AIDS battle burnishes Bush's legacy in Africa

Caring for orphans, vulnerable children
PEPFAR says its programs have helped care for nearly 4 million orphans and vulnerable children.

One of them is Frans Dobola, who at age 13 lost his parents to AIDS. Heartbeat, an organization helping AIDS orphans with $750,000 in PEPFAR grants, trained a neighbor to act as his foster mother, provided a daily meal, and an after-school program.

Dobola, 20, now works at Heartbeat, in a township near the South African capital, Pretoria, and dreams of a job in computers. Meanwhile, he grows beets and tomatoes at the after-school center's garden and gives poetry and dance lessons.

"I am giving back to the community what they gave me," he says, smiling.

South Africa is also the biggest single recipient of PEPFAR money — $590 million last year, more than it received during the entire eight-year Clinton administration, according to U.S. ambassador Eric Bost.

After years of denial about the AIDS crisis by former President Thabo Mbeki, the new government is finally serious about tackling the epidemic.

Francois Venter, an outspoken doctor who heads a PEPFAR-funded program at the University of the Witwatersrand in Johannesburg, says because of its emphasis on measurable targets, "PEPFAR is different."

"A lot of previous donor projects were touchy-feely, fuzzy," says Venter, adding that U.S. funding helped boost the number of South Africans on medication to 700,000.

But with 2.5 South Africans becoming newly infected for every one put on treatment, Venter says that prevention remains a "black hole."

Prevention is weakest link
Supporters and critics alike agree that prevention is the weakest link in global AIDS initiatives. When he launched PEPFAR, Bush said he wanted to prevent 7 million new infections but it is hard to tell whether that goal has been met.

PEPFAR says its funds have provided drugs to 250,000 pregnant women to prevent them passing on the AIDS virus in the womb. In countries like Uganda, babies born with the AIDS virus still account for 15-25 percent of new infections and so the increase in therapy to stop mother-to-child transmission offers one of the few rays of hope in an otherwise bleak prevention outlook.

Denis Farrell / AP Blood is tested Dec. 15, 2008 at the AIDS Care Training and Support Initiative (ACTS) at White River Junction, South Africa.

Another promising option would be male circumcision, which can cut transmission by up to 60 percent. But it has so far received little PEPFAR backing because any mass program is thought to be too complex for impoverished countries to undertake.

Most experts agree that prevention means a fundamental change of behavior — fewer sexual partners and mutually faithful relationships. "We are trying to change culture, tradition," says Mandla Ndlovu, project officer for Johns Hopkins Health and Education in South Africa.

"It is not going to be a one-round fight," says Ndlovu, who runs a PEPFAR project to increase AIDS awareness among men in Carltonville, a gold mining town outside Johannesburg where men live in hostels away from their families and there are few pastimes besides alcohol and casual sex.

'He cares about people'
Bost brims with superlatives about the achievements of PEPFAR in South Africa, and believes Bush will be judged more kindly in history than on Jan. 21.

Dybul, a specialist in infectious diseases whose title is now U.S. Global AIDS Coordinator, concurs.

"It's the largest international health initiative in history for a single disease," he says. "In any other circumstances, he (Bush) would be getting a Nobel prize."

Sweetness Mzolisa, overflowing with energy and enthusiasm, puts it more simply.

"He's got heart," she declares. "He cares about people."

More from msnbc.com Move over, feds — locals try stimulus, too  Daily Nightly: Tim McGraw helps neighbors in need Were you paying attention? Take our weekly quiz World Blog: China puts foot down on 'Oba Mao' T-shirts Scoop: Levi Johnston poses with only a hockey stick Stimulus tracker: See where millions of dollars went On Twitter: Breaking news updates | Weird and wild

MORE FROM AFRICA

Africa Section Front

Ghana illegal mine collapse kills 15 Tanzanian landslide kills 11 children, 9 adults Make peace — mom's dying wish to rebel leader son Zimbabwe judge: Torture can be raised in case Kenyan girls given a chance to dream Africa Section Front   Add Africa headlines to your news reader: