Kikwete was passionate about the fight against disease. He and his wife, Salma, had taken an AIDS test on national television to set a good example for the Tanzanian people. Even more impressive, the Kikwetes adopted an orphan whose parents had died of AIDS.
President Kikwete took us to an HIV/AIDS clinic at the Amana District Hospital, which had opened in 2004 with support from PEPFAR. As the director of the hospital showed us around, Laura and I saw a girl sitting on a bench in the courtyard with her grandmother. She was nine years old and HIV-positive. She had received the virus from her mother, who had died. AIDS had taken her father, too. Yet the little girl was smiling. Her grandmother explained that Catholic Relief Services had been paying for the girl to receive treatment at the PEPFAR clinic. “As a Muslim,” the elderly woman said, “I never imagined that a Catholic group would help me like that. I am so grateful to the American people.”
At a news conference, I reiterated my call for Congress to reauthorize and expand PEPFAR. President Kikwete jumped in: “If this program is discontinued or disrupted, there would be so many people who will lose hope; certainly there will be death. My passionate appeal is for PEPFAR to continue.” An American reporter asked him if Tanzanians were excited about the prospect of Barack Obama becoming president. Kikwete’s reply warmed my heart. “For us,” he said, “the most important thing is, let him be as good a friend of Africa as President Bush has been.”
As we were flying back to Washington, Laura and I agreed the trip had been the best of the presidency. There was a new and palpable sense of energy and hope across Africa. The outpouring of love for America was overwhelming. Every time I hear an American politician or commentator talk about our country’s poor image in the world, I think about the tens of thousands of Africans who lined the roadsides to wave at our motorcade and express their gratitude to the United States.
By the time I left office in January 2009, PEPFAR had supported treatment for 2.1 million people and care for more than 10 million people. American taxpayer dollars had helped protect mothers and babies during more than 16 million pregnancies. More than 57 million people had benefited from AIDS testing and counseling sessions.
The results of the Malaria Initiative were equally encouraging. Through the distribution of insecticide-treated bed nets, indoor spraying, and the delivery of medicine for infected and pregnant mothers, the Malaria Initiative helped protect twenty-five million people from unnecessary death. Several countries, including Ethiopia, Rwanda, Tanzania, and Zambia, were ahead of schedule in meeting the goal of cutting malaria infection rates by more than 50 percent.
Passing out bed nets to mothers in Arusha, Tanzania, as part of our malaria initiative.
Africa’s needs remain tremendous. There are still more than twenty-two million people living with AIDS. Some who need antiretroviral drugs still go without. While malaria is in retreat, there are still children dying needlessly from mosquito bites. Poverty remains rampant. Infrastructure is lacking. And there are pockets of terrorism and brutality.
While these challenges are daunting, the African people have strong partners at their side. The United States, the G-8, the UN, the faith-based community, and the private sector are all far more engaged than ever before. The health infrastructure put in place as part of PEPFAR and the Malaria Initiative will bring wide-ranging benefits in other areas of African life.
Perhaps the most important change in recent years is in the way Africans see themselves. Just as AIDS is no longer viewed as a death sentence, the African people have newfound optimism that they can overcome their problems, reclaim their dignity, and go forward with hope.
On our trip to Rwanda in 2008, Laura and I visited a school where teenagers—many of them orphans—were taught about HIV/AIDS prevention. One lesson focused on showing girls how to reject the advances of older men, part of the abstinence component of PEPFAR.
As I walked by a cluster of students, I said, “God is good.” They shouted back in unison, “All the time!”
Here in Rwanda, a country that had lost hundreds of thousands to genocide and AIDS, these children felt blessed. Surely those of us in comfortable places like America could learn a lesson. I decided to say it again.
“God is good.”
The chorus responded even louder, “All the time!”
*The team included Dr. Tony Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases, and his assistant director, Dr. Mark Dybul; Gary Edson, my deputy national security adviser and top staffer on international development; Jay Lefkowitz, my deputy domestic policy director; Robin Cleveland from the Office of Management and Budget; Kristen Silverberg, one of Josh’s deputies; and, later, Dr. Joe O’Neill, the director of national AIDS policy.
**Botswana, Cote d’Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia. At Congress’s request, we later added one Asian nation to PEPFAR, Vietnam.
***We visited Benin, led by Yayi Boni; Tanzania, led by Jakaya Kikwete; Rwanda, led by Paul Kagame; Ghana, led by John Kufuor; and Liberia, led by Ellen Johnson Sirleaf.
n September 2006, with the midterm elections approaching, my friend Mitch McConnell came to the Oval Office. The senior senator from Kentucky and Republican whip had asked to see me alone. Mitch has a sharp political nose, and he smelled trouble.
“Mr. President,” he said, “your unpopularity is going to cost us control of the Congress.”
Mitch had a point. Many Americans were tired of my presidency. But that wasn’t the only reason our party was in trouble. I flashed back to the Republican congressmen sent to jail for taking bribes, disgraced by sex scandals, or implicated in lobbying investigations. Then there was the wasteful spending, the earmarks for pork- barrel projects, and our failure to reform Social Security despite majorities in both houses of Congress.
“Well, Mitch,” I asked, “what do you want me to do about it?”
“Mr. President,” he said, “bring some troops home from Iraq.”
He was not alone. As violence in Iraq escalated, members of both parties had called for a pullout.
“Mitch,” I said, “I believe our presence in Iraq is necessary to protect America, and I will not withdraw troops unless military conditions warrant.” I made it clear I would set troop levels to achieve victory in Iraq, not victory at the polls.
What I did not tell him was that I was seriously considering the opposite of his recommendation. Rather than pull troops out, I was on the verge of making the toughest and most unpopular decision of my presidency: deploying tens of thousands more troops into Iraq with a new strategy, a new commander, and a mission to protect the Iraqi people and help enable the rise of a democracy in the heart of the Middle East.
The pessimism of September 2006 came in contrast to the hope so many felt after the liberation of Iraq. In the year after our troops entered the country, we toppled Saddam’s regime, captured the dictator, rebuilt schools and health clinics, and formed a Governing Council representing all major ethnic and sectarian groups. While the lawlessness and violence exceeded our expectations, most Iraqis seemed determined to build a free society. On March 8, 2004, the Governing Council reached agreement on the Transitional Administrative Law. This landmark document called for a return of sovereignty in June, followed by elections for a national assembly, the drafting of a constitution, and another round of elections to choose a democratic government.
For almost three years, this road map guided our strategy. We believed that helping the Iraqis meet those milestones was the best way to show Shia, Sunnis, and Kurds they had a stake in a free and peaceful country. Once Iraqis were invested in the democratic process, we hoped they would resolve disputes at the ballot box, thereby marginalizing the enemies of a free Iraq. In short, we believed political progress was the path to security—and, ultimately, the path home.
Our military strategy focused on pursuing the extremists while training the Iraqi security forces. Over time, we would move toward a smaller military footprint, countering the perception that we were occupiers and boosting the legitimacy of Iraq’s leaders. I summed up the strategy: “As the Iraqis stand up, we will stand down.” Don Rumsfeld had a more memorable analogy: “We have to take our hand off the bicycle seat.”
