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Go Home Bush's Legacy on AIDS--and Ours

JONATHAN COHN DECEMBER 1, 2010

Bush's Legacy on AIDS--and Ours

On the train this morning I thought back to a grad school lunch I attended long ago with Randy Shilts. He noted that he would be out for coffee with someone, notice a blotch on the man's forehead, and then quietly register that yet another friend would probably be dead in six months. Shilts died not long after that, one of almost 600,000 Americans who have died of AIDS. 

You won't hear this from me every day—virtually any day, ever. I hope President Obama, Harry Reid, and John Boehner read George W. Bush's op-ed this morning in Washington Post. In fifty years, people will have even lower regard for the Bush presidency than they do today. PEPFAR will be one shining exception to that judgment. He believed in it, listened to people, mobilized a coalition, found the money, made it happen. It was flawed in many ways, but the guy deserves his due. 

I will always wonder whether Bush could have achieved a more humane and successful presidency, were it not for 9/11 and what accompanied it. Whatever there might have been to compassionate conservatism was cut short by both the loosening of political constraints and the incredible psychological pressures associated with the global war on terrorism and the wars. PEPFAR was the one large exception.

The Obama administration hasn't backslid on AIDS. They have good people, good policies. They talk sensibly and humanely about HIV prevention. They are fixing the domestic public health infrastructure, which Bush's people really screwed up. As always, they don't have enough money to really do what must be done. People will look back on this time and say: We should have done more.

I shake my head when purported deficit concerns lead our society to under-fund the national and global fight against AIDS, maternal and child health, education, and development. Is there any better illustration of how stupidly we think about our future?

Harold Pollack is the Helen Ross Professor of Social Service Administration at the University of Chicago. 

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Employed by an NGO subcontractor but paid ultimately by CDC, my wife worked on PEPFAR implementation in Namibia. Were it not for visa issues and bad timing, I would have done so as well. Indeed PEPFAR was imperfect, and at least in Namibia it was possible to raise serious questions about the program's sustainability. The epidemic was so far advanced and the existing health care infrastructure was so weak that at times it was hard to envisage how PEPFAR would/could continue, especially once western medicos--my wife and I being two of them--were withdrawn. That said, PEPFAR was better than no PEPFAR. Tens of thousands of Namibians received ARV treatment who otherwise wouldn't, and the evidence is strong that some ARVs, no matter how haphazardly taken and administered, are better than none.

- AaronW

December 1, 2010 at 1:09pm

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That's all good, but if we have to cut this funding to pay for extended unemployment benefits, I would do it in a heartbeat. Neil

- purcellneil

December 1, 2010 at 1:31pm

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