BRANCACCIO: Welcome to a special edition of NOW.
Congratulations. You may have helped someone live today. Alas, you may have also let someone die.
When you pay taxes to your government that's them behind me a crucial piece of that money can play a huge role in the health of poor people in far flung parts of the world.
This week, public television in concert with other media, has been taking a concentrated look at what can be done to stop people around the world from dying of preventable diseases.
A key part of this is the compelling tale of America's response to that killer of more than 20 million people the AIDS virus. President Bush has pushed through an exponential increase in money to fight aids around the world. There's a scramble to put that money to the best use - including, for the first time, large scale treatment in poor countries of those who carry the AIDS virus.
That's not all. There's a lot of money going to groups who say the best way to prevent AIDS is abstinence until marriage. In fact, religious groups are fighting to apply their moral agenda to America's international public health response. Tom Casciato produced our report.
Uganda is a jewel of East Africa a mountainous country of 27 million straddling the Equator.
This world of bountiful banana trees and rich coffee beans might seem a million miles away from the concerns of Americans. But America, you might be surprised to learn, is in deep in Uganda politically, financially, medically, and morally #151; all because of AIDS.
Coping with AIDS has become a way of life and death in Uganda. In the past quarter century the disease has claimed about a million lives.
But Dr. Peter Mugyenyi, who leads Uganda's battle against the disease, finds hope today where once there was none: even in the most dire cases.
DR. PETER MUGYENYI: now we are seeing infiltrations of disease, both sides of the chest and this infection is most likely tuberculosis for which he is receiving treatment.
BRANCACCIO: Eleven-year-old Paul Tebusweke Kiwanuka lost both his parents to aids. Just over a month ago, he came to see Dr. Mugyenyi suffering multiple infections.
DR. PETER MUGYENYI: This child is a miracle child. When I saw this child about a month ago, he could hardly sit; he had to be lifted everywhere. I didn't think he would survive. In the days gone by this kind of child would have absolutely no chance. He would have long been dead. Because besides treating him for tuberculosis, other secondary chest infections, he is also on antiretrovirals. So that's why he's gaining his strength and now, happily, he can play and begin to draw some pictures.
BRANCACCIO: Paul's life is being saved by drugs paid for directly by the United States your tax dollars. And to understand how that came about is to understand one of the most extraordinary American policy decisions of our time, one that is changing the world.
Life-saving aids drugs were invented a decade ago, but it is only in the last two years that the US has paid big money to provide them in developing countries.
The man behind that sea-change in American foreign aid policy is one better known for his prosecution of a different kind of war.
HOUSE OF REPRESENTATIVES: Mr. Speaker, the President of the United States!
BRANCACCIO: January, 2003. In the same State of the Union address in which he makes known his intention to attack Iraq, President George W. Bush is about to announce another plan to lead America down a path from which it will not easily - if ever - return.
PRESIDENT GEORGE W. BUSH: Today on the continent of Africa nearly 30 million people have the AIDS virus, including three million children under the age 15. There are whole countries in Africa where more than one-third of the adult population carries the infection. More than four million require immediate drug treatment. Yet, across that continent, only 50,000 AIDS victims - only 50,000 - are receiving the medicine they need. 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.
BRANCACCIO: The President was about to launch an unprecedented plan which would give 15 billion dollars to fifteen countries - including Uganda - to fight the global AIDS epidemic.
PRESIDENT GEORGE W. BUSH: I ask the Congress to commit 15 billion dollars over the next five years, including nearly 10 billion dollars in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean.
DR. PETER PIOT: When the history of AIDS will have been written, I think that President Bush's emergency plan will be a key event. A milestone.
BRANCACCIO: Dr. Peter Piot is head of UNAIDS, the United Nations arm which pushes for global action against the epidemic.
DR. PETER PIOT: This is the really defining event where we move from the M word to the B word when it comes to money. Before we had millions and millions of dollars. But President Bush put billions on the table.
Dr. Peter Mugyenyi was a special guest at the State of the Union address.
DR. PETER MUGYENYI: What are you working on now?
BRANCACCIO: He runs Uganda's Joint Clinical Research Centre, the hub of the country's anti-AIDS effort, recipient of about seven million dollars since the president's plan passed in 2003.
He says he was moved by the president's humanitarian gesture. From the beginning, he also recognized the plan as part altruism, part politics.
DR. PETER MUGYENYI: First of all, this was an emergency. It was imperative that America does something about a crisis that affected humanity, so this was point number one. Point number two-America, of course-- was involved in a-- other world affairs. Some of which did not exude humanitarian and charity characteristics. And it was very important for America, not always to be seen in the light of militaristic tendencies. It had to be-- to show its compassion to the world.
Compassion is abundant in the President's program. It's been hailed by the right, left and everyone in between for its treatment provision, which is keeping poor AIDS victims alive.
But the plan isn't only about treating AIDS - it's about preventing it, as well - and many advocates say there are aspects of the prevention part of the plan that are less about compassion and more about pushing the ideological agenda of the President's powerful electoral base: the Christian right.
