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Bush sees results of his AIDS plan in Africa

The $15 billion relief plan aims to help 1.5 million HIV patients live longer, healthier lives.

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"As far as prevention is concerned, I have not seen any evidence that PEPFAR has made a difference," says Mark Heywood, director of the AIDS Law Project in Johannesburg. "Now it may be that prevention itself is difficult. But when the fundamentalism of Bush and company intrude – with restrictions that programs shouldn't provide encouragement to use condoms or shouldn't provide assistance to sex workers – then the consequences of abstinence-only programs are felt."

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AIDS activists say PEPFAR funds could do a lot more if they were directed toward more proven strategies of lowering infection rates through encouraging the use of condoms, rather than on the more difficult goal of promoting abstinence.

"There are many sex workers who get infected with HIV, but the programs say that we can't give them assistance," says Luckyboy Makhondwane, a social worker who teaches adults about HIV in Johannesburg. "These sex workers get marginalized. They are out of the system. So then you have no way to influence them, to help them, to prevent the spread of HIV to their customers."

PEPFAR makes a big difference in Rwanda

Two years ago, Anastasia Uklimana – a housewife in Kigali, Rwanda – was too weak and thin to lift the yellow plastic jerrycans women here use to collect water. Her husband had to do it after a long day of work – along with the cooking, the cleaning, the laundry, and the many duties that go with caring for a newborn baby.

That seemed fair enough, she says, because "he is the one who brought the problem" – the HIV – "into the home."

But thanks to free ARV drugs – provided by PEPFAR – she now has enough energy to raise her three children, as well as volunteer as a community health worker, counseling her neighbors to seek out treatment as well.

Ms. Uklimana is one of 27,800 Rwandans – more than half of the population infected with HIV – receiving free ARVs through PEPFAR. Since Rwanda began receiving the funds in 2005, medical professionals here say the health infrastructure, and the people it can serve, have improved dramatically.

"I think PEPFAR makes a very big difference – not only in the number of people receiving [medication], but also in the quality of care," says Joseph Nyibizi, acting coordinator of care and treatment at the Treatment and Research AIDS Center (TRAC).

A recent TRAC evaluation of care in 2004 and 2005 showed that patients are staying alive longer and coming in for relevant checkups more frequently, and staff are receiving better training in care management, he says.