HIV病毒和其引起的疾病AIDS的生物学特点。影响这一疾病的传播和预后的社会、经济和政治因素。科学研究和治疗手段的发展情况。关于艾滋病的恐惧和希望的来源。(想预览课程论坛上已有的材料，请前往@AIDSFAH或#AIDSFAH)
04.04 - Four Presidents (3): Bush
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来自 University of Michigan 的课程
AIDS：恐惧与希望
216 个评分
从本节课中
Unit 4 - Living With HIV
Not a death sentence, but not easy; More Politics, Sexual Orientation
与讲师见面
Richard Meisler, Ph.D.Lecturer
Department of American Culture, University of Michigan
Hello, this is the third in our series of sessions about presidents.
We will discuss the record of President George W Bush of the United States.
In the minds of many people,
Bush is viewed very negatively because of the wars in Iraq and Afghanistan.
His record in the area of HIV and AIDS may surprise his critics.
There is little question that President George W Bush had the greatest
positive impact of any world political figure in fighting AIDS.
Here is an excerpt of President Bush's State of the Union address in 2003,
complete with the obligatory, ritual, standing ovations.
Bush is announcing PEPFAR,
the President's Emergency Program for AIDS Relief.
>> We must also remember our calling as a blessed country is to make the world
better.
Today on the continent of Africa,
nearly 30 million people have the AIDS virus,
including 3 million children under the age of 15.
There are whole countries in Africa where more than one third of the adult
population carries the infection.
More than 4 million require immediate drug treatment.
Yet across that continent, only 50,000 AIDS victims,
only 50,000 are receiving the medicine they need.
Because the AIDS diagnosis is considered a death sentence,
many do not seek treatment.
Almost all who do are turned away.
A doctor in rural South Africa describes his frustration.
He says we have no medicines.
Many hospitals tell people, you've got AIDS.
We can't help you, go home and die.
In an age of miraculous medicines, no person should have to hear those words.
>> [APPLAUSE]
>> AIDS can be prevented.
>> Antiretroviral drugs can extend life for many years.
And the cost of those drugs has dropped from $12,000 a year to under $300 a year,
which places a tremendous possibility within our grasp.
Ladies and gentlemen, seldom has history offered a greater opportunity to do so
much for so many.
We have confronted and will continue to confront HIV AIDS in our own country.
And to meet a severe and urgent crisis abroad,
tonight I propose the Emergency Plan for AIDS Relief, a work of mercy beyond all
current international efforts to help the people of Africa.
This comprehensive plan will prevent 7 million new AIDS infections,
treat at least 2 million people with life-extending drugs.
And provide humane care for millions of people suffering from AIDS and
for children orphaned by AIDS.
>> [APPLAUSE]
>> I ask the Congress to commit $15 billion over the next five years,
including nearly $10 billion in new money to turn the tide against
AIDS in the most afflicted nations of Africa and the Caribbean.
>> [APPLAUSE]
>> As one AIDS activist said, Bush used
the B word in place of the M word, thereby changing the history of the pandemic.
There is a big difference between millions and billions of dollars.
Doctor Anthony Fauci was the director of the National Institute of Allergy and
Infectious Diseases.
He has been an important figure in the scientific and
medical fight against HIV/AIDS.
He has advised several presidents and
was a member of the team that formulated PEPFAR.
Here is his description of the origins of the program.
Note that this video was recorded during the Bush administration.
So the officials mentioned are no longer in the positions that they held when Dr.
Fauci referred to them.
>> Well I had the privilege of being intensively involved
in the establishment and the architecture of PEPFAR.
It was really an interesting situation.
I also in my position at the NIH had the privilege and
the opportunity to interact with multiple administrations.
Multiple presidents that I had the opportunity to advise and
discuss this whole issue, not only of domestic, but of global HIV AIDS,
and I can tell you exactly how PEPFAR came about.
There had been a lot of activity on the part of a number of people
of what we can do to help globally for those people who were HIV infected.
Because remember, early on from what I mentioned to you, we thought that this
incorrectly was a disease of middle class white gay men in the United States.
And it's the farthest from it.
It's a disease heterosexually mostly in low and middle income countries.
90% of the cases are in the developing world.
67% of the cases are in Sub-Saharan Africa.
So there was a lot of activity of now this was in 1996 was when
we first had the development of what's called the combination anti-viral therapy.
HAART, they refer to it as highly active anti-retroviral therapy
that was transforming the lives of HIV infected individuals.
Where you would go from, every one of my patients would die within a short
period of time, but my becoming aware of their being infected in the early 80s.