For example: many AIDS prevention programs around the world have long provided condoms to prostitutes and their clients to prevent the transmission of HIV during sex.
Conservatives in Congress have made sure that American law mandates that any group that receives HIV-AIDS money must publicly pledge its explicit opposition to prostitution, as well as sex-trafficking.
DAVID BRANCACCIO: Do you feel that this kind of pledge against prostitution would get in the way of condoms getting to places where maybe condoms should be used?
JANICE CROUSE: Well, it definitely does get in the way of condom distribution. But the thing that is I think really important for the American public to understand is that condoms are not a solution to the problem.
BRANCACCIO: Janice Crouse is a senior fellow at the Beverly Lahaye Institute, think tank for Concerned Women for America, one of several Christian right groups pressuring the President to tilt global AIDS prevention efforts emphatically from condoms to sexual abstinence until marriage.
JANICE CROUSE: I'm against condoms as a solution to the-- problem of sexually transmitted diseases. I'm against condoms as a solution to the AIDS epidemic. Uh… I hear so many people blithely say, okay, let's distribute condoms and we'll cut down on the disease. We'll make it much safer for a girl to be a prostitute. And she can choose this as an appropriate career option.
DAVID BRANCACCIO: You really see people, officials, promoting prostitution as some sort of legitimate career path?
JANICE CROUSE: There's no question. And there are people who passionately believe that it's a matter of women's rights and, that this is a-- way to make a living, particularly for people in very poor countries where they don't have a lot of options for women.
JODI JACOBSON: I know of no organization that says, "Gee, let's go out and invite people to become commercial sex workers."
BRANCACCIO: Jodi Jacobson runs the Center for Health and Gender Equity, a liberal advocacy group which monitors U.S. overseas funding policy.
JODI JACOBSON: Nobody in the public health field supports prostitution. And you cannot go in waving a flag into a community in India, saying, "We hate you and we think you're immoral. But we want to work with you anyway." You need to work where the population is and the only way to do that is to build trust.
BRANCACCIO: Advocates like Jacobson point to one of the world's few AIDS success stories: Thailand. A member of the Thai Senate has become a bit of an AIDS-prevention legend for his promotion of condoms among sex workers.
MECHAI: She says she uses a condom every time.
Thailand, with perhaps the world's most flourishing sex trade, had an 83% drop in new infections between 1991 and 2002.
Then there's the case of Brazil. Earlier this year, a coalition of Brazilian nongovernmental organizations turned down $40 million in American aid for HIV-AIDS, rather than take that U.S. Pledge to condemn prostitution.
The director of the country's AIDS program said, quote "We must remain faithful to the established principles of the scientific method and not allow theological beliefs and dogma to interfere."
DAVID BRANCACCIO: You know, Brazil says, we're gonna have trouble taking U.S. money, because we feel that giving out condoms will reduce the spread of AIDS. That from their moral point of view not to give out condoms will is morally reprehensible.
JANICE CROUSE: Right. And, they've taken that stance, and they've said, you know, "We're not going to accept money." And, I say, "Tough. You know, it'll go to somebody else."
America's AIDS law does recognize the importance of condoms in preventing HIV, and provides money to promote and distribute them. But conservatives in Congress pushed through a provision stating that fully 33 per cent of prevention funds are set aside for programs that promote only abstinence and faithful heterosexual marriage.
JODI JACOBSON: We are sending these-- these monies to so-called faith-based organizations. At a very rapid clip. Many of which have no public health history or public health capacity. They merely qualify because they are quote/unquote faith-based.
BRANCACCIO: Jacobson says the faith-based approach is bound to fail in preventing AIDS.
PASTOR MARTIN SSEMPA: Okay. Who is doing the drama?
BRANCACCIO: Ugandan Evangelical minister Martin Ssempa Begs to differ. He testified before Congress this year that the problem is the U.S. isn't spending enough on abstinence.
PASTOR MARTIN SSEMPA (Congressional testimony): The reasons why South Africans and Ugandans are dying is because of sexual promiscuity. That is what's killing us.
PASTOR MARTIN SSEMPA (school event): Ay, Grace High, oh yea!
BRANCACCIO: Ssempa is Uganda's most provocative abstinence promoter. On the grounds of a Christian high school, just outside the capital city of Kampala, it's easy to see why.
PASTOR MARTIN SSEMPA (school event): Who has the greatest sex? Is it the single guys? Is it the Hollywood people? Who do you think? Ask your neighbor, who do you think has the greatest sex? Is it the guy who has, you know, a woman with the biggest breasts and the biggest cabina who walks like that?
PASTOR MARTIN SSEMPA: Some of the American foreign-- aid agency workers. Some of them think that abstinence is President George Bush's big joke from Texas. Before we ever heard of George Bush, I didn't even know the guy, I was an abstinence activist. Long before Bush is gone, we will still be promoting abstinence before marriage and fidelity in marriage as the major way of fighting HIV/AIDS.
PASTOR MARTIN SSEMPA (school event): The lightest? The one with greatest hair? Which one? They found that for people who have the greatest sexual satisfaction were married people who have a relationship with God.
