Next week, First Lady Laura Bush travels to Africa, where she will assess the progress of President George W. Bush's Emergency Plan for AIDS Relief, also known as PEPFAR.
The plan was created in 2003, when the president pledged $15 billion over five years for AIDS relief; most of the money was earmarked for Africa. Now, President Bush is asking Congress for $30 billion more through 2013.
This is by far the largest amount any country has spent fighting a disease outside its borders. In an interview at the White House's China Room, Laura Bush speaks with Michele Norris about the huge problems facing Africa, and the challenge of fighting AIDS in a place where infections are outpacing treatment.
Every year, 3 million Africans contract HIV. Still, Mrs. Bush remains optimistic.
FIRST LADY LAURA BUSH: I think we do actually see really good numbers. We know what it takes in the United States. We've worked on this issue ourselves for years. We know it's a combination of education, prevention, treatment — which is very important — and in a country like many of the countries that are targeted in Africa, where there is not great infrastructure, it's difficult to get treatment out into the bush to all the people that need it.
But on the other hand, I think we're obligated to do as much as we can do to reach as many people as we can, and to use every one of the strategies that we know work: education, reaching treatment, the prophylactics, antiretroviral prophylactics for pregnant mothers. I've seen some terrific programs in Africa that counsel mothers, and so that's part of the goal of it.
MICHELE NORRIS: Critics say restrictions on how U.S. money can be spent are hindering efforts. Under what's known as the "ABC plan" — abstinence, be faithful and use condoms — condoms are distributed to high-risk groups, such as prostitutes and truckers, but not to young people in school. They get abstinence education, and Congress requires that one-third of the money spent on prevention goes toward teaching abstinence and fidelity — two things Laura Bush supports.
BUSH: In countries where there are gender issues and where girls feel like they have to comply with the wishes of men, I think abstinence [and abstinence education] become even more important. We need to get the message to girls everywhere, not just in Africa, that they have a choice, that they can be abstinent and make choices for themselves that keep themselves safe.
So I think in these countries, for one thing, we also know that abstinence is the 100-percent safe way to know you won't acquire HIV, and when you're in a country where your chances — where 30 percent of the population are HIV-positive, or more, as in some of these countries — then abstinence becomes even more important.
NORRIS: Now, the Institute of Medicine has recommended that Congress lift this earmark. They're suggesting that Congress remove these legislative requirements that one-third of the money go toward abstinence programs. They say that much more flexibility is needed on the ground and that people on the ground know best how the money should be spent in preventive efforts.
BUSH: I think that's certainly up to Congress and in the reauthorization that will come, hopefully, with the extra money. I do think that each one of these parts of the ABC program is important, and I will say, ABC was developed by Africans. Many African governments support the ABC program, and the United States government stands with them.
And you're right: It is the people on the ground who know the best. That's what PEPFAR does, and the U.S. Agency for International Development (USAID). We work with African groups that are on the ground, that are already successful, that already have a reach to a lot of people and know what each one of these different communities want and need, what addresses their needs in the best way, and so that sort of flexibility that's part of PEPFAR, is what does make it successful.
NORRIS: You could, though, make a strong argument that they have some flexibility under PEPFAR but that they need much more.
BUSH: I think that there is a lot of flexibility under PEPFAR, actually, and the percentage of money that goes to abstinence programs is quite small compared to the large amounts of money that go to the antiretroviral, the treatment, for instance. But each one of the parts of ABC are important, and the United States government, through our programs, both PEPFAR and USAID programs, have a huge portfolio of strategies that we are using to try to reach as many people as possible.
This transcript was edited for clarity.
Copyright 2022 NPR. To see more, visit https://www.npr.org. 9(MDAzMjM2NDYzMDEyMzc1Njk5NjAxNzY3OQ001))
