Manzini, Swaziland—Mrs. Precious Dube, a 50-year-old, no-nonsense nurse matron, is exactly the sort of person you want in charge of your local health clinic if a deadly epidemic hits. Her mountainous Southern African nation has the highest prevalence of AIDS in the entire world—nearly one in every three people between the ages of 18 and 49 is HIV positive.
Ten years ago, Precious Dube feared that the killer virus would cause her country to disintegrate. Today, she is hopeful. Swaziland is part of the unprecedented multi-billion-dollar, continent-wide campaign to provide Africans with antiretroviral drugs (ARVs). This huge effort, two-thirds of it funded by the United States, has already prevented the death of millions of people.
“People in America have saved the Swazi Nation,” she says with feeling. “If you had not helped us, our people would be sleeping in the streets and dying of disease and hunger. Instead, now, we are about to contain AIDS.”
“Please give us another five years of help,” she asked. “We are winning. We have made it up to a middle level. Help take us up a little bit higher. Our people are taking the ARVs and becoming productive again. As our healthier population goes back to work, we will be able to fund health programs ourselves.”
Precious Dube’s growing optimism is echoed across the wide swaths of Eastern and Southern Africa that the AIDS epidemic hit hardest. The latest statistics are astonishing. In 2003, only 50,000 people in Africa were taking the anti-AIDS drugs. Today, that figure is 7 million. In Africa, the majority of people living with AIDS are women—59 percent, by one calculation. In 2003, hardly any HIV-positive pregnant African mothers had access to the medications that could have reduced the risk of transmission to their children. Today, nearly 1 million kids are alive because America and the other donors got the drugs to their mothers.
Public health experts have learned that “treatment is prevention.” The millions of people taking the ARV medications are much less likely to spread the disease further. New infections worldwide are down one-third from the peak year of 1998, with Africa accounting for most of the decline.
The campaign against AIDS in Africa has already set two world records. It is the most effective foreign aid program since the Marshall Plan helped rebuild Europe after World War II. It is also the largest single medical intervention ever. The successful effort is also an extraordinary tribute to international solidarity, as gay American activists joined courageous Africans to force governments to pay attention and big pharmaceutical companies to back down. The containment of AIDS also refutes the cynical assertion that trying to help the Global South always ends up as pouring money down a rathole.
Yet this victorious program, which spans an entire continent, is hardly getting any publicity at all.
What’s worse, instead of building on this success, the Obama administration is flat-lining its budget request for next year, at $5.7 billion, although even more Africans will need the life-saving drugs. (The largest American program, the President’s Emergency Fund for AIDS Relief, or Pepfar, is budgeted at $4.35 billion, and the United States will contribute another $1.35 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria.) The administration’s timidity is particularly hard to understand, given that prominent Republican legislators are already on record supporting more money. After all, it was George W. Bush who unexpectedly tripled funding for AIDS in Africa back in 2003, and who deserves tremendous credit for the much brighter picture today.