Linda, a 24-year-old sex worker in Kigali, Rwanda, didn’t want to be tested for HIV because she feared she would find she would soon die. Her fear was not unfounded. Being aware of one’s HIV-positive status was a first step toward dying of AIDS in Rwanda, as in most parts of Africa. Anti-retroviral drugs were expensive and hard to come by. But that was before PEPFAR.

Then-President George W. Bush launched PEPFAR — the President’s Emergency Plan for AIDS Relief — in 2003, committing $15 billion over five years to combat HIV/AIDS globally. PEPFAR has been hailed as the largest international health initiative in history to fight a single disease. Through the program, the U.S. joins with local communities and organizations to support HIV/AIDS treatment, care and prevention activities.

About 1.4 million HIV-positive people have received anti-retroviral drugs through PEPFAR, an increase from the 50,000 who received U.S.-funded drugs before the initiative was launched. In addition, according to White House figures, PEPFAR has provided care to about 6.7 million people affected by HIV/AIDS, including 2.7 million orphans and other children. Drugs from PEPFAR to prevent mother-to-child HIV transmission have prevented an estimated 152,000 pediatric HIV cases.

PEPFAR has 15 focus countries — Botswana, Cote d’Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia and Vietnam — and 12 of them are in Africa. It is estimated that, so far, PEPFAR has supported lifesaving anti-retroviral treatment for over 1.3 million people in sub-Saharan Africa alone.

In July 2008, Bush authorized PEPFAR to continue for five more years (fiscal years 2009-2013) when he signed the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act. The act was named in honor of the two late members of the U.S. House, one Republican and one Democrat, who authored the original 2003 act. In 2007 Bush proposed to double America’s initial commitment and provide an additional $30 billion. He also called on Congress to pass reauthorizing legislation to maintain PEPFAR’s founding principles.

As a result of the “PEPFAR Effect” in Rwanda, Linda agreed to be tested and became aware of her HIV status. She is HIV positive but upbeat. “They said they could make us well, that they have these drugs. So I got tested and I have the drugs,” she said.

In Rwanda, PEPFAR is delivering anti-retroviral treatments to over 44,000 people. U.S. funding for HIV/AIDS there grew from $39 million in fiscal year 2004 to $103 million in fiscal year 2007.

Dr. Agnes Binagwaho, head of Rwanda’s National AIDS Council, says “the impact is huge. The average life expectancy of Rwandans has improved by four years because of PEPFAR.” According to Binagwaho, the program is the major contributor to a tenfold increase over the past four years in the number of Rwandans on anti-retroviral drugs, to nearly 50,000 people. Presently, about 70 percent of Rwandans who need the drugs receive them.

Others who like Linda owe their lives to “George Bush and the Americans” include Kunene Tantoh of South Africa and her child, Baron. Indeed, Bush named Tantoh as one of the five people that made his year 2007 special.

When Tantoh arrived at the Mothers to Mothers-To-Be Clinic in Cape Town, South Africa, in 2003, she had just discovered she was pregnant — and HIV positive. Mothers Centers, which receive PEPFAR seed money, give HIV-positive women information and support to keep their unborn babies free of HIV.

A normal person’s CD4 count, which measures immune cells, is between 500 and 1,500. Tantoh’s count was 2. She was not expected to survive. But with the treatment and nurture she received at the Mothers Clinic, she survived and gave birth to Baron, who is HIV negative. Tantoh became a mentor to other mothers and now serves as a site coordinator at the largest Mothers to Mothers-To-Be facility in South Africa.

PEPFAR may indeed turn out to be Bush’s major redeeming value as he continues to be criticized at home and abroad for his relentless war-making in Iraq and Afghanistan. The New York Times has argued that PEPFAR could be his “most lasting bipartisan accomplishment.”

Says Dr. Alex Coutinho, a top AIDS expert in Uganda, “When I’ve traveled in the U.S., I’m amazed at how little people know about what PEPFAR stands for. Just because it has been done under Bush, it is not something the country should not be proud of.”

In Uganda, where Coutinho works, 110,000 people are under treatment, and 2 million have HIV tests each year, a huge difference from the 10,000 treated and 400,000 tested annually before PEPFAR. According to Coutinho, “The money comes mostly from PEPFAR, and also from a United Nations fund to which the United States contributes.”

Indeed, Bush was honored on the 20th anniversary of World AIDS Day with the International Medal of Peace, given by the Saddleback Church’s Rev. Rick Warren on behalf of the Global Peace Coalition during the Saddleback Civil Forum on Global Health.

At the 2008 Bishop John T. Walker Memorial Dinner, Africare, the oldest and largest black-run African aid organization, awarded the group’s Distinguished Humanitarian Service Award to Bush for the work done for Africa by his administration and family, and described that work as “a labor of love.”

