AWASA, Ethiopia — Though President Obama's trip to Africa this week focused on the Muslim world, by looking south from Egypt across the Sahara to the rest of the continent he could have seen the dramatic impact of another American president's policy. George W. Bush's efforts to deal with HIV/AIDS in Africa have saved more than a million lives; Obama needs, even in these tough times, to continue them.
In 2003, when Bush announced the President's Emergency Plan for AIDS Relief, or PEPFAR, it was a history-making commitment. Here in Ethiopia, where fully 10 percent of urban populations between the ages of 15 to 49 are infected and the lifespan has dropped seven years, the initial investment of $48 million in 2004 grew to more than $350 million last year.
And the results are impressive both in Ethiopia and throughout the 15 focus countries of the program, where more than 2 million people have received lifesaving antiviral drugs free of charge. People who used to be bedridden are now up and working. Some children who were once almost certain to go through life as orphans now have the possibility of seeing a parent survive.
That's the good news. The bad news is that the number of infections has not decreased and there are still millions of children who have been either orphaned or made vulnerable to a life of desperate deprivation due to HIV/AIDS. In more than 77,000 households in Ethiopia, there are no adults at all. That's why Cokie traveled to this Horn of Africa nation — to see how Save the Children, where she is a trustee, has used PEPFAR money to reach more than 500,000 children.
Driving south from Addis Ababa to the city of Awasa past the tiny, round, thatched-roof "tukuls" that serve as houses, watching oxen pull rudimentary plows, seeing women bent from the weight of wood on their backs, only the cars on the road give any indication that the 20th century has come and gone.
But the 20th-century scourge of AIDS brought Save the Children down this road to work in the towns between Addis and Awasa, organizing and training tens of thousands of volunteers. Knowing that attempts to alter behavior can't be imposed from the outside, the Positive Change Program finds local religious groups and individuals who are willing to go out and identify the children in need, and then, through regular visits, to make sure that the kids are healthy, fed, have roofs over their heads, and go to school.
One way to improve children's lives: improve the lives of their caretakers. So Save the Children works with local charities to teach women how to save miniscule amounts of money. They receive a token stipend during training, use it as their nest egg and put aside a few cents at a time into a central savings pool that they use to lend each other money to finance some small enterprise. At a meeting of the savings group in the town of Debra Zeit, one woman said she sold pepper spice, another wood and charcoal, another vegetables and several made the injera bread served with every meal. They were all able to support their children and keep them — includng the girls — in school.
And it's the children themselves who are the most enthusiastic supporters of these programs. At a youth center in Dukem where a poster proclaims "Positive change is a process, not a phenomenon," young boys jostle with each other to tell how much they like coming to a place where adults pay attention to them and try to teach them how to make good choices. That's the best way to reduce the incidence of AIDS in the long run. The 2.2 billion condoms that U.S. taxpayers have supplied under the PEPFAR program haven't done the trick.
But those condoms plus the billions of dollars spent on drugs have performed a lifesaving mission and started to get the continent of Africa on its feet. President Obama's proposed budget for next year has angered AIDS activists because he doesn't deliver on his campaign promise to increase funding for PEPFAR; in fact, he would decrease it somewhat from what the Congress has authorized.
That's an understandable choice in recessionary times, but an unwise one given the success of the program. As President Bush said at a global-development summit last year, "The cost of abandoning our commitments would be far higher than the cost of fulfilling them." The children of Ethiopia would agree with him.
Cokie Roberts' latest book is "Ladies of Liberty: The Women Who Shaped Our Nation" (William Morrow, 2008). Steve and Cokie Roberts can be reached at firstname.lastname@example.org.