BRANCACCIO: Ssempa drew international attention not long ago when he publicly set fire to a box of condoms…yet he does concede they're necessary in some situations.
PASTOR MARTIN SSEMPA: The message is I believe you can abstain. I also tell them, "If you're gonna be so foolish as to have sex outside of marriage, condoms may reduce your chances of getting HIV."
BRANCACCIO: But his troupe performs a skit to teach that relying on condoms for protection is downright dangerous.
DOCTOR: Penny, do you have a boyfriend?
PENNY: That's normal for every one, Doctor. I have-- and I have only one. One-- one boyfriend.
DOCTOR: You have only one. Have you been having sex with this boy?
PENNY: Yes, Doctor. We have it once. And-- and we used a-- a condom.
DOCTOR: It was once and used a condom?
PENNY: Yes. And I have been faithful to him. And he's been faithful to me, I guess.
DOCTOR: Penny, believe it or not, these are your results.
PENNY: HIV positive? I'm even pregnant? Are you sure? This can't be my results.
DOCTOR: I'm sorry, but they're your results.
PENNY: No, doctor, these can't be my results. I'm telling you!
BRANCACCIO: The State Department lists Ssempa's church as a "sub-partner," which means U.S. money has been given to a Ugandan AIDS prevention group, and then, in turn, has gone to Ssempa. Ssempa says he's gotten no such money, though he expects to soon.
PENNY: Oh my God!
PASTOR MARTIN SSEMPA (school event): You have to say, "No, I don't want to have sex."
BRANCACCIO: Furthermore, Ssempa believes America should be funding him directly, and says he'll apply for a grant to spread his unique brand of talk about sex, faith, and condoms.
PASTOR MARTIN SSEMPA: Most guys that I talk about it are like, "Ooh, man. If she says to me no condom, that would be the greatest thing in the world. I would do it, because why have your candy inside a jacket? Eat the candy with-- without the wrapper." That's the way it's supposed to - Now with talk like this, I keep telling them, "Guys, I want you to have the candy. You can eat the candy in the morning, at midnight, before the sunset without the wrapper, but do it in a confine of marriage.
PASTOR MARTIN SSEMPA (school event): Father, we just thank you for the opportunity of Grace High School….
BRANCACCIO: How did the Christian right's particular moral vision become imbedded in America's largest commitment ever to deal with global AIDS? There's a story behind the evolution of the U.S. Policy. It begins in 1981 when AIDS first darkened America's door.
President Ronald Reagan had just come into power, in part by successfully courting the Evangelical right's nascent political movement. Its most visible spokesperson was the Reverend Jerry Falwell, who in one of his televised sermons called aids "God's punishment" for violating his laws.
JERRY FALWELL: This lethal epidemic sweeping out of control through the homosexual enclaves of America has been turned into a propaganda ploy, in our opinion.
BRANCACCIO: Reagan aide Pat Buchanan joined in, claiming that gays "…have declared war upon nature, and now nature is exacting an awful retribution."
BRANCACCIO: The president they had helped bring to power was saying nothing at all. In fact, it appeared no one in the administration wanted to address the public frankly about AIDS education…no one, that is, except for one person.
DR. C. EVERETT KOOP: If you were to get together a think-tank of people from various walks of life and said, "I want you to construct a disease that will be a scourge to the country, and will have political, social, economic, sexual, all sorts of overtones," you could not invent anything better than AIDS.
Dr. C. Everett Koop was America's Surgeon General under President Reagan. He'd been appointed to the office based on his solid anti-abortion credentials, and a belief that he wouldn't make waves.
DAVID BRANCACCIO: Now Dr. Koop, just to explain-- you're not some libertine in your-- you're a pretty straight-laced guy?
DR. C. EVERETT KOOP: Well, you would have label me a conservative. And-- but I'm a flexible conservative. And to make it clear, we had never, as a medical profession, dealt with people when they were sick on the basis of how they got sick.
You have this bully pulpit, you're the surgeon general. Could you get out there and speak out and do your job?
DR. C. EVERETT KOOP:
Early on I was taken aside by assistant secretary for health, that was my immediate superior and-- he said that-- in the scheme of things, I would not be required to do anything about AIDS. And it was-- it was enforced in a strange way. Whenever I appeared on, GOOD MORNING AMERICA, or THE TODAY SHOW, or something like that, there was always somebody from the public relations department who either preceded me or accompanied me and made it very clear to the anchor that I was not to discuss AIDS. And I was told, "If you get a question, evade it."
DAVID BRANCACCIO: Evade it?
DR. C. EVERETT KOOP: Evade it.
BRANCACCIO: The scientific community was not evading aids. It identified HIV as the virus that caused it, came up with a test for it, and even developed a drug that modestly slowed its progress: AZT.
AIDS ACTIVISTS: Shame, shame, shame, shame!
BRANCACCIO: None of it was happening fast enough for gay activists. People were dying, and they wanted a cure -- now. They lobbied and harassed the U.S. government, pushing for more research money and more access to more drugs more quickly. All the while, the Christian right held its ground. The problem wasn't AIDS. The problem was sex.