Barack Obama acknowledged Bush’s AIDS relief efforts in taped remarks to the Saddleback Civil Forum on Global Health. “I salute President Bush for his leadership in crafting a plan for AIDS relief in Africa and backing it up with funding dedicated to saving lives and preventing the spread of the disease,” said Obama, who went on to promise to continue working “to address the crisis around the world.”

Deddeh Zaizay, a Liberian woman, was abandoned by her husband because she was illiterate. Left alone to struggle to bring up the three children of the marriage, she soon picked up the pieces of her life. But before she could put the humiliation of her abandonment behind her, she had to do one thing — learn to read and write. She started learning to read under a program supported by the Africa Education Initiative, AEI, another of Bush’s “Africa programs.”

When AEI was launched in 2002, Bush committed to provide $600 million over eight years to increase access to quality basic education in 39 sub-Saharan countries through scholarships, textbooks and teacher training programs. Thanks to AEI, Deddeh has put her pain behind her. She now plans to go to college.

So far, the Africa Education Initiative has trained 700,000 teachers, distributed more than 10 million textbooks and provided hundreds of thousands of scholarships to help girls go to school. By 2010, AEI will have distributed over 15 million textbooks, trained nearly 1 million teachers and provided 550,000 scholarships for girls. The United States Agency for International Development (USAID) estimates that, overall, 80 million African children will have benefited from AEI by 2010.

African girls like Esther Gohole are beginning to dream. Says Esther, “My favorite subject is math. I want to be a pilot when I grow up.” Hawa Hussein says, “My favorite subject is biology. … I would like to be a medical doctor.” Phales Malisope wants to be a scientist.

Dr. Sarah Wright, chief education officer of USAID in Kenya, supports the dreams of these Kenyan girls. She says: “Education is a key element in long-term sustainable development. If children are educated, particularly the girl child, she is more likely to send her children to school, they are more likely to be healthy, they are more likely to be more productive citizens as a result of the influence of their educated mother.”

Rougiatou Diallo, a mother of two in the Guédiawaye district near Dakar, Senegal, is a beneficiary of the President’s Malaria Initiative (PMI), a $1.2 billion, five-year plan to reduce deaths caused by malaria by 50 percent in 15 African countries. The program was launched in June 2005 by President Bush. Diallo received an anti-malaria bed net when she took her children to participate in a combined micronutrient and bed net campaign in May 2007. She was so pleased with the free net that “came from the Americans” that her family bought a second net at a nearby health center to help protect her and her six children from malaria. In seven months of using the nets, she said, no one in her family came down with the mosquito-borne disease.

In addition to providing bed nets, the malaria initiative supports indoor spraying of insecticide as well as drugs and medicine to treat the disease. Manufacture of mosquito nets, treated with a special insecticide, can also provide employment for local people.

According to the United Nations, malaria is the main cause of death for children in Africa, killing a child every 30 seconds. The World Health Organization also argues that one in five childhood deaths in Africa is due to the effects of the disease. Pregnant women and small children are advised to sleep under mosquito barriers treated with insecticide, but many African mothers, such as Rakiatou Touré of Kabara, Mali, cannot afford a net, which cost $10. The PMI has stepped in. Touré got a net through PMI. “Without this program I would never have been able to afford a net. Now I sleep well, and my kids aren’t bothered by mosquito bites,” she says. It is estimated that the PMI has already reached 25 million people in sub-Saharan Africa alone.

President Jakaya Kikwete of Tanzania signed a five-year, nearly $700 million Millennium Challenge Compact with President Bush in February 2008. The compact is designed to help build Tanzania’s infrastructure. During the signing ceremony in Dar-es-Salam, he told Bush that the compact is a “source of pride … making it possible for the people of Tanzania to chart a brighter future.”

Bush launched the Millennium Challenge Account in 2004 as a new model to support governments that commit to rule justly, invest in people and encourage economic freedom. The Millennium Challenge Corp. seeks to reduce poverty by increasing economic growth in recipient countries through a variety of targeted investments.

Of MCC’s original 16 grant agreements, nine are with African countries — Benin, Cape Verde, Ghana, Lesotho, Mali, Mozambique, Madagascar, Morocco and Tanzania — and total approximately $3.8 billion. This represents 70 percent of the agency’s total grants to date. Malawi and Mauritania were added in February 2008. Liberia, Namibia and Burkina Faso are on the threshold of MCC compacts.

MCC’s compacts are beginning to change and shape lives across Africa. In Madagascar’s agricultural cooperatives, farmers are learning new techniques to make transitions to higher-value crops like geraniums, which are sold to produce high-value oil for use in soaps and perfumes. Such products are allowing farmers to access new markets and take advantage of the tariff-free provisions of the African Growth and Opportunity Act.

