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Feb 3, 2003

AIDS and Africa

Calvin College professor Amy Patterson watched President George W. Bush's recent State of the Union address with more than a passing interest.

As a political scientist she is, of course, a keen observer of all things political. But Patterson's primary research interest is AIDS and Africa, a topic that was a significant part of President Bush's speech.

In fact, Patterson had just completed, on the day of the speech, a three-week Interim course at Calvin on the politics of AIDS in Africa. And so she listened to Bush's words with careful attention.

Patterson said she was pleased the President used such a public forum to announce his AIDS initiative. And she especially liked the fact that the President acknowledged the need for drug treatment for the millions of Africans currently living with the disease. She did wonder, however, about parts of the President's plan.

She notes that while the Bush pledge of $15 billion over five years is a large increase over current U.S. spending, it may not be enough. "Estimates are," she says, "that it will take $7 to $10 billion annually to fight off the global AIDS epidemic. Further, this funding would need to be sustained for several years."

However, she adds, by the President making such a proposal and Congress allocating the money, there is some hope that this will also encourage other wealthy industrial nations to give more. "Certainly some of them," she says, "have taken a 'wait and see what Washington does' attitude on funding."

Another area of uncertainty in the African AIDS crisis, says Patterson, is how exactly to allocate money.

"Should it be used for prevention," she says, "and if so, what does that entail? Does it mean only abstinence programs or also condom distribution? How much money is for treatment programs with the antiretrovirals (ARVs) that the President mentioned."

Patterson says that such treatment often can include providing ARVs to pregnant HIV-positive women so that they reduce the risk of transmitting the virus to the baby during pregnancy or labor. Because they are used for a shorter course of treatment, these "mother-to-child transmission" ARVs are cheaper than ARVs for HIV-positive adults and have been an easier political sell for policy makers.

Another question, says Patterson, is whether the administration will allow money to be spent on generic versions of ARVs, which are much cheaper than brand-name drugs.

"Although the administration has come out in support of generics in health emergencies such as the AIDS epidemic," says Patterson, "I think that this might become a point of political debate in the U.S. Congress, especially since protecting intellectual property is a key aspect of U.S. trade concerns."

Patterson says most AIDS experts, public health officials and African leaders today argue that money must be used for both prevention -- including abstinence education, condom distribution, workplace and school education programs and peer counseling among sex workers -- and treatment with ARVs.

She says that more programs also must be developed to help individuals cope with the loss of income and labor that occurs when a family loses someone to AIDS. And that orphan support programs are also needed, especially so that extended family members have the resources to care for orphans and these children are not forced to leave home or live on the streets. While some of these programs do exist, they are not sufficient to meet growing needs.

The timing of the President's push to assist Africa includes a number of factors says Patterson.

One critical issue is security.

"There is a growing realization," says Patterson, "that the potential economic insecurity that the AIDS epidemic will create in many African countries may lead to greater political instability in Africa. And arenas of political instability, such as Afghanistan, are ripe for terrorism. Further, young people without parents, education, jobs, or hope are easily mobilized by adults such as warlords, terrorist leaders, etc. There are estimates of 40 million AIDS orphans, one-third of young people in some African countries, in the near future. So, the AIDS issue has become more closely tied to security issues. "

Patterson notes too that the United Nations Secretary General, who is well-liked in Washington, has made a commitment to discuss this issue and get it on the international policy-making agenda and that Americans are becoming more aware of AIDS in Africa, especially Americans in some of Bush's traditional camps of supporters. Finally, she says, there are some key individuals in the US Congress who have been pushing for more funding for AIDS in Africa, including Bill Frist, the new Senate Majority leader.

And politically AIDS funding might be a positive for Republicans who, after the Trent Lott dust-up, are looking for ways to improve their image with African-American voters. It also may help the U.S. image abroad in a time of Iraq crisis that sees conflicts between the U.S. and some of its important European allies.

Patterson's African expertise includes not only book chapters and articles on the continent and AIDS, but also a two-year stint in Senegal as a member of the Peace Corps. She also has received a variety of outside funding to study AIDS and African politics.

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Contact Phil de Haan
616-957-6475 (v)
616-957-7069 (f)