PHYLLIS SCHLAFLY: I would prefer that public schools teach children to abstain from sexual activity until they get married. But it doesn't take very long to say that. I mean how long does it take to say that? Just tell them to keep your hands out of what's inside your swimming suit. That takes care of both girls and boys.
President Reagan kept mum: he didn't give a major speech on AIDS until 1987, six years into the epidemic.
Other world leaders, particularly in Africa, didn't do much better. But one president was speaking up in the 1980s: the president of Uganda. Yoweri Museveni had come to power in 1986 following one Of Sub-Saharan Africa's bloody, post colonial wars.
When he sent some troops to Cuba for training, Fidel Castro had the men tested for HIV. Then the Cuban president told Museveni "you've got a problem." Not only were soldiers infected - aids in Africa was quickly spreading heterosexually.
PRESIDENT YOWERI MUSEVENI: I could see that-- heterosexually transmitted-- disease could be catastrophic Therefore, as soon as I knew that-- AIDS could spread heterosexually, I knew that our-- our community was in very grave danger.
DR. PETER PIOT: President Museveni himself took on the fight against AIDS. It became a priority for the country as a whole.
PRESIDENT YOWERI MUSEVENI: We should care for people with AIDS as a community and as individuals.
BRANCACCIO: Museveni urged young people to delay having sex. And in a country where it was common for men, particularly, to have many sexual partners he stressed a concept known as "zero grazing."
DR. PETER PIOT: Because - in Uganda, lots of stories that are around cattle and cows. And-- zero grazing meaning that the-- the bull-- has only one cow. And-- with a stick in the ground and so that, you know, there is grazing around that stick and not further on.
DR. PAUL DE LAY: There was theater, street drama-- puppet shows-- things that were really part of the culture. And, then the use of the limited electronic media like radio and like newsprint.
BRANCACCIO: Dr. Paul De Lay evaluated AIDS prevention projects in over 50 countries when he led the HIV/AIDS division of the U.S. Agency for International Development. He found the most vigorous sex education in Uganda.
DR. PAUL DE LAY: there was a very courageous decision to-- to move the actual facts about AIDS to younger and younger groups. Uganda led the way. They had the most graphic and probably the most useful-- education programs in schools than anywhere in sub-Saharan Africa.
BRANCACCIO: No such public education could be found in America. But there came a point where surgeon general c. Everett Koop felt he couldn't maintain his silence any longer.
DR. C. EVERETT KOOP: AIDS. Most of us know the facts about the disease, but we don't understand the facts, so that we can use them in our lives.
BRANCACCIO: He issued a pamphlet to every American household based on a report he'd made to the President.
DR. C. EVERETT KOOP: And when I put out that first report, I used four words that never had appeared before in the Congressional record, "Penis, Vagina, Rectum and Condom." That you-- you would think that World War was an inevitable result of that. It was unbelievable. Three weeks after I put that report out I was visited by a delegation from the domestic policy counsel. And what they wanted to know is if I didn't think it was time for a second edition. And I said no, we have about a million copies left. And-- why would I want a second edition? Cause, I knew why they wanted it.
DAVID BRANCACCIO: They wanted to revise it.
DR. C. EVERETT KOOP: Yeah. I said-- "Was there something about the first one that you didn't like?" "Well, we thought a few words might be changed." And I said to myself, "Penis, Vagina, Rectum, Condom." And I said, "Could you tell me what those words were?" Well, we think that-- you could do the whole thing without mentioning penis, vagina, rectum and condom. And-- I said no. We'll make no changes.
BRANCACCIO: HIV kept up its murderous onslaught, killing over 85,000 Americans during the 1980s.
Worldwide, by 1991 projections ranged from eight to twelve million infections.
By the early 90s, the highest prevalence of AIDS in the world was in Uganda.
DR. PETER MUGYENYI: It was a period of non-stop funerals. Offices were coming to standstill. Schools were losing teachers. Hospitals were losing doctors. I saw kids as young as six years becoming head of families. And me in my position, working in an AIDS research and treatment center, I lived the daily nightmare day after day.
BRANCACCIO: In the early 90s, Uganda's President Museveni added condom promotion to his anti-AIDS message, and soon the country was importing over 30 million per year and promoting them in the media.
Man #1: I use them all the time.
Man #2: You do?!
Man #1: I do.
BRANCACCIO: The campaign was meant to get maximum attention. One newspaper ad suggested that while the Bible could save your soul, the condom could save your life.
The ad infuriated religious leaders, as did a suggestion that condoms and Bibles be placed side by side on tables in hotel rooms.
Museveni's now-comprehensive prevention message eventually became known as ABC - A for abstinence, B for be faithful, and C for condoms…for those moments when A & B weren't on the table.
Prevention campaigns in Uganda and throughout the developing world were funded in part with U.S. Money. But global AIDS was never a top American priority, including when a democrat came to the White House.
PRESIDENT BILL CLINTON: In the last thirteen years, AIDS has claimed the lives of more than a quarter million of our fellow citizens.
