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A surprise: Bush is respected in Africa for launching huge campaign against AIDS

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George Bush

George Bush

George W. Bush will go down in history as one of the worst American presidents ever, the “decider” who was responsible for the disastrous invasion of Iraq. It may therefore come as a surprise that Bush is widely popular across wide swaths of eastern and southern Africa, where he is justifiably credited with launching the successful campaign to provide AIDS medications that has already helped to save millions of lives.

Antiretroviral drugs started to come into wide use in Western countries in 1996-97, and people with AIDS who had been about to die made miraculous recoveries and went back to work. But the Clinton administration did nothing to spread the life-saving drugs to the millions suffering in Africa. The United States even defended the big pharmaceutical companies, who were changing $10,000 per person a year for the medications.

Enter George Bush. In 2003, he unexpectedly tripled American funding for AIDS in Africa, and then five years later more than tripled it again. Only 50,000 African got the medications back in 2003; the figure today is 7 million, two-thirds paid for by the United States. I have just been to Swaziland, the worst hit country on the continent, where I learned first-hand just how successful the campaign has been, and how much Bush is respected for starting it (as I report in The Nation, “The Campaign Against AIDS in Africa Is Saving Lives—So Why Isn’t the US Investing More In It?”).

In Bush’s memoirs, he dismisses the theory that he proposed the big anti-AIDS effort as compensation for the violent invasion he was about to launch against Iraq. Let us take him at his word. Whatever his motivation, his history-changing act may just be another example of Dr. Martin Luther King Jr.’s conviction that even people who have dark sides are also capable of great humanity.

James North
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21 Responses

  1. LeaNder
    LeaNder on May 2, 2014, 12:51 pm

    James, without following your links. On the run, as Phil says. Basically true even our most cherished “enemies” may be human after all. But for whatever reason, I seem to remember, and no doubt I may keep the wrong synaptic connections in mind in this context. How could one ever have the knowledge ultimately needed? Wasn’t there a connection with big pharma at least in the Bush family. Am I a victim of rumors?

    This basic semi-prejudice out in the open, did he also support research into the huge riddle, I seem to remember from looking into the topic posed to research confronted with some “carriers”, of the VIP victims of the virus developing astonishing resistance against it? What exactly would that teach us?

    Closely following “big pharma”, comes another riddle. I think links I followed in a Krauss comment context. On the average the “third world” is steadily increasing average income, with the exception of Africa, apparently. Now I will spare you my non-expert associations in that context. Among others: Darwin’s nightmare. But no doubt it raises questions.

    • JeffB
      JeffB on May 2, 2014, 2:17 pm


      The Bushes are rather well connected. There is some vague connection to big everything in the USA economy. But no there was nothing particular about big pharma. Bush in 2002 decided that a core piece of his foreign policy would be a focus on fighting disease: malaria, TB and AIDS. There wasn’t much ulterior motive. Rather this was a foreign policy human rights issue which rightwingers were willing to support so people like Kerry and Biden were able to work with Helms, Bush… and pass this easily.

      AIDS was something that the evangelical community cared a great deal about. First off in the 1980s they had been ambiguous about the disease seeing it as divine punishment for immoral activities and this was a stain that many in the next generation wanted to fix. Further, evangelical Christianity is doing very well in both Latin American and Africa. There was genuine cooperation among the like minded. Also the UN unusually enough decided that side with evangelicals vs. seculars in treating AIDS as a moral issue with preventative counseling (morals based education). This was structurally very similar to the Christian temperance movements of a century earlier in the USA.

      And of course the entire countering disease approach helped fight Al Qaeda propaganda about the role of the USA.

      • lysias
        lysias on May 2, 2014, 2:49 pm

        2003 was also the year Bush had Congress institute Medicare Part D, which gave the pharmaceutical companies much more in the way of profits than they lost through Bush’s African AIDS program. Not a bad trade for Big Pharma.

