President George W. Bush will bequeath his successor one of the more vexed foreign policy environments ever to face an incoming U.S. leader. But one exception is the case of AIDS in Africa, where most analysts agree the Bush legacy will be almost wholly benign. Since 2003, the U.S. government has spent $15 billion on care and treatment for AIDS under the President's Emergency Plan for AIDS Relief (PEPFAR). The program has helped 1.4 million people in 15 countries, most of them in Africa, the continent with the highest HIV/AIDS infection.
The President this week began a tour of five countries in Africa Benin, Tanzania, Rwanda, Ghana and Liberia clearly selected to highlight U.S. benevolence and to showcase the sort of genuinely enthusiastic public welcome all too rare in Bush's trips abroad. At the start of his trip, Bush told reporters he wanted to draw attention to some of the success stories on a continent all too often considered one big disaster zone. The visit was about "heralding good leadership, it's heralding honest government and is focusing our help on local folks' efforts to deal with malaria and AIDS," he said.
The President has asked Congress to extend and double the funding of PEPFAR when the five-year program expires in 2008. PEPFAR provides anti-retroviral drugs and other treatment for HIV-positive and AIDS patients in developing countries, while also trying to prevent new infections using the "ABC" approach: abstain, be faithful and use condoms. An earlier controversy over the first tenet of that drive abstinence, which critics claimed reflected an effort impose a conservative Christian morality amid a humanitarian catastrophe remains. "Certain constituencies, such as sex workers, are excluded from PEPFAR money," says Ayesha Kajee, program director of the International Human Rights Exchange at Wits University in Johannesburg. But the program is also just one of the ways in which the Bush Administration has dramatically increased aid to Africa.
The President also led a $1.2 billion initiative to fight malaria, focusing on low-tech solutions such as bed nets, and, along with other leading industrialized nations, has granted $34 billion in debt relief for African nations in the past 18 months. While warning that proposed changes to PEPFAR's priorities, including dropping a requirement that 55% of funding be spent on medical care, could "cut the heart out of this life-saving AIDS care and treatment program," the AIDS Healthcare Foundation acknowledged PEPFAR was "widely expected to be among the President's most lasting and favorable legacies."
Alex de Waal, program director at New York's Social Science Research Council and author of several books on Africa, says that Bush had "exceeded expectations" on Africa. "Clinton talked the talk," said de Waal, "but Bush has actually done something. The amount of resources now dedicated to Africa are more than the Democrats ever even talked about. That's quite impressive." Kajee concurs. "Most analysts agree that there has been a far more concentrated Africa policy under Bush than under previous administrations."
In Dar es Salaam, Tanzania's commercial capital, on Monday, Bush praised efforts by his Tanzanian counterpart, Jataya Kikwete, to fight corruption: "You are a strong leader," he said. According to the U.S. embassy in Tanzania, Washington will contribute $662 million to the East African nation this year. The Millennium Challenge Corporation also granted Tanzania $698 million for water, energy and infrastructure projects. "I'll just put it bluntly," said Bush. "America doesn't want to spend money on people who steal the money." Kikwete replied: "Different people may have different views about you and your Administration and your legacy. But we in Tanzania ... know for sure that you, Mr. President, and your Administration have been good friends of our country and have been good friends of Africa. Rest assured that you will be remembered for many generations to come for the good things you've done."
There's no question, of course, that President Bush is accentuating the positive. In Tanzania's northern neighbor, Kenya, corruption and vote-rigging is at the center of a bloody stand-off between the government and the opposition in which 1,000 have died since a disputed general election in December. Notwithstanding the President's comments in Tanzania, the U.S. gives $1 billion a year in aid to a Kenyan government that ranks eighth from the bottom in Transparency International's world corruption tables. Bush has declined to visit Kenya, a key ally in Africa, sending Secretary of State Condoleezza Rice to bolster mediation efforts by former U.N. secretary general Kofi Annan.
Even more pressing than Kenya is Darfur in western Sudan, where civil war has killed 200,000 people and made refugees of more than 2 million more; Zimbabwe, where President Robert Mugabe, 83, presides over a deepening economic collapse; and Somalia, where civil war has raged for 17 years and where a U.S.-backed Ethiopian invasion in early 2007 helped exacerbate what the U.N. now says is the worst humanitarian crisis in Africa. De Waal described Somalia as "the greatest" of the "major shortcomings" in the Administration's policy towards Africa, which also included a "largely negative" impact of the war on terror. So far Bush has yet to mention either Somalia or U.S. military expansion in Africa, which culminated in the establishment of a separate military command for the continent, Africom, last October.
Kajee suggests that the places not on Bush's itinerary but nevertheless bearing some degree of a U.S. footprint will also have some impact on how the current Administration is viewed. "To ignore the Horn of Africa, which is the region with the highest rate of humanitarian need in the world, is a bit of a slap in the face for citizens of those countries," said Kajee. "It's very significant that he has chosen not to visit Kenya or Ethiopia when the U.S. is so close to both. It seems opposed to the stated U.S. focus on Africa and concern for its citizens. You have to ask if Bush is only focusing on feel-good stories and avoiding the hot spots."