DR. KENNETH BERNARD: He clearly understood the issue.
PRESIDENT BILL CLINTON: For nearly every American now, the face of AIDS is no longer the face of a stranger, but the face of a friend.
DR. KENNETH BERNARD: He was just eloquent as Clinton can be when he deals with issues that he feels strongly about.
Dr. Kenneth Bernard is currently advisor to the director of the World Health Organization in Geneva. During the Clinton years, he advised the National Security Council on health issues - the first physician ever to serve in that capacity.
DR. KENNETH BERNARD: The biggest problem with the Clinton administration was, while everyone understood the issue, it seemed to me that there was not enough push put behind expending the political capital to raise the funding.
BRANCACCIO: Clinton had promised a massive undertaking to stop aids when he was running for president, a modern day "Manhattan Project" he called it. Activists tried to hold him to that promise.
AIDS ACTIVIST (off screen - interrupts Clinton): If you are so concerned about AIDS where is the Manhattan Project on AIDS that you promised during your campaign?! One year! Lots of talk! No action!!
AIDS ACTIVIST (in front of White House): This president committed that he would launch an all out research effort to find a cure for AIDS…
BRANCACCIO: During Clinton's eight years in office, the U.S. Increased spending on global AIDS, from about 125 million dollars to about 340 million.
DR. KENNETH BERNARD: $340 million is still just an absurdly small amount. We tried to increase that, but Congress was somewhat reluctant.
BRANCACCIO: The reluctant Congressman-in-chief was North Carolina Senator Jesse Helms, champion of the religious right, and opposer of all things he connected with homosexuality - including increasing government funding for aids treatment, care, and education.
SEN. JESSE HELMS: …and I think it's about time that this Senate address the moral issue, and I've not heard one Senator, except listening to myself, who've said look, let's talk about who's causing this, who caused it from the very beginning?
DR. PAUL ZEITZ: He was certainly opposed to any effort to-- deal with HIV-AIDS because he understood this as-- being a disease that only affected morally corrupt people.
BRANCACCIO: Global AIDS activist, and public health official, Dr. Paul Zeitz.
DR. PAUL ZEITZ: And so he created a very difficult environment on Capitol Hill that actually slowed progress immensely.
BRANCACCIO: In 1995, Senator Helms sought to actually cut federal funds for domestic aids care, telling THE NEW YORK TIMES that people suffered from it due to their "deliberate, disgusting, revolting conduct."
Helms was denouncing the Senate action that reauthorized The Ryan White Care Act, named for an Indiana boy who died when he was infected through a blood transfusion.
Funding disputes aside, the Clinton years did witness a dramatic decline in U.S. deaths from AIDS. Miraculous new anti-retroviral drugs - if you could afford them -- reduced aids from a certain killer to a manageable disease.
And the Clinton administration led the world in recognizing that the epidemic had moved beyond a public health issue to one of international security.
VICE PRESIDENT AL GORE: Today marks the first time after more than 4,000 meetings stretching back more than half a century that the Security Council will discuss a health issue as a security threat.
BRANCACCIO: Still, activist Paul Zeitz believes the Clinton administration failed on AIDS because it didn't spend the big money it would have taken for a global prevention and treatment program.
DR. PAUL ZEITZ: If Clinton would've done a large multi-billion dollar initiative at the beginning of his second term, the trajectory of the whole pandemic globally especially in Africa would be completely different. We would've been able to nip this in the bud much earlier.
Clinton's successor in the White House didn't look at all like he was going to attack the global AIDS epidemic. He did have a strategy for improving society based on providing federal money to faith-based charities. But he was largely silent about global AIDS on the campaign trail.
Behind the scenes, though, something was brewing. Dr. Paul Zeitz recalls meeting with administration officials during the transition.
DR. PAUL ZEITZ: I was really excited during that time because I was impressed by their knowledge and their insight. They understood that millions of people were dying each year. They understood that we had it within our means to do a lot more than we were doing.
BRANCACCIO: Pressure was building from outside Washington, as well. Bush's supporters on the Christian right didn't like sex outside of marriage any more than they ever had. But it appeared they had decided to separate how someone got the disease, from what the Christian response to it ought to be.
FRANKLIN GRAHAM: …and issue an appeal to Christians worldwide to join us in the battle against HIV-AIDS.
AIDS ACTIVISTS: Where's the ten billion? Where's the ten billion?
BRANCACCIO: AIDS activists, meanwhile, who had historically focused mainly on domestic AIDS, were finally agitating for a global response.
DR. ANTHONY FAUCI: We started to see the same questions asked by the activists in Sub-Saharan Africa modeled and tutored by-- I'm sure-- the activists here in the United States-- about, "Hey, why not us? Why can't we have access to therapy?"
BRANCACCIO: Dr. Anthony Fauci, longtime director of The National Institute of Allergy and Infectious Diseases, Remembers the very recent past when conventional wisdom said you just couldn't treat AIDS in poor countries.