      • LeaNder
        LeaNder on May 3, 2014, 8:08 am

        JeffB, lysias,

        now that I have read James article, I feel completely embarrassed about my comment. But there you go, I was in a very peculiar mood yesterday, thus I should again have left my fingers off the keyboard. ;)

        It is really long ago, but it was absolutely horrible to watch an old friend slowly die. That was in 1987. I should have been aware that much has happened meanwhile.

        Sorry to James, ultimately his story shows what can be done if people get active. And why Obama cut aid in this context is indeed a bit mystifying. Great article anyway. And I bow to your knowledge of Africa.

        Maybe there is a grain of truth in the “compassionate conservatives” tag? ;)

  2. smithgp
    smithgp on May 2, 2014, 2:27 pm

    Misplaced credit! We should be celebrating South Africa’s Treatment Action Campaign (TAC) much more than PEPFAR for progress in antiretroviral (ARV) accessibility. Whereas Bush vigorously defended and enforced drug companies’ patent rights (while at the same time funding very modest levels of drug availability), TAC has been at the forefront of the generic ARV movement that has had far more impact on ARV accessibility. PEPFAR’s disproportionate emphasis on abstinence and fidelity in its anti-AIDS programs was an ideologically-motivated impediment to progress ( (It was TAC, too, that was primarily responsible for defeating denialism in South Africa.)

    • James North
      James North on May 2, 2014, 2:58 pm

      George Smith: Thanks for your thoughtful comment. I’m second to none in my respect for the South African TAC, and I had the good fortune to meet Judge Edwin Cameron during my recent stop in Johannesburg. You are of course right that TAC and other groups were indispensable in the campaign for generic ARVs that reduced the astronomical prices that big pharma had been charging for the life-saving drugs.
      The truth is that Pepfar shifted to generics almost right from the start, and quietly downplayed the abstinence/fidelity elements of the program, which had been inserted by some Republicans in Congress.
      The fact remains that without enough money even generics would not be reaching 7 million Africans today. Bush tripled the existing U.S. funding in 2003, and then more than tripled it again 5 years later.
      Proof of the importance of George W. Bush is that the AIDS activists at the heart of the campaign all give him tremendous credit. In my Nation piece, I talk to Eric Sawyer, a founder-member of ACT UP in New York who is as responsible as anyone for the successful effort in Africa. Sawyer remembers that he was “dumbfounded” by Bush’s 2003 speech, “shocked and really, really grateful.”

      • just
        just on May 2, 2014, 3:57 pm

        Thanks James North and George Smith.

        It was the ONLY thing that I ever appreciated from GW.

        (though the odious & unrealistic insertion of fidelity/abstinence junk was repulsive to me in oh so many ways! It stank to high heaven of holier- than- thou hypocrisy that the pols are ever so good at here in the US. A bit of the same old ignorance and racism on display.)

      • smithgp
        smithgp on May 2, 2014, 10:57 pm

        OK, James North, I bow to your greater familiarity with PEPFAR, and have to admit that I was exaggerating my criticism of the program for my own ideologically driven reasons. And it’s news to me that President Bush was willing to downplay the abstinence/fidelity requirement.
        It must have been a great honor to meet Judge Cameron in person.

  3. Krauss
    Krauss on May 2, 2014, 2:35 pm

    James North does a few necessary cast-away lines to cover up the inevitable fact: a slobbering sop to George Bush, a man responsible for millions either dead or displaced.

    FYI: Describing Dubya as doing an “act of great humanity” is nauseating. In large part because he didn’t do anything courageous. The early 2000s was the period when there was a lot of international pressure on this issue from people like Gates, Bono, Geldof and so on. Even Blair. Whoever had been president would have done what had to be done.

    But I guess North doesn’t really get that, instead he is slobbering to Dubya.
    Which kind of sums up James North.

