Jesse Helms, former six-term Republican senator from North Carolina and de-facto leader of his party's "culture wars," found a way to make HIV-AIDS the communism of the 1990s. As chair of the Senate Foreign Relations Committee, Helms did not simply use his power to cut U.S. government assistance to international HIV-AIDS programs, he leveraged his political position to create an environment that sought to stigmatize and shame AIDS victims both at home and abroad.
President Bush's trip this week to Benin, Tanzania, Rwanda, Ghana and Liberia would appear at first glance to be a reversal of Senator Helms' efforts, but in many ways this administration's HIV-AIDS policy in Africa, and the current foreign policy apparatus that implements it, may be Helms' most desired legacy.
Most may remember Helms' long-held vile views on homosexuals and the AIDS crisis in America. Though he did not quite have the same repulsive reactions to the spread of HIV-AIDS in Africa – there, it wasn't about homosexuality, but poverty, he reasoned - it took some star-studded diplomacy to get Helms to support US assistance to fight the disease.
In 2002, after a few near-spiritual visits with U2 artist Bono on the crisis in Africa, Helms had an epiphany and reversed his stalwart opposition to U.S. support for battling AIDS on the continent. In the new book, Righteous Warrior: Jesse Helms and Modern American Conservatism, author William Link recounts the senator's change of heart. Referring specifically to his position on AIDS in Africa, Helms declared before a conference of Christian activists, "I have been too lax, too long in doing something really significant about AIDS." He added, "I'm so ashamed that I've done so little." Kudos to Bono for masterminding Helms change of heart, yet the impact of his positions was already wide and deep.
Today, the U.S. Agency for International Development (USAID), at one time the lead agency for implementing assistance to combat HIV-AIDS, has been merged into the U.S. Department of State and stripped of its prominent role on the issue. This went a long way toward answering Senator Helms' prayers to re-orient foreign aid by consolidating the American foreign affairs apparatus. And on the eve of his retirement from the Senate, Helms seemed to have gotten exactly what he wanted, the near privatization of development assistance led by faith based organizations.
In his 2003 State of the Union address, President Bush announced the establishment of the President's Emergency Plan for AIDS Relief (PEPFAR), a five-year $15 billion effort to combat disease around the world. PEPFAR's strategic approach is to support treatment, prevention and care programs.
Abstinence, being faithful, and the use of condoms became the Bush Administration's controversial "ABC" policy for fighting AIDS. A significant amount of the funds go to faith-based organizations, including evangelical Christian groups, , to carry out abstinence-training, while condoms manufactured in Alabama, the home state of GOP Senator Jeff Sessions make their way to Tanzania and Uganda.
AIDS is the primary cause of death in sub-Saharan Africa. About 1.6 million people in the region died of AIDS in 2007. This number is down compared to the past four years, due in large part to scaling up of antiretroviral treatment services. To its credit, PEPFAR efforts have contributed significantly to getting more people on antiretroviral treatment. The plan is also supported by an unparalleled amount of money. But more needs to be done. Prevention has been badly neglected. In 2007 alone, 1.7 million people were newly infected with HIV. Women make up the majority of people living with the virus. Children are also bearing the brunt of the disease; it is estimated that there are 11.4 million orphans in the region due to AIDS. These numbers are staggering.
AIDS in Africa, and anywhere around the world, can do without the politics of moral ideology. The structures in place for delivering relief, orchestrated in large part by Jesse Helms and implemented by President Bush, are as much about satisfying American political interests as they are about foreign assistance. President Bush's trip this week, a campaign that aims to highlight "compassionate conservatism," is far from a victory lap.
Sundaa Bridgett Jones is an International Affairs Fellow at the Council on Foreign Relations.