To the mid-90s where you could get therapy that was truly life-saving,
not only just keeping people alive, but keeping them healthy.
So the question is, how do we get the fruits of research and public health that
was developed in the developed world, how do we get that to the developing world?
And it turned out that President Bush, George W Bush,
essentially sent Tommy Thompson, who was the then Secretary of Health and
Human Services in the spring of 2002, and I.
He sent us to Sub-Saharan Africa and said, scope it out.
And see what it is that we, as a rich nation,
can do to help people in the developing world with HIV.
So we went there.
We visited a bunch of different countries.
And at that time, there was the understanding that you could
very cheaply give a certain dose of a drug to a woman and
to a baby after they were born, and block mother-to-child transmission.
So I came back and presented, in the Roosevelt room, to the President and
his staff.
Everyone was there, all the people who were involved, Karl Rove,
and Andy Card, and Josh Bolten.
And I presented this what I thought would be about at $500 million program to
block mother to child transmission.
So the President immediately said, great idea, let's do it.
Turned to his staff and said, make it happen.
And then on the way out, he grabbed me with one arm and grabbed Josh Bolten,
who was then the Deputy Chief of Staff,
who is currently the Chief of Staff to the President.
And he said, I want you to go back, and I want you to put together a program that's
much more transforming, much more bold than this.
Don't worry about how much it'll cost, but
something that's a game changer is the word he used for the developing world,
something that we, a rich country, can do for them.
So I went back and kept on doing mathematical modelings
of how we can encompass the most people, what countries would be, benefit the most?
What would a reliable and reasonable goal be?
So, we came up with a program of $15 billion over five years,
aimed at treating 2 million people, preventing 7 million infections, and
caring for 10 million people, including AIDS orphans.
And we worked on that, myself and a bunch of other people over a period of several
months, from the late spring, early summer of 2002 through the entire fall.
Never knowing whether the White House was gonna accept this at all.
And then right before the State of the Union address in January of 2003,
I got a call from the White House to come down and
help Mike Gerson who was the speech writer for the president at the time.
To put a paragraph together, how we were going to announce the PEPFAR program, and
that's how it came about.
And it was really extraordinary, a, that we would do it.
But the thing also is that it has been a spectacularly successful program.
It will likely be the major legacy of this administration,
certainly in the arena of health and maybe in anything.
And now, as most people know, it's been reauthorized for
an additional five years at the tune of $48 billion.
So it went from a $15 billion program to a $48 billion program.
They're very similar in many respects.
One of the things that the President mentioned to me as he sent us
to Africa and then when I came back.
And I worked with Josh Bolten and Gary Edson and others at the White House was
that there was a lot of issues of when we were giving money to the developing world.
When you have multiple partners involved, you never know where the money is going,
and often it gets misspent.
So he wanted something that was not only a game changer as he said, but
that was totally accountable.
And the administration felt the only way to be totally accountable is
if you do a bilateral thing between the United States government and
a particular organization.
Not necessarily a government, it could be an NGO.
It could be things like Partners in Health,
Poor Farmer's Organization, or the Bill and Melinda Gates Foundation.
But it had to be something that was accountable.
The Global Fund for HIV/AIDS, Malaria, and Tuberculosis is a multilateral
organization that involves not just HIV, but also TB and Malaria.
And it is a central fund that people make pledges to.
And then the Global Fund distributes it out to people, depending on what their
proposals for doing various types of distribution of drugs or what have you.
It should be noted that the United States of America
is also the largest contributor to the Global Fund.
We contribute about one-third of all the resources to the Global Fund.
So the United States' role in international HIV AIDS and
other third world diseases like malaria and tuberculosis takes two channels.
A bilateral channel that's totally accountable to
the United States via PEPFAR and a multilateral that
goes to the Global Fund that has a much more diffuse aspect to it.
>> What were some of the criticisms of PEPFAR?
At first, a specified amount of the funding for prevention programs,
6.7%, was set aside for abstinence until marriage programs.
PEPFAR funds were denied to organizations that would not explicitly
condemn prostitution and sex trafficking.
Subsequent legislative action and
a Supreme Court decision have nullified these two provisions.
PEPFAR funds have never been available for
use by needle exchange programs for drug users.
Criticisms aside, it is hard to view PEPFAR as anything but a big step forward.
In a later session in this course, Infected But Not Treated, we will look at
how much progress has been made globally in the fight against HIV and AIDS.
Much of it as a result of PEPFAR, and also, at how much remains to be done.