    • James North
      James North on May 2, 2014, 3:15 pm

      Krauss: Once again, you hide your ignorance behind ad hominem attacks. Reading a couple of Wikipedia articles is no substitute for real knowledge.
      I know the AIDS activists who have spent 2 decades fighting to bring the life-giving medications to Africa and elsewhere in the Global South. They would not agree with your uninformed view that “whoever had been president” would have taken action; after all, they had just watched as the Clinton-Gore administration did next-to-nothing. By contrast, these veteran campaigners would agree that George W. Bush changed history when he launched Pepfar in 2003.

      • Donald
        Donald on May 2, 2014, 8:04 pm

        I’ve always given Bush credit for this and certainly don’t think you were “slobbering to Dubya”, but at the same time I’ve always also assumed that the pressure exerted by AIDS activists (and even some evangelicals, though their support was a mixed blessing) would have eventually swayed a Gore Presidency as well. I don’t know why the Clinton-Gore Administration ignored the issue during the 90′, though it’s no great surprise. But I assume that the same activism that persuaded Bush would have persuaded Gore–political climates on various issues change and can change suddenly, as has happened with gay marriage. Unless this was a Nixon goes to China sort of thing–maybe only a conservative evangelical President could spend billions fighting AIDS in Africa.

      • James North
        James North on May 3, 2014, 10:50 am

        Donald: It is certainly possible that a President Gore would have acted decisively on AIDS in Africa, although it is unlikely he could have done more than Bush did in 2003.
        What is unquestionably true is that the activist community had plenty of reasons to doubt Gore on AIDS. The Clinton-Gore administration spent the late ’90s boasting about balancing the budget and putting any surpluses in a “lockbox.” Gore himself went out of his way to defend Big Pharma’s pricing policy — which is partly why the AIDS activists targeted him during the 2000 presidential race.
        Since Clinton left office, he has regularly apologized for his inaction on AIDS in Africa during his time as president.

    • Hostage
      Hostage on May 2, 2014, 6:40 pm

      But I guess North doesn’t really get that, instead he is slobbering to Dubya.
      Which kind of sums up James North.

      No, as usual it just shows that you’re too narrow-minded and vindictive to analyze things and give credit where it’s due. History is full of ironies like this and North was just highlighting one of them, not “slobbering to Dubya”.

  4. brenda
    brenda on May 2, 2014, 3:15 pm

    Every once in awhile I run across a reference like this, something outside of the prevailing ideology on the Bush presidency. It was stunning the first couple of times this happened to me. Not that I’ve changed my mind on anything important, just a realization that we did demonize Bush — the same way the right demonizes Obama. The Martin Luther King quote is very apt.

  5. eljay
    eljay on May 2, 2014, 3:51 pm

    Whatever [Bush’s] motivation, his history-changing act may just be another example of Dr. Martin Luther King Jr.’s conviction that even people who have dark sides are also capable of great humanity.

    Bush should be praised for his great humanity, and held to account for his dark side.

  6. DICKERSON3870
    DICKERSON3870 on May 2, 2014, 8:03 pm

    SEE: “How Bush’s AIDS Program is Failing Africans”, by Michelle Goldberg,, July 10, 2007
    The president’s much-lauded AIDS initiative has succeeded in saving lives through treatment. But its abstinence- focused prevention programs have put many more lives in jeopardy.
    LINK –

    • Citizen
      Citizen on May 3, 2014, 8:19 am

      Excerpts from January 2012 Report Sponsored by the Council for Global Equality: Why PEPFAR Has Failed to Meet its PoetentiaL:

      The efficacy of the ABC approach lies to a certain extent in how it is defined. The UNAIDS definition, for example, neither emphasizes abstinence until marriage nor limits the pro- motion of condoms to those engaging in “high-risk” behaviors. It defines ABC as:
      Abstinence or delayed first sex
      Being safer by being faithful to one partner or by reducing the number of
      sexual partners
      Correct and consistent use of condoms for sexually active young people, couples in which one partner is HIV positive, sex workers and their clients, and anyone engaging in sexual activity with partners who may have been at risk of HIV exposure28

