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AIDS fight is worth it

The Baltimore Sun

In remote villages throughout Africa, most people appear far removed from the financial crisis rolling through much of the world. The economy these villagers encounter is unconcerned with complex financial instruments and liquidity on Wall Street.

But millions of these men, women and children will suffer the consequences of this crisis unless the new administration and Congress refuse to let the poorest of the poor suffer due to the mistakes of the richest of the rich.

Many expect an Obama administration to be very friendly toward Africa; it is not every day that the United States gets a president with a Kenyan father and a Swahili name.

But the fact is, Mr. Obama will have a hard act to follow in terms of U.S.-Africa relations, thanks in large part to PEPFAR - the President's Emergency Plan for AIDS Relief. On this World AIDS Day, the last under President Bush, we should acknowledge what PEPFAR has accomplished and recommit our nation to continuing its mission of alleviating the misery caused by this pandemic.

PEPFAR began in 2003 as an ambitious, $15 billion program designated to fight AIDS in Africa, Asia and the Caribbean. The main focus has been on Africa because that is where the problem is the biggest, with 22 million of the 33 million people living with this disease.

PEPFAR's success is indisputable. Before it began, only 50,000 people were being treated for HIV and AIDS in sub-Saharan Africa. Now, thanks to PEPFAR and other programs, 1.68 million are.

The biggest impact comes from PEPFAR's making antiretroviral drugs available to the mainly poor, HIV-positive population of Africa. Before, these drugs were too expensive or just plain unavailable. Now they are commonplace.

In 2007, the number of AIDS-related deaths actually went down. And infection rates in more countries are declining as education and other outreach efforts begin to take hold.

Last year, a broad coalition of health and aid groups working with senators and representatives from both parties hammered out a five-year extension of PEPFAR. The new bill sought to fine tune the original legislation - recognizing, for instance, that malaria and tuberculosis also need to be treated as they interact with AIDS in devastating poor populations.

The PEPFAR renewal sought to strengthen local health infrastructures and went further than the original bill in supporting the many children orphaned or left vulnerable as so many parents and providers continue to succumb.

It is a good bill. It had broad support in Congress and in the aid community. But it is also expensive: $48 billion over five years. At a time when automobile companies and financial institutions and a growing number of unemployed American workers are coming hat-in-hand to Washington, it might be tempting to look at that number and decide not to fully fund the authorized amount for PEPFAR.

That would be a huge mistake. For starters, any backsliding in the fight against HIV and AIDS is going to be costly. It is much more expensive to play catch-up than to keep the momentum going. Part of this is medical: If someone goes off of antiretroviral treatment, the virus adapts. Starting treatment again requires a more expensive drug regimen. Part of it is logistical: If the current structure built to fight HIV and AIDS is not strengthened and extended but instead allowed to crumble, rebuilding it will cost much more.

Part of the reason is that it makes good foreign-policy sense. The HIV epidemic is one of the main stumbling blocks that developing countries face as they seek economic improvement. Untreated, the disease's spread kills the productive adults in a society, leading to lethargy, fatalism and despair, enemies of the modernization these countries need. Such despair is a breeding ground for the kind of chaos that leads to international insecurity. Funding PEPFAR lets the people of these countries know that the United States is on their side.

But the main reason for fully funding PEPFAR is that it is the right thing to do. This horrible pandemic is affecting the poorest people in the world, those least able to address the ravaging effects of this disease. If we do not help them, we will cede the moral authority that the United States needs to lead the world in the 21st century.

Ken Hackett is president of Baltimore-based Catholic Relief Services. His e-mail is

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