DR. ANTHONY FAUCI: Drug's too expensive. Health care delivery system not available. Africa isn't-- isn't amenable to this because of the logistic difficulties that you would face.
ANDREW NATSIOS: In many of these countries, there are no physicians to administer. One…
BRANCACCIO: In 2001, Andrew Natsios, appointed by President Bush to head USAID, told Congress it would be futile to spend money to try and treat AIDS in Africa because the drugs had to be taken at specific times each day, or the patient would become drug resistant. Some rural Africans, he said, don't tell time like we do.
ANDREW NATSIOS: They do not use western means for telling time, they use the sun. These drugs have to be administered during a certain sequence of time during the day. And when you say "Take it at 10 o'clock," people will say "What do you mean by 10 o'clock?"
BRANCACCIO: But even as it appeared as unlikely as ever that America would mount an all-out treatment assault on global AIDS, there was a new prevention effort that gained the support of the religious right, AIDS activists and politicians. It involved a new drug called nevirapine, which could simply and inexpensively stop the transmission of HIV from mother to child.
Anne Peace Baguma is an HIV-positive mother living in the Ugandan capital, Kampala. It wasn't until sometime after 11 year-old son Jeremiah was born that both Anne and her husband Grace became infected with HIV.
Neither was aware of it when Anne gave birth to a baby daughter, Dorcas.
ANNE PEACE BAGUMA: Here she was three weeks and here she was six months…
BRANCACCIO: Dorcas seemed healthy at first. But when she reached 8 months she started to get sick - a lot.
GRACE: She suffered from malaria and then, ah, later on with this pneumonia and then she got tuberculosis. After long illness, she died.
ANNE PEACE BAGUMA: He called me and said Dorcas is dead. They came rushing, but already he had finished dressing her up…This was the last picture she took. Her last picture…
If Anne had known she had HIV, nevirapine might have saved her daughter's life.
Stories like Anne's propelled the first mother to child prevention initiative - sponsored by Senators Bill Frist and Jesse Helms in the spring of 2002.
That's right, the same Jesse Helms who had tried to block the reauthorization of The Ryan White Act less than a decade before.
In one of public health's strangest couplings ever, the right wing Senator From North Carolina credited at least part of his conversion to an activist pop star from Ireland: the lead singer of U2, Bono.
BONO: Well, you know, it's an extraordinary thing, I will admit, to have Jesse Helms throw a lunch for you. And I will say it's extraordinary on a few levels because, you know, it's bad for both of our images.
BRANCACCIO: And at the White House, momentum was building toward something big: a foreign aid plan that wouldn't just prevent AIDS, but for the first time, treat it.
President Bush asked the government's experts, including Dr. Anthony Fauci, to hatch a plan. They came up with one which would blow the lid off any previous American effort against global AIDS.
DR. ANTHONY FAUCI: And just as we were getting to the point of some decision making going on, they said, "You know we can't just depend on you and a couple of your colleagues. We need to get some input from people who are actually in the field. Give us some models."
BRANCACCIO: Fauci called in several accomplished doctors, among them was an American, Paul Farmer.
DR. PAUL FARMER: You know, the-- current administration in Washington he said is trying to do due diligence-- Is this really possible to take on AIDS in-- places like Rwanda or Haiti or, you know, countries that are really poor.
DAVID BRANCACCIO: And treat AIDS.
DR. PAUL FARMER: And treat -- And you know I said, "I'd be honored to-- talk about that."
BRANCACCIO: Farmer had proven, in a little medical outpost in Haiti, that committed doctors and community-based health workers could successfully treat AIDS - if they only had the money for drugs.
DR. PAUL FARMER: So far in the last 20 years of working in Haiti, Rwanda, prisons in Siberia, slums in Latin America. I've never seen a situation, I've never been in a place where it's impossible to take care of the sick.
BRANCACCIO: Fauci also called an African colleague to help him make the case, Dr. Peter Mugyenyi.
DR. ANTHONY FAUCI: And I said, "Peter, you gotta come to Washington because we need you to do some convincing."
DR. PETER MUGYENYI: He would call and say "Peter, please-- come to Washington. to assure the skeptics that AIDS treatment was not only possible, but was also going to make a very big difference to the lives of people who were dying a preventable death."
BRANCACCIO: The doctors met with officials in Washington's Old Executive Office Building in November of 2002, not knowing what to expect.
DR. PAUL FARMER: And we got grilled. We were supposed to be there for an hour. We were in there for hours. The questions were really smart. They were critical and they were saying, "Well we're not gonna invest in something that isn't effective, that isn't gonna work."
BRANCACCIO: They asked Mugyenyi whether a clinic in a poor country could handle the technical and logistical challenges.
DR. PETER MUGYENYI: As to the difficulties of the technical tests and so on, we are doing it. And it is getting on quite well. As to the-- as to whether the drugs were going to be effective, we have patients, although not so many, on these drugs. And they are doing very well. So it is not a question of whether it would be feasible or not. It is a question of getting the drugs there as soon as possible.
DAVID BRANCACCIO: So you come out of the meeting. You're thinking it's going okay.