      Yet PEPFAR adopted an ABC strategy of “population-specific interventions” that emphasized:
      Abstinence for youth, including the delay of sexual debut and abstinence until marriage Being tested for HIV and being faithful in marriage and monogamous relationships Correct and consistent use of condoms for those who practice high-risk behaviors29

      PEPFAR required 55 percent of funds to go to HIV/AIDS treatment, 20 percent to prevention initiatives,
      15 percent to palliative care, and 10 percent to support for orphans and vulnerable chil- dren. In addition, one-third of the prevention slice of the funding pie was earmarked for abstinence-until-marriage programs, leaving all other prevention programs—including condom promotion, safe medical injections, sexual transmission prevention, and non- sexual transmission prevention—to divide up the rest of the money.

      And then the Bush administration announced a new directive in 2005 specifying that
      “66 percent of resources dedicated to prevention of HIV from sexual transmission must be
      used for activities that encourage abstinence and fidelity,” while the remaining one-third could be spent on “condoms and related activities”—thereby putting still tighter limits on spending for condoms.35

      In the real world, abstinence and fidelity do not ensure that an individual will not become infected, and marriage in and of itself provides no protection from infection. For example, many people are unsure of their partner’s HIV status, and those who are faithful cannot be certain that their partner is practicing the same level of commitment. In addition, women are often unable to negotiate sex free from violence or coercion, or to exercise control over prevention methods.38 “A focus on abstinence is unrealistic when the vast majority of new HIV cases internationally—estimated at 80 percent—are among married women or women in monogamous relationships,” writes Hayley Hathaway, grassroots coordinator for the Student Global AIDS Campaign.”39 In fact, one could argue that the largest HIV risk factor for young women in Africa is marriage.

      2010 Recommendation:
      Eliminate funding quotas and rules around abstinence and be faithful programs.
      The reauthorization of PEPFAR eliminated the legislative requirement that one-third of all prevention funds be directed to abstinence-until-marriage programming, but the new language includes a reporting requirement that calls on the U.S. global AIDS coordinator to offer an explanation to Congress if 50 percent of funds in countries with generalized epidemics are not directed to A (abstinence) or B (be faithful) programs. This change provides some additional opportunities for program implementers to conduct prevention programs as they see fit, but it has resulted and will continue to result in confusion and misinterpretation. People and organizations managing programs should be empowered to design and implement initiatives based on scientific evidence, cultural relevance, and local decision making and not be hindered by a congressional rule written in authoriza- tion language. This report recommends that Congress work to eliminate this rule in the appropriations process and/or subsequent reauthorizations.

  7. Qualtrough
    Qualtrough on May 3, 2014, 1:30 am

    Forgive me for going Godwin on this thread, but warts aside, Hitler made a lot of positive contributions to Germany, including presiding over an economic recovery, the autobahn, birth of the Volkswagen, etc. He was a vegetarian and loved animals, and women thought he was a great gentleman with a good sense of humor. For good reason most people do not dwell on those accomplishments because the many horrific things Hitler did far outweigh any good he did. The same should be true for GW. The evil he did in Iraq alone is good reason to demonize him. Let the Africans thank him, but I don’t really care that he was the one to do that. In any case I don’t see how it is relevant to the I/P discussions that I thought were the focus of this site.


    Hitler was a better artist.

  8. Citizen
    Citizen on May 3, 2014, 8:29 am

    2014 Status of PEPFAR under Obama, and including Hillary Clinton plan link:

    ps: PEPFAR is scheduled for congressional reauthorization in 2015.

  9. Citizen
    Citizen on May 3, 2014, 8:56 am

    Surprised Africans respect Bush Jr? Maybe you will be equally surprised African nations lead the way in being disappointed by Obama:

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