Skip to main content

U.S. budget ax threatens successful AIDS program in Africa

By Eric Marrapodi, Jim Acosta and Tom Foreman, CNN
Click to play
Battle over funding an AIDS drug program
  • Key program to fight AIDS in Africa is under fire
  • Plan was centerpiece of George W. Bush's Africa policy
  • Rep. Ron Paul thinks it and other foreign aid should be cut

Editor's note: This story is from the CNN special "Stories: Reporter" which aired Saturday night at 7:30 EDT.

Washington (CNN) -- The Biblical story of Lazarus is happening again in Africa. At least it looks that way.

One moment, men, women and children suffering from AIDS are lying at death's door, barely able to move, open their eyes, or speak. Then a few days or weeks later, they are walking, talking, laughing; truly appearing to have come back from the dead.

This astonishing transformation has been repeated all over the continent thousands of times over the past decade. And, since 2003, America has been helping to pay for it.

But a budget-slashing effort in Congress this year threatens to bring much of that progress to a sudden and catastrophic halt.

"There are good foreign policy reasons to do this."
--Michael Gerson, former Bush speech writer

Michael Gerson, a conservative columnist with the Washington Post and a force behind the foreign aid program that is the focus of an HBO special called The Lazarus Effect, is fighting hard to hold on to the funding that started with his boss, nearly a decade ago.

"There are good foreign policy reasons to do this," said Gerson, a senior fellow with the Council on Foreign Relations.

Gerson was also the chief speech writer for the man who got this rolling.

"He often talked about 'To whom much is given, much is required,' " said Gerson, of the sponsor of the plan. "There was a motivation here of what America should do and be; that we should be a source of hope but also a kind of conscience motivation here, very much rooted in his faith."

The "he" in question, was President George W. Bush.

In 2003, Bush started the President's Emergency Plan for AIDS Relief, or PEPFAR -- an unprecedented, $3-billion a year program to help the world fight AIDS and has resulted in an 80-fold increase in the number of Africans receiving life-saving AIDS treatments since the program began.

In 2008, Bush led the charge for renewal and expansion. "We can bring healing and hope to many more. So I ask you to maintain the principles that have changed behavior and made this program a success," Bush told Congress in his State of the Union address that year. "And I call on you to double our initial commitment to fighting HIV/AIDS by approving an additional $30 billion over the next five years."

He was not alone. A driving force in the effort was evangelical Christians who pushed the Bush administration and Congress to support it.

Justin Fung, works at the District Church in Washington. Like many of the early backers of the effort, he sees it as a natural expression of faith. "One of the biggest themes in the Bible, throughout scripture, is 'God cares for the poor.' This is something that is really important, and it shouldn't be an issue that divides us, you know," he said.

But division -- and subtraction -- are precisely what supporters of PEPFAR now fear. The program has steadily grown into a hefty $50-billion project and as Congress wrestles with the debt limit and trillion dollar budget worries, foreign aid is under sharp fire.

GPS: 4 ways to save $2 billion while improving U.S. foreign aid

Rep. Ron Paul, R-Texas, has been an outspoken critic of the PEPFAR from the start.

"I concede it's very well intended...(but) we ought not be naive enough to believe we can change habits that occur in Africa."
--Rep. Ron Paul, R-Texas

"I concede it's very well intended," he said on the House floor when debate first came up in 2003. "I'm a physician. I can't think of anything better than to wipe out AIDS in Africa, or in the United States for that matter."

But he adds that PEPFAR is fighting against the current economic and social realities. "I think if we're going to be doing any social engineering or social suggestions it ought to be here, and we ought not be naive enough to believe we can change habits that occur in Africa."

Paul is now running for president and declined CNN's request for comment, but his office said he stood by his statements from 2003 and continues to be critical of the plan.

It was not just Rep. Paul who declined to speak about why they wanted to cut PEPFAR. So did a half-dozen other Republican members of Congress who have voted against continuing full funding for this part of the Bush legacy, even though foreign aid makes up only about 1% of the federal budget.

And it's not just lawmakers who are concerned. A CNN/Opinion Research Corporation poll earlier this year found that most voters want foreign aid reduced or even eliminated.

Gerson said he understands the reasoning. "There's a perception out there that foreign assistance is wasteful; that it's thrown down a rat hole of corruption. A lot of people believe that, especially on the right."

He readily agrees that federal budget cuts are needed. "The argument isn't that there shouldn't be any cuts in government. The question is whether or not we're going to have indiscriminate cuts. Are we going to cut programs that are working; programs that when you make those cuts it has a tremendous human cost?"

Honda: A budget plan that puts people first

That's why the HBO film was commissioned by the ONE campaign, an advocacy group working on AIDS in Africa and debt forgiveness, and produced by (RED), a for-profit initiative that has generated more than $170 million for AIDS programs worldwide. They are trying to save PEPFAR from the budget ax.

The film points out that when PEPFAR began only 50,000 people in Sub-Saharan Africa were on AIDS drugs; today, it's 4 million. The cost has been driven down to 40 cents per person, per day. And in a region with more than a million AIDS deaths annually, and 16 million AIDS orphans, keeping parents alive can keep families, communities, whole countries afloat, according to the film.

Gerson concedes many Americans just don't know about the good PEPFAR has done, but he said, "I will tell you, people in Africa know that Americans were responsible; know what was done to save these societies; and they are deeply grateful."

Church leaders all over the United States are urging their members to watch the movie and call Congress.

Still, it is not yet clear amid all the crushing economic problems at home, which way the country's political leadership will go. President Obama himself has praised President Bush for all that PEPFAR has accomplished, but has been slow to expand key provisions of health support in Africa.

Gerson said PEPFAR's supporters in both parties will have to get louder to save the program, or a lot of African families will be without alternatives.

"I think it's going to be a struggle," he said.