DR. PAUL FARMER: I'm thinking, "Hey I've never been to a meeting in, you know, in-- Washington, DC. You-- and-- -- invited to testify in closed quarters with the stalwarts of the Republican administration. How did I do?" And I thought-
DAVID BRANCACCIO: Well, because you get a meeting like that right and there could be-money attached to this.
DR. PAUL FARMER: Yeah, there could be huge things for your patients and people living in poverty.
DAVID BRANCACCIO: Do you think that meeting played a role, maybe an important role in shifting US policy?
DR. FARMER: So I'm told.
Indeed, history will likely say that meeting in that building sealed the deal. It was the last hurdle in a stunning, two-decade evolution that led to President Bush's historic announcement…
…15 billion dollars to fight global aids.
For the President's supporters on the Christian right, the plan had everything: billions to fulfill the genuine humanitarian ambition to save lives...And a channel for billions to be funneled into faith-based organizations to advance the movement's moral agenda.
Which brings us back to Uganda.
Uganda, you see, was an inspiration and a model for President Bush's Emergency Plan for AIDS…why? Because under President Museveni's leadership, the country lowered its AIDS-prevalence from about 15% in the early 90s, to about 5% a decade later. How did it come about?
DR. PETER PIOT: The problem is of course that we will never know, probably, what percentage of-- the decline is due to condom use. What percentage is due to abstinence. And so it's-- you can't always disentangle that. But we also know that no country has been successful in bringing down the number of new infections of HIV without strong condom promotion.
PASTOR MARTIN SSEMPA: Save Uganda…
BRANCACCIO: Those on the Christian right disagree…they claim too few condoms came too late to Uganda to have played much of a role in the country's AIDS turnaround.
Uganda's most prominent proponent of that theory is the country's First Lady, Janet Museveni.
FIRST LADY JANET MUSEVENI: You must acquire the personal discipline of abstinence, faithfulness and self-respect.
BRANCACCIO: She hosted a party for some 600 virgins late last year in an effort to promote abstinence until marriage. She has also called for a government census of virgins.
As for the "C" in the ABC approach, thanks to the First Lady you have to look a little harder for it than you used to.
She is behind a recent billboard campaign stressing abstinence and faithfulness … with condoms nowhere to be found…unless it's to disparage their effectiveness.
This year the U.S. is sending Uganda over 8 million dollars to promote abstinence and faithfulness, with some of that going to groups associated with the First Lady.
To see how abstinence, faithfulness and condom use play out in one Ugandan marriage, come visit a U.S.-funded program called ICOBI.
HEALTH WORKER: How are you? How are you? Good afternoon. Good afternoon. Good afternoon. Good afternoon Madame. Good afternoon. Good afternoon.
BRANCACCIO: Its mission includes trying to stop transmission of HIV by first testing for the killer virus.
A community health worker is going to explain what's going to happen to this couple…married for 10 years and parents of five children.
The couple has agreed to be tested today.
WIFE: For-- for me I have been-- fearing-- fearing testing. Because I think if I test I will die.
BRANCACCIO: He assures them that HIV is not necessarily a death sentence, and goes on to explain the testing procedure.
HEALTH WORKER: it will take about two hours. You will ask your questions…
BRANCACCIO: Next, up come the lab technician and counselor, who will do the test, and help the family understand the results.
COUNSELOR: if you have decided to take an HIV test…
BRANCACCIO: But first there's a counseling session. It begins with a challenge: the husband would prefer that his wife not hear the results of his test.
HUSBAND: My position is that to me I'd like to get my results individually. Because I don't want this woman to know my status. If it's very bad I'd like to receive them myself.
FEMALE COUNSELOR: I know.
HUSBAND: But only myself.
FEMALE COUNSELOR: Yeah, please can you tell us why you want to have the results as individual, not a couple?
HUSBAND: No, she's not supposed to know me.
FEMALE COUNSELOR: But-- she's your wife.
FEMALE COUNSELOR: Yeah.
HUSBAND: She's my wife. My wife-- why-- why you know my status?
MALE COUNSELOR: Yes. It is better when you accept TO take an HIV test as a couple. You get your results even if you become a positive both of you. Even if you are discordant. One of you is positive while one of you is negative. You shouldn't worry. We shall help you to cope with this situation and understand. So are you accepting take an HIV test and get the results as a couple or as individuals?
WIFE: Answer the question.
HUSBAND: Why not individually?
BRANCACCIO: They finally convince him that if husbands and wives know each other's results, then if one is positive and the other negative, they can use a condom to ensure the virus does not pass between them.
Next, they will speak with the wife and husband individually…about their sexual activities.
MALE COUNSELOR: When did you last have sex-- sexual contact?
HUSBAND: With another person?
MALE COUNSELOR: Any person. Whether your wife or any sexual partner outside marriage.
HUSBAND: It is of yesterday, last night.
MALE COUNSELOR: It is of yesterday last night.
HUSBAND: It was--
MALE COUNSELOR: No-
HUSBAND: And-- and because-- I don't live here all the time.
MALE COUNSELOR: Okay.
