Treating the symptoms of aids v. prevention

NY Times:

Dr. Jean W. Pape did not know what to expect in early January 2003, when he slipped away from his work treating AIDS patients in Haiti and flew to Washington for a secret meeting with President Bush.

Mr. Bush was considering devoting billions to combat global AIDS, a public health initiative unparalleled in size and scope. The deliberations had been tightly carried out; even the health secretary was left out early on. If President Bush was going to shock the world — and skeptical Republicans — with a huge expenditure of American cash to send expensive drugs overseas, he wanted it to be well spent.

“He said, ‘I will hold you accountable, because this is a big move, this is an important thing that I’ve been thinking about for a long time,’” recalled Dr. Pape, one of several international AIDS experts Mr. Bush consulted. “We indicated to him that our arms are totally broken as physicians, knowing that there are things we could do if we had the drugs.”

Nearly five years later, the President’s Emergency Plan for AIDS Relief — Pepfar, for short — may be the most lasting bipartisan accomplishment of the Bush presidency.

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The global AIDS program is a rare exception. So far, roughly 1.4 million AIDS patients have received lifesaving medicine paid for with American dollars, up from 50,000 before the initiative. Even Mr. Bush’s most ardent foes, among them Senator John Kerry of Massachusetts, his 2004 Democratic challenger, find it difficult to argue with the numbers.

“It’s a good thing that he wanted to spend the money,” said Mr. Kerry, an early proponent of legislation similar to the plan Mr. Bush adopted. “I think it represents a tremendous accomplishment for the country.”

Announced in the 2003 State of the Union address, the plan called for $15 billion for AIDS prevention, treatment and care, concentrating on 15 hard-hit nations in Africa and the Caribbean. An enthusiastic Congress has already approved $19 billion.

Mr. Bush is pressing for a new five-year commitment of $30 billion. He will travel to Africa in February to make his case — and, the White House hopes, burnish the compassionate conservative side of his legacy.

Despite the effort, there are still 33 million people living with H.I.V., and the United Nations estimates that there were 1.7 million new infections in 2007 in sub-Saharan Africa alone. Critics, including Mr. Kerry, are particularly incensed by the requirement that one-third of the prevention funds be spent teaching abstinence, despite a lack of scientific consensus that such programs reduce the spread of H.I.V.

When a Ugandan AIDS activist, Beatrice Were, denounced the abstinence-only approach at an international AIDS conference last year, she received a standing ovation. Paul Zeitz, executive director of the Global AIDS Alliance, an advocacy group here in Washington, says the Bush program has been hamstrung by “ideologically driven policies.”

That assessment was echoed, in more diplomatic terms, by the independent Institute of Medicine, which evaluated the program in March. It called on Congress to abandon the abstinence requirement and to lift the ban on paying for clean needles for drug addicts, among other changes.

Yet the institute concluded that, over all, the program had made “a promising start.” And when they step back, even critics like Mr. Zeitz concede that Mr. Bush spawned a philosophical revolution. In one striking step, he put to rest the notion that because patients were poor or uneducated they did not deserve, or could not be taught to use, medicine that could mean the difference between life and death.

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Aids is spread because at least one of the sex partners has had promiscuous sex. That is the fact that the opponents of the abstinence program choose to ignore. Those who do not engage in promiscuous sex are not at risk. It is as simple as that. A program that gives this simple fact to people should not be controversial, but it is for liberals because liberals believe that people will still act irresponsibly even when they are aware of this fact. The same people who want a health warning on a pack of cigarettes do not want to give a health warning to those engaged in promiscuous sex. Go figure.