- The Washington Times - Tuesday, September 30, 2003

Yesterday, Randall Tobias, former CEO of Eli Lilly and chairman of ATT International, appeared before the Senate Foreign Relations Committee as President Bush’s nominee to fill the new post of AIDS czar. Mr. Tobias will be charged with implementing the president’s five-year, $15 billion plan to fight HIV/AIDS in 14 African and Caribbean countries. Congress should fund it later this month. Here are 10 suggestions for Mr. Tobias to get a quick start, gathered during a 10-day August visit to Africa in a delegation led by Senate Majority Leader Bill Frist:

1. Go to Africa — To understand the disease that has delivered a death sentence to 29 million Africans, to make good spending decisions and to cut red tape, you should be where the action is. While there, show some respect for the African way. When in Namibia, play the Namibian national anthem; leave it to the local mayor to say (as he did to us), “God Bless America.”

2. Make needles and blood transfusions safe — Reused needles, contaminated blood and other unsafe health practices will cause at least 175,000 new AIDS infections this year in sub-Saharan Africa. In one Namibian hospital, health workers were recapping used needles risking themselves in the process.

3.Savethebabies—In Botswana, 40 percent of pregnant women are HIV positive, so one in three of those babies will be HIV positive. Administering nevirapine to the mother in labor and to her child after birth reduces this risk to 1-in-10. Congress already hasappropriated millions to start to create an AIDS-free African generation.

4. Make inexpensive drugs widely available — There is no vaccine or cure for AIDS, but there are medicines that prolong life. These anti-retroviral drugs are cheaper than ever; in Namibia the cost was $160 per person per year. In South Africa, the availability of these treatments can decide whether 5 million infected people die in the next five years or in 20 years.

5. Encourage rapid tests and routine tests — Most Africans who are infected don’t know it and are reluctant to find out because of the stigma attached to AIDS. New rapid tests report results in 20 minutes. Inexpensive treatments provide new incentive to take the tests.

6. Teach the ABCs — “Abstain. Be Faithful. Use Condoms.” Using this approach, Uganda has reduced its infection rate from 20 percent to 8 percent. Ninety per cent of AIDS is transmitted by sexual intercourse, something many Africans (and many Americans) don’t know. The first lady of Uganda, Janet Museveni, encourages “A” and “B” more than “C”: “I am not comfortable,” she says, “with the thought that the extinction of an entire continent could depend upon a thin piece of rubber.”

7. Form an AIDS Corps — The greatest need is for manpower and training. Hospitals need doctors, clinics need nurses, nonprofits need counselors to recruit patients and to hold the hands of the dying. Create a private-sector clearing house for Americans to go to Africa from three months to two years; connect these volunteers with structures in Africa.

8. Dig some water wells — In Mozambique, three of four deaths of children under five are caused by diseases carried by unclean water. Since AIDS destroys immune systems, victims of all ages live longer with clean water. One nonprofit showed us a well dug for $2,800. Two boys, were filling 10-gallon water cans which they carry each day in a wagon to their home six miles away. Forty percent of rural Africans don’t have this much access to clean water.

9. Focus on logistics — Faith-based organizations are active. A surprising number of talented U.S. government people are already on the ground. Don’t overplan; ride the horses already running.

10. Move fast, but don’t spend the $15 billion too fast — The African health-care system cannot absorb too much money too quickly. There are treatment guidelines to prepare and teach, staff to recruit, patients to find and persuade, health organizations to establish. For example, last year Anglo-Gold mining company in South Africa made an all-out effort to recruit the first 1,000 of its 25,000 infected employees to take free treatments; it persuaded only 622.

Mr. Tobias has already led a distinguished career. We should all thank him for answering the call of public service to face this enormous challenge.

Botswana’s life expectancy has dropped from 72 years of age to 34. In Namibia, teachers miss school to visit sick colleagues and attend their funerals. Two or three generations of South African children will grow up without parents. In August, a local journalist in Windhoek told me: “Please get it across how much we appreciate President Bush’s $15 billion grant. It puts a human face on America.”

Sen. Lamar Alexander, Tennessee Republican, is chairman of the Senate’s Subcommittee on African Affairs.

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