HUSBAND: I came yesterday and had to-- to do that.
MALE COUNSELOR: Okay now-- you have said you don't actually stay here throughout. You are working somewhere. Okay. Could you have had sex outside the marriage during your previous past three months? Could you have had sexual contact outside of marriage in the last three months?
HUSBAND: At least once.
MALE COUNSELOR: At least once. Did you use a condom with that sexual partner?
MALE COUNSELOR: You used a condom?
HUSBAND: I used a condom.
MALE COUNSELOR: How long have you been with that sexual partner?
HUSBAND: The other one or this?
MALE COUNSELOR: The other one?
HUSBAND: For quite a long.
MALE COUNSELOR: For quite a long.
HUSBAND: About three months.
MALE COUNSELOR: About three months.
HUSBAND: But always using a condom.
MALE COUNSELOR: But you always use a condom. Could you have had sex with any other person apart from that one whom you have stayed with in the past three months? Maybe in the past one year? How many sexual partners have you had?
HUSBAND: At least four.
MALE COUNSELOR: At least four.
FEMALE COUNSELOR: How many sexual partners are you having in the last three months apart from your spouse?
WIFE: For me since I get married-- I have never had sexual partner with another-- with another person.
FEMALE COUNSELOR: Another person.
WIFE: Only my husband.
FEMALE COUNSELOR: Only your husband.
BEATRICE WERE: However faithful a woman will be they do not have control over the sexual relationships that their spouses have with other women-- outside their marriages. And it is very common in Uganda that men have more than one sexual partner.
BRANCACCIO: Beatrice Were, HIV-positive herself, is a longtime Ugandan AIDS activist.
BEATRICE WERE: So it's these sort of situations that-- need to be borne in mind when we are promoting-- abstinence only or faithfulness-- against the other options.
BRANCACCIO: Were believes that all sexually active or potentially sexually active Ugandans - even married ones - need information about proper condom use, or HIV will spread even more than it already does.
BEATRICE WERE: We are seeing increasing-- number of-- infections in marriage settings. What that is communicating to us is that faithfulness per se is not enough.
FEMALE COUNSELOR: Sorry, sorry, sorry.
BRANCACCIO: Back in the village, the ICOBI technician performs the HIV-test in the back room of the couple's home.
MALE COUNSELOR: The results are ready, they are out. Now, both of you are HIV negative. Which means she's negative, you're negative.
WIFE: Now, I'm feeling very happy. Because I have tested-- negative. HIV negative. So, I feel very happy. And-- now, I'm trying to-- to protect myself from getting that virus. I will be faithful to my husband. He has tested negative also. That's why (LAUGHTER) we are very happy.
HUSBAND: To know that I'm negative, then it's very good. Yeah.
QUESTION: Now, tell me your plan now to avoid getting HIV/AIDS.
HUSBAND: I shall be faithful to her. It is number one. And secondly when I am going outside without her, I have to go with a condom, having protected sex.
DR. PETER MUGYENYI: The disease we are dealing with is a killer disease and we are absolutely sure of one thing. Not everybody will abstain. But what we know is that among those who are not abstain a big number of them will use condoms. And when they use condom it is another preventive tool. So in the war which is life and death you cannot be foolish and say you choose to use only part of your weapons. You have to unleash all the weapons that you have in your armaments so that you have the most effective outcome possible.
BRANCACCIO: The fact that this couple is HIV-negative means they're part of the Ugandan success story…transmission averted…so far.
Remember though, AIDS is a good news/bad news story in Uganda. In a nearby village, ICOBI community health workers have tested a family in which a four-year-old is not carrying the virus, but HIV has infected his father…his mother…his aunt…and his grandfather. Only the boy's father is getting anti-retroviral drugs. In Uganda, despite aid from America and other countries and donor organizations, over 60% of AIDS sufferers are not getting the medicine they need. But if this family represents the country's tragedy…
Anne Peace Baguma represents the country's hope. Just two years ago, shortly after the death of her daughter, Dorcas, she too was dying of AIDS. You wouldn't know it to see her today.
ANNE PEACE BAGUMA: Anybody would just look at me and know I have AIDS. Now my color is black, but then I had turned blue. And my lips were really red, like an alcoholic. But now unless I tell you that, because I don't have AIDS, do I? I only have the HIV, eh? That's actually a remarkable difference.
PHARMACIST: You will see that the packet has changed, but it is still the same drug. It is now in this blister pack.
BRANCACCIO: Once a month, she gets her drugs from Dr. Mugyenyi's clinic…
ANNE PEACE BAGUMA: It is time for medication.
BRANCACCIO: She takes them at prescribed times, twice a day. Ordinary activities - once impossible for Anne, are available again…like a trip on a motorcycle taxi with her son, Jeremiah, to Sunday services.
About 900,000 people in Uganda are HIV-positive. There were 70,000 new infections last year alone. A government survey suggests the AIDS prevalence rate is on the rise again.
Around the world the numbers are staggering: 40 million people are infected. 6.5 million are sick enough to need treatment…only 15% of them are getting it.
Only they have a chance to survive.