April 17, 2008 | Read Time: 5 minutes
Efforts to fight AIDS overseas will soon get a major infusion of money from the U.S. government. The House of Representatives this month passed an extension to the President’s Emergency Plan for AIDS Relief, which will increase spending from $30-billion to $50-billion over five years, and it is likely to become law soon.
To be sure, the federal government’s AIDS program, known as Pepfar, has done enormous good. Thousands of lives have been prolonged and saved through efforts it has supported. Coupled with the money that private grant makers are spending to fight HIV/AIDS overseas, this is a significant step forward for the 114 countries that receive a share of this money, as well as the new countries that may be included in the 2008 plan.
Yet as Congress puts the finishing touches on legislation to nearly double spending on the effort, it is important to look at limitations that hobble the federal program from doing the most it could.
Under the current law, the majority of money goes to nonprofit groups based in the United States or American-led groups that have headquarters in the countries where the government’s AIDS program works. Yet a lack of local health-care professionals and workers trained in preventing the spread of HIV remains a key challenge facing developing countries as they attempt to build sustainable efforts to curb the disease.
Many American nonprofit organizations are providing much-needed prevention, care, and treatment services around the world, mostly by sending Americans overseas to provide services. And they are to be applauded.
But while those organizations are clearly filling a vital role, the money from the American government should be focused on efforts to build a long-term solution, and that means paying to train foot solders who can be equipped to fight the disease in their home countries. If all Pepfar does is give money to expand American nonprofit groups, then we have failed people counting on the United States for a hand in the fight against a deadly disease.
In countries where HIV is endemic, it is difficult to imagine that Americans can solely devise and carry out solutions that will eradicate the disease. For instance, in South Africa — a country that has a population totaling less than 15 percent that of the United States, yet has a rate of HIV that is 12 times that of America — cultural, social, economic, and political realities are clearly presenting a different face of the disease than what charities see in America.
People from all countries that have been hard hit by HIV/AIDS must be the ones to translate what is too often largely Westernized HIV education into local culture. They must be the ones to explain to AIDS specialists how the lessons need to be altered and what larger social, economic, and gender-related issues must be confronted before it is possible for local people to consistently practice HIV prevention.
Although HIV-prevention methods are well known and proven to work, many people in the hardest hit countries, like South Africa, often do not or cannot take the steps that are most likely to protect them from disease.
In some poor countries, it is not uncommon for women to offer to be paid for sex just so they can afford to buy uniforms for their children to go to school or other necessities like food. In other places, men must relocate away from their families for long periods of time to find work, and they have unprotected sex with other women while they are away. It is not uncommon for these men, upon returning home, to ask their wives to have unprotected sex.
The wives and other women in these situations are at risk of getting a disease, but they also need the financial support provided by the men in their lives.
To offer women like these a lecture about how to put a condom on a banana is not enough; they need advice and instruction from people they know understand exactly what is like to live in a culture where women face such difficult choices. Individual counseling, not group instruction about AIDS prevention, is often what these women need — but not necessarily what Americans have been trained or given money to offer.
Without this localized approach to AIDS prevention, a reversal of the epidemic is inconceivable. South Africans, not Americans, will save South Africans from HIV.
Aside from the concerns about whether Western values and a Western curriculum make sense, one must also question the financial efficiency of putting so much of the Pepfar in the hands of American groups. The travel costs of sending Americans around the world are exploding rapidly with increases in the costs of fuel. Money would go much further if it were invested in hiring and training people in their own counties.
Moving forward, Pepfar should ensure that wherever possible, the majority of the new money Congress provides — as well as the extensions of any contracts — go to indigenous groups rather than nonprofit groups based in the United States. In addition, the U.S. government should encourage African and other developing nations to invest more of their own budgets in training and retaining health-care and social-service workers in their countries.
In settings as varied as U.S. agricultural aid to Africa and the war in Iraq, it has become clear that building the ability of local people to fight their problems rather than subsidizing American providers is the only way to ensure effective and sustainable solutions to complex problems like food insecurity, national peace, and, in this instance, preventing and treating AIDS and HIV.
Often in the grant-making world, we ask grantees what their “exit strategy” will be once their program efforts conclude. As a nation of donors who are giving our tax money through Pepfar, we need to ask ourselves the same question: What happens when American money to fight AIDS leaves the developing world?
Nancy Mahon is senior vice president of MAC Cosmetics and executive director of the MAC AIDS Fund, which has provided more than $115-million to AIDS projects around the world since 1994.
