Twenty years ago, Republicans, Democrats, evangelicals, gay activists, and African leaders joined forces to combat AIDS. Will their legacy survive today’s partisanship?
In Malawi, medical records look a bit like passports: little blue books emblazoned with scribbles and ink stamps. When Agnes Moses was starting out as a doctor at a Christian hospital there more than 20 years ago, one stamp would bring her spirits low.
In those days, no treatment was available for patients diagnosed with HIV. So doctors would write an order in patients’ books for spiritual counseling. After a visit, the counselor would stamp the page by the doctor’s notes.
“To me that was a death sentence, every time I saw the stamp,” Moses said. At the time, about a third of the patients in her ward had HIV. She lost medical colleagues and members of her church to the virus, too. In southern Africa especially, hospitals were overwhelmed with dying patients.
A United Nations report in 2000 was grim, predicting that as many as half of teenagers in southern Africa would die early due to AIDS. In 1998, 30 percent of pregnant women in Blantyre, Malawi, were testing positive for HIV. Life expectancy in Malawi that year was 43 years. In sub-Saharan Africa, the epidemic was hitting women much harder than men.
In Botswana and South Africa, life expectancy dove by about a decade as HIV took over in the 1990s. “We are threatened with extinction,” Botswana president Festus Mogae said in 2002, when 39 percent of adults in his country were infected with HIV.
There was a way to make HIV a survivable condition: Effective antiretroviral therapy (ART) had been developed in 1996, but few had access to it.
In 2003, president George W. Bush convinced Congress to pass the President’s Emergency Plan for AIDS Relief, or PEPFAR. It was an unprecedented global health program, appropriating about $5 billion a …
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