysts who predicted that if the U.S. government will not act now then the HIV/AIDS epidemic that is spreading like wildfire in sub-Saharan Africa will no longer be contained inside the continent. With globalization and efficient world travel it would be easy for infected Africans to travel beyond their borders. And it will be a matter of time before the African refugees will be scattered all over the planet. Another worst case scenario is the emergence of resistant strains that is the direct result of mismanaged intervention programs in Africa. If this resistant strain will reach America then the cost of dealing with an epidemic will be greater than foreign aid.
Thus, in 2003 the Bush administration championed the PEPFAR. It is an ambitious project that will use up $15 billion dollars in five years time. The amount of money in a relatively short period of time helps describe how serious the Bush administration was in attempting to solve the current health crisis in Africa. But it did not take very long before controversies and problems began cropping up.
It turns out that the Bush administration made concessions to religious groups and it prevented PEPFAR from gaining momentum in early phase of implementation. In the said concessions there was a renewed emphasis on behavior modification such as abstinence before marriage and being faithful with one partner. No one can discount the importance of these strategies but the HIV/AIDS epidemic has evolved into something terribly complex and the Africans are dealing not only with promiscuity but also the reality of mothers infecting unborn children. It has come to a point when the HIV virus is being passed on from one generation to the next.
Another contentious issue involves antiretroviral drugs. The effectiveness of the said drug added fuel to the controversy. PEPFAR wanted ARVs to be used in Africa but then it made U.S. FDA to be the regulatory body responsible for approving the drugs used for the program. At first this is simply the result of having some sort of check and balance in the system. The only problem is that the U.S. FDA only approved expensive ARVs coming from reputed pharmaceutical companies. Many cried foul and PEPFAR was forced create a mechanism that will speed up the licensure of cheap, easy to use and most importantly effective ARVs.
The second major issue is with regard to the wisdom of injecting massive amounts of money into the program. There are those who contend that this will only result in providing a great number of drugs but without the proper channels, misuse will potentially create resistant strains. There is therefore the need not only to bridge the funding gap but to provide a system so that the funds will be used cost-efficiently.
The solution to the African health crisis requires a paradigm shift from all participants – donor governments, NGOs, religious organization, African governments and the African people. The HIV/AIDS epidemic has evolved and will continue to evolve each passing day. Right now communities are being wiped out. If this will continue then it is possible for a whole generation to disappear. This means that Africa will lose everything that was gained in the past century. But it is also wise to consider that the epidemic can possibly spill beyond African borders. If this happens then in the long run the $15 billion dollar package is cheap, the program must continue.
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