PEPFAR was a new chapter in Africa’s unfolding story of freedom, dignity, and hope. In every country I visited, I promised that America would meet our commitments. In South Africa, where nearly five million lived with HIV, I urged a reluctant President Thabo Mbeki to confront the disease openly and directly. In Botswana, a relatively wealthy country where 38 percent of the adult population was infected, President Festus Mogae pledged to use PEPFAR funds to continue the impressive effort he had begun to fight the disease. At the national hospital in Abuja, Nigeria, I visited with women who had benefited from the mother and child initiative. They beamed with joy as they showed me their healthy children. But for every infant born infection-free, many more began life facing the burden of HIV.
The most memorable part of the trip was our visit to the TASO clinic in Uganda, where I met Mohamad Kalyesubula. Escorted by President Yoweri Museveni and his wife Janet, Laura and I went around the room and hugged the patients. Many opened up to us. They shared their hopes and fears. One nurse named Agnes told me her husband had died of AIDS in 1992. When she got tested, she found out that she, too, had HIV. She was one of the lucky few who had been able to get antiretroviral drugs. She urged me to send more medicine, as soon as possible. When the drugs supported by PEPFAR reached Uganda, Agnes helped nurse many of TASO’s patients back to health. One was Mohamad. When he came to the White House in 2008, Agnes came too.
The director of TASO, a doctor named Alex Coutinho, later said I was the first world leader he had seen hug an African with AIDS. I was surprised. I remembered that Mother had made international news when she hugged an HIV-infected baby in 1989. Her act dispelled the myth that the disease could be transmitted by incidental human contact. I was proud to carry on her legacy by reducing the stigma associated with AIDS. I hoped in some small way to restore the dignity of suffering people. Above all, I wanted to show that the American people cared.
At the TASO AIDS clinic in Uganda. White House/Susan Sterner
One highlight of our Africa trip was that our daughter Barbara joined us. In Botswana, she, Laura, and I went on safari in the Mokolodi Nature Reserve. We were hoping to relax, get some fresh air, and see some wild animals. To feed the appetite of the traveling press, the White House staff decided we should have a photo op.
As always, the preparations were meticulous. A press truck full of cameras and reporters was prestationed in a clearing. As our vehicle rounded the corner, the press was lined up for a perfect shot of us observing several elephants. Apparently, the elephants were not given the script. Shortly after we arrived, a randy male elephant mounted one of his female counterparts on live international TV. Our advance team turned pale under the hot African sun. Laura, Barbara, and I burst out laughing.
The trip was Barbara’s first to Africa, and it touched her deeply. After graduating from college and volunteering on my 2004 campaign, she went to work for a pediatric AIDS clinic at the Red Cross War Memorial Hospital in Cape Town, South Africa. Inspired by her experience, she later founded a nonprofit, Global Health Corps. Based on a model similar to Teach for America, her organization sends recent college graduates to clinics in three African countries and two American inner cities. They support care for patients with AIDS and other diseases, strengthening the health infrastructure and helping people live with dignity and hope.
Jenna also discovered a passion for working with AIDS patients. She volunteered for UNICEF in several Latin American countries. When she got home, she wrote a wonderful book, a bestseller called Ana’s Story, about a girl who was born with HIV.
Laura and I are very proud of our daughters. They have become professional women serving a cause greater than themselves. They are part of a larger movement of Americans who devote their time and money to helping the less fortunate. These good souls are part of what I call the armies of compassion. Many come from faith-based organizations and seek no compensation. They receive payment in another form.
One of the most important early decisions on PEPFAR was who should run it. I wanted a proven manager who knew how to structure an organization that would focus on results. I found the right man in an experienced Indiana businessman, former Eli Lilly CEO Randall Tobias.
Randy’s first reports were discouraging. A year after I signed PEPFAR, fewer than one hundred thousand patients were receiving antiretroviral drugs. “That’s it?” I snapped. “We’re a long way from two million.”
Randy assured me PEPFAR was on track. The most important tasks during the first year were to get partner countries to devise their strategies, mobilize manpower, and start establishing infrastructure. Once we had this foundation in place, the number of people receiving drugs would ramp up dramatically.
By the fall of 2005, our African partners were fully engaged. Faith-based and other groups supported by PEPFAR, both African and American, helped staff clinics and spread prevention messages to millions across the continent. Orphans and the dying were receiving compassionate care. Some four hundred thousand people were taking antiretroviral drugs. We were on pace to reach our goal.
Unfortunately, AIDS wasn’t the only disease ravaging Africa. By 2005, malaria was killing approximately one million Africans a year, the majority of them children under the age of five. Transmitted by a mosquito bite, malaria accounted for 9 percent of all deaths in Africa, even more than AIDS. Economists estimated that the disease cost Africa $12 billion a year in medical expenses and lost productivity, a crippling blow to already fragile economies.
Every one of those deaths was unnecessary. Malaria is treatable and preventable. The United States had eradicated malaria in the 1950s, and there was a well-established strategy for battling the disease. It called for a combination of insecticide sprays, bed nets, and medicine for infected patients. The remedies were not particularly expensive. Bed nets cost $10 each, including delivery.
In June 2005, I announced a five-year, $1.2 billion program that would fund malaria-eradication efforts in fifteen countries. Like PEPFAR, the President’s Malaria Initiative would empower Africans to design strategies to meet their needs. We would work toward a measurable goaclass="underline" cutting malaria mortality rates by 50 percent over the next five years.
I named Rear Admiral Tim Ziemer, a retired Navy pilot with experience in international relief efforts, to lead the Malaria Initiative. In its first two years, the initiative reached eleven million Africans. It also generated a passionate response from the American people. Boys and Girls Clubs, scout troops, and school classes donated money in ten-dollar increments to buy bed nets for African children. Faith-based organizations and major corporations, especially those doing business in Africa, gave generously to the cause.