Malians are using MCC funds to improve irrigation systems in the Niger River Delta and modernize the Bamako Airport. This will boost agricultural productivity and expand access to markets and trade. Cape Verde is using MCC funds to improve roads and bridges.

A Madagascan named Jaona lost his job in the aftermath of the 2002 political and economic crisis that resulted from a disputed presidential election in Madagascar. The impact of the crisis was such that 80,000 workers in the export processing zone alone were laid off. Jaona’s wife succinctly recounts the hardship brought about by the crisis: “We used to cook three meals a day, but now we can only afford one, and poor quality cassava is replacing rice.”

The new government of Madagascar began a series of actions to put the country back on track, one of which was to attract international investment to the island. USAID began working with a group of Malagasy entrepreneurs to promote the nation’s products and improve trade ties to the United States. They formed the Madagascar-U.S. Business Council, which in turn led to the formation of an American counterpart, the U.S.-Madagascar Business Council. The U.S. trade mission was a catalyst for the signing of 12 commitments with the government of Madagascar to explore investment opportunities.

Madagascar’s trade ties to the U.S. are part of the benefits of the African Growth and Opportunity Act, a U.S. law designed to spur African trade development. Even though the act was approved in 2000, Bush worked with Congress to extend and reauthorize it in expanded form in 2004. It provides trade benefits with the United States for 40 African countries that have implemented reforms to encourage economic growth. Since 2001, U.S. exports to Africa have more than doubled to $14 billion a year, while African exports to the United States more than tripled to $67 billion.

The top five beneficiaries of the act are Nigeria, Angola, South Africa, Chad and Gabon. Other leading beneficiaries are Republic of Congo, Lesotho, Madagascar, Kenya, Cameroon, Swaziland and Mauritius.

Critics of Bush’s African largesse argue that it is not totally altruistic. They argue that Washington’s real interest is Africa’s natural resources. Africa produces 90 percent of the world’s cobalt (used in aircraft jet engines), 80 percent of coltan (used in computers and cell phones) and 20 percent of petroleum. The United States imports 18 percent of its crude oil from West Africa, against 17 percent from the Persian Gulf, and expects to export 25 percent from West Africa by 2015.

Other critics point to China’s growing influence in Africa, which they say America is becoming increasingly uncomfortable with. Chinese-owned companies have built factories, roads and other infrastructure across the continent. Still, others point to AFRICOM, the U.S. military’s African regional command, with one critic describing it as “the militarization of U.S. aid to Africa.”

Critics of PEPFAR are also not happy with the requirement that one-third of the prevention funds be spent to teach sexual abstinence even though there is little if any scientific evidence that such programs reduce the spread of HIV. Paul Zeitz, executive director of the Washington-based advocacy group Global AIDS Alliance, says the Bush program has been inhibited by “ideologically driven policies.”

However, ordinary Africans whose lives have been touched by Bush’s programs respond to critics of his efforts in Africa with a simple proverb: Before a man refuses to eat at the table of his enemy, he has to be sure his friends have food to offer him; otherwise he will end up with nothing.

HIV-positive Linda, the recipient of anti-retroviral drugs, is free in praising the former president and his country. “George Bush has helped us live,” she says. Kunene Tantoh, the South African mother, took her son Baron to the Rose Garden at the White House in 2007 to show President Bush and his wife, Laura, “an HIV-free baby.” Says Edward Phillips, a Catholic priest who oversees the distribution of anti-retroviral drugs in Nairobi, Kenya: “This is the best thing that ever happened to the poor people I work with. It’s one of the few times I’ve seen U.S. government money really reach down to the poorest of the poor. It’s kept a hell of a lot of people alive.”

Senegalese mother Rougiatou Diallo is grateful for the mosquito net that came from “the Americans.” It helps her to keep her children malaria-free. Rakiatou Touré of Mali could not afford the lifesaving $10 insecticide-treated mosquito nets until she got a new net through the President’s Malaria Initiative. She says that “without this program I would never have been able to afford a net. Now I sleep well, and my kids aren’t bothered by mosquito bites.”

Because of the books he got from the Textbooks and Learning Materials Program (a component of the Africa Education Initiative), Sadio Gueye, a primary school student in Senegal, is happy “to have my own books at home” because he believes having his own textbooks will help his studies. “What I don’t learn at school, I can learn at home,” he says.

Tanzanian President Kikwete told President Bush in February 2008 at the signing of Tanzania’s MCC Compact, “all that I can say, President, is words of appreciation and thanksgiving. You have done a tremendous job.”

The Millennium Challenge Corp.’s $698 million aid package will help Tanzania build better roads and increase access to safe drinking water.

Kikwete said recently: “Of course, people talk with excitement of Barack Obama. For us, the most important thing is, let him be as good a friend of Africa as President George Bush has been.”

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