The President is just back from a whirlwind tour of Africa. He swept across the continent in 6 days, leapfrogging to friendly and peaceful countries while dispatching Secretary Rice to areas that need a little work (see my Kenya post). While much of the headlines these days deal with wars in Iraq and Afghanistan, the Bush administration has been waging a more silent war against AIDS in the developing world.


I’ve spent the last month in Northern Tanzania, observing the work of an NGO called Light in Africa. Light in Africa, or LIA, began as a children’s home on the foothills of Mount Kilimanjaro. Since work began in 2000, founder Lynn Elliot (aka Mama Lynn) has gradually expanded its ministries to include food, nutrition and medical programs to the surrounding areas. The operation has since moved off the mountain to be mainly concentrated in the village of Boma N’gombe. LIA now raises some 150 children, around 40 of whom are living with HIV/AIDS. Below, children at Light in Africa’s Pilgrim House for boys.


A marked change has come since former visits I’ve made to LIA in 2002 and again in 2004: all the children who previously lived (or sadly, died) from day to day with the effects of HIV now have access to antiretroviral drugs without cost. Furthermore, the children receive regular checkups from doctors and nurses. Thus, children whose quality of life was once severely diminished can now live a relatively normal life compared to their peers who are not infected with HIV. Below, Omega and Felix are two of about 40 children at Light in Africa with HIV.


Antiretroviral drugs suppress the replication of the HIV virus in the body, allowing more T-cells to grow. T-cells are needed for a strong immune system in order for the body to fight off diseases and viruses. Such drugs are expensive. The majority of people around the world infected with HIV lack access to them either financially or geographically. It is little known that George W. Bush has made it a goal of his administration to change this. Below, Sonya lacked antiretroviral treatment from an early age. Her condition is now moving from HIV into AIDS.


Doctors recommend beginning antiretroviral therapy when one’s T-cell count falls below 350 and surely when reaching dangerous levels below 200. When word of Phineus reached Light in Africa, their social worker, Samueli was sure he could not be saved. Samueli had been dispatched by Mama Lynn to bring the child, whose parents had both died of AIDS, under her care. Phineus was langushing at home in bed, nursed by his grandmother with what doctors would later find to be a T-cell count of 6. Upon seeing his condition, Samueli returned to LIA without the child. By now accustomed to miracles, Mama Lynn insisted Samueli bring Phineus to live at LIA.


Two years later, Phineus (shown above on a recent checkup) is now healthy and lives once again with his grandmother. He receives antiretroviral drugs and health screenings from nurses and doctors at a local hospital or LIA’s clinic. The medication and care he receives are made possible with funds from PEPFAR, the President’s Emergency Plan For AIDS Relief.


Passed by Congress in 2003, the Global AIDS Act that authorized PEPFAR was first touted in Bush’s 2003 State of the Union address. The program has continued to be funded each year since and was greatly expanded in 2006. The funding is distributed both to trustworthy local governments as well as to aid-groups and hospitals in the field. PEPFAR is currently working in 13 “focus” countries in Sub-Saharan Africa, in addition to Vietnam and Guyana.


In addition to structured prevention, care and treatment programs for AIDS, the act also authorized funds for the prevention and treatment of malaria and tuberculosis. Despite the relative lack of publicity, malaria is the continent’s most deadly disease, though AIDS can be more debilitating for a longer period of time. The incidence of co-infection of HIV/malaria and HIV/tuberculosis is also common. As of 2005, an estimated 24.5 million people in sparsely populated Sub-Saharan Africa were suffering with HIV. Though the area accounts for just 12% of the world population, it contains a disproportionate 60% of the world’s total AIDS population.


Two hours from Moshi by dusty, bumpy, almost-undriveable road to the dry Tanzanite mining town of Mererani, nurses from KCMC hospital in Moshi have come (thanks to a lift from Mama Lynn) to conduct HIV tests. Enough funding for the program exists for the hospital to regularly distribute antiretroviral medications to the village should enough people be found to have the virus. Word spreads quickly of the nurses’ presence and within a few minutes there is a line of twenty or so people waiting to be tested.


Sun pours in an otherwise dark room where tests are being conducted. The atmoshphere is tense. One man, after waiting all morning for the nurses’ arrival, is overcome with the anxiety of knowing his diagnosis. He removes the tourniquet from his arm before nurses can take a blood sample. After a few minutes he again consents to the test which later comes back positive. It seems that many who enter already know their fate and request antiretrovirals before the test is even administered. After the first 90 minutes, all but one of the villagers tested is HIV positive.


Assuming that KCMC approves the outreach to Mererani, the HIV+ villagers there are more fortunate than most. Even though antiretrovirals are freely administered in hospitals, they are far out of reach for people in remote areas like Mererani. The drugs may be free, but getting to and from the hospital requires bus fair, meals and a day or more away from the shamba, or field, where most people earn a living. Furthermore, queuing at a hospital in Sub-Saharan Africa is often a multi-day ordeal.


This is where PEPFAR’s work is most effective. By bringing the medicines as well as medical workers out into the bush, PEPFAR is sustaining the lives of many who would otherwise have stayed home.

“I know it is about life, and it is! But what do they do out in Checkireni (another remote region of Tanzania) when they don’t have the money to feed their kids and have to come up with 10,000 shillings to get to KCMC?” says Laura Cox, Mama Lynn’s daughter and fellow worker at LIA. Sadly, for most, there is no answer.


We return to Light in Africa later that evening to find that social services has delivered two more children to the orphanage: Hasani, a boy aged four, and his sister Azziza, aged 2. The pair look as if they have come from a famine-stricken refugee camp; Hasani weighs about 16 pounds and his sister not quite 10. They suffer from AIDS and Tuberculosis. The two however, did not come from a refugee camp, but from a mother who is dying of AIDS in a hospital bed at KCMC; they are despairingly inconsolable and in tears at being separated from her. Above and below, Mama Lynn and Laura administer antiretrovirals to Hasani and Azziza.


Within a few weeks in Light in Africa’s care, Hasani has shown improvement and is able to walk while holding someone’s hand. Azziza (below) does not fair so well and is checked into the hospital with pneumonia.


Despite its generous and far-reaching effects, PEPFAR is not without its critics. One third of the program’s prevention budget, or 6.6% of the overall budget, is spent on abstinence-only programs, to the chagrin of some public health experts who are concerned that Christian or moral agendas, rather than those of public health or human rights are PEPFAR’s motivating factors. Certain restrictions for funding are also placed on organizations working with prostitutes.


Whatever the motivations, according to PEPFAR’s reports, the program has administered antiretroviral therapy to some 1.4 million people. Though a tremendous amount of work remains, the results are significant. As the program expands, people are healthier and living longer, economies are strengthened because of a greater workforce, and HIV infection rates are decreased giving greater hope to the next generation. Time will tell whether or not these achievements will be overshadowed by the administration’s foreign policy failures elsewhere in the world. But one thing is sure, as the President leaves office next year, he leaves Africa in much better shape than when his two terms began.