were suffering.
I was willing to take on that objection. I was confident I could explain how saving lives in Africa served our strategic and moral interests. Healthier societies would be less likely to breed terror or genocide. They would be more prosperous and better able to afford our goods and services. People uncertain of America’s motives would see our generosity and compassion. And I believed the American people would be more supportive if we could show that their tax dollars were saving lives.
Critics would later claim that I started PEPFAR to appease the religious right or divert attention from Iraq. Those charges are preposterous. I proposed the AIDS initiative to save lives. Mike Gerson, my chief speechwriter and trusted adviser, put it best in a November 2002 meeting. “If we can do this and we don’t,” he said, “it will be a source of shame.”
I made the decision to move forward with PEPFAR in December 2002. Only a few people knew about the plan. I instructed the team to keep it that way. If word leaked out, there would be a turf war among government agencies for control of the money. Members of Congress would be tempted to dilute the program’s focus by redirecting funds for their own purposes. I didn’t want PEPFAR to end up hamstrung by bureaucracy and competing interests.
“Seldom has history offered a greater opportunity to do so much for so many,” I said in my State of the Union address on January 28, 2003. “… Tonight I propose the Emergency Plan for AIDS Relief—a work of mercy beyond all current international efforts to help the people of Africa.”
Members of both parties rose to support the plan. Standing next to Laura in the First Lady’s box was a man whose program and country had served as an inspiration for PEPFAR, Dr. Peter Mugyenyi of Uganda.
I had intended the announcement to make a big impact, and it did. President Clinton’s top AIDS official called it “inspiring and clearly heartfelt.” The
As expected, there were some objections. The biggest came in response to the ABC prevention strategy. Critics on the left denounced the abstinence component as an ideological “war on condoms” that would prove unrealistic and ineffective. I pointed out that abstinence worked every time. Some on the right objected to distributing condoms, which they felt would encourage promiscuity. At least members of Congress were smart enough not to criticize the B, being faithful within marriage.
Ironically, both sides charged that we were imposing our values—religious fundamentalism if you asked one camp, sexual permissiveness if you asked the other. Neither argument made much sense to me, since the ABC strategy had been developed in Africa, implemented in Africa, and successful in Africa.
In the spring of 2003, the House of Representatives took up PEPFAR legislation. The bill was sponsored by Republican Congressman Henry Hyde of Illinois and Democratic Congressman Tom Lantos of California, two principled supporters of human rights. In a fine example of bipartisan cooperation, they helped steer the bill through the House with a vote of 375 to 41.
The bill then moved to the Senate, where it received strong backing from Majority Leader Bill Frist, a doctor who took annual medical missionary trips to Africa, and Senator Dick Lugar of Indiana, the thoughtful chairman of the Foreign Relations Committee. Bill and Dick rallied support among a wide range of lawmakers, from conservatives like Jesse Helms of North Carolina to liberals like Joe Biden of Delaware and John Kerry of Massachusetts. I told Bill I hoped to sign a bill before I left for the 2003 G-8 summit in Evian, France, so that I would have more leverage to persuade our allies to join us. Bill worked tirelessly to meet the deadline. Three days before I left the country, I signed PEPFAR into law.
Two months later, Laura and I touched down in sub-Saharan Africa. Our first stop was Senegal. After a morning meeting at the presidential palace, President Abdoulaye Wade and his wife, Viviane, escorted us to one of the most haunting places I visited as president, Goree Island.
Standing at the threshold of the Door of No Return on Goree Island.
Our tour began in a pink stucco structure, the Slave House. The museum curator showed Laura and me through the small, hot rooms. One had contained scales to weigh the slaves. Another was divided into cells to separate men, women, and children. We walked through a narrow passageway to the Door of No Return, the starting point for the horrific Middle Passage. I could only imagine the fear of those hopeless souls who were stolen from their families and shoved onto ships bound for an unfamiliar land. I put my arm around Laura as we peered out at the blue ocean.
Standing behind us were Colin Powell and Condi Rice. I thought about the contrast between what their ancestors had endured and what Colin and Condi had accomplished. After the tour, I gave a speech from the island:
PEPFAR was a new chapter in Africa’s unfolding story of freedom, dignity, and hope. In every country I visited, I promised that America would meet our commitments. In South Africa, where nearly five million lived with HIV, I urged a reluctant President Thabo Mbeki to confront the disease openly and directly. In Botswana, a relatively wealthy country where 38 percent of the adult population was infected, President Festus Mogae pledged to use PEPFAR funds to continue the impressive effort he had begun to fight the disease. At the national hospital in Abuja, Nigeria, I visited with women who had benefited from the mother and child initiative. They beamed with joy as they showed me their healthy children. But for every infant born infection-free, many more began life facing the burden of HIV.
The most memorable part of the trip was our visit to the TASO clinic in Uganda, where I met Mohamad Kalyesubula. Escorted by President Yoweri Museveni and his wife Janet, Laura and I went around the room and hugged the patients. Many opened up to us. They shared their hopes and fears. One nurse named Agnes told me her husband had died of AIDS in 1992. When she got tested, she found out that she, too, had HIV. She was one of the lucky few who had been able to get antiretroviral drugs. She urged me to send more medicine, as soon as possible. When the drugs supported by PEPFAR reached Uganda, Agnes helped nurse many of TASO’s patients back to health. One was Mohamad. When he came to the White House in 2008, Agnes came too.
The director of TASO, a doctor named Alex Coutinho, later said I was the first world leader he had seen hug an African with AIDS. I was surprised. I remembered that Mother had made international news when she hugged an HIV-infected baby in 1989. Her act dispelled the myth that the disease could be transmitted by incidental human contact. I was proud to carry on her legacy by reducing the stigma associated with AIDS. I hoped in some small way to restore the dignity of suffering people. Above all, I wanted to show that the American people cared.
At the TASO AIDS clinic in Uganda.
One highlight of our Africa trip was that our daughter Barbara joined us. In Botswana, she, Laura, and I went on safari in the Mokolodi Nature Reserve. We were hoping to relax, get some fresh air, and see some wild animals. To feed the appetite of the traveling press, the White House staff decided we should have a photo op.
As always, the preparations were meticulous. A press truck full of cameras and reporters was prestationed in a clearing. As our vehicle rounded the corner, the press was lined up for a perfect shot of us observing several elephants. Apparently, the elephants were not given the script. Shortly after we arrived, a randy male elephant
