Just to give you an idea of the scale, here are some headline figures from a recent op-ed by U.S. Global AIDS coordinator Eric Goolsby:
In 2012 alone, PEPFAR directly supported nearly 5.1 million people on antiretroviral treatment -- a three-fold increase in only four years; provided antiretroviral drugs to prevent mother-to-child transmission of HIV to nearly 750,000 pregnant women living with the disease (which allowed approximately 230,000 infants to be born without HIV); and enabled more than 46.5 million people to receive testing and counseling.
So it's safe to say this one program has been a titanic force for good over the past decade. The number of deaths from AIDS has been steadily declining over the past few years, and PEPFAR has certainly been a big help. But ask an American -- or a Western European -- if they've ever heard of the program, and they're almost certainly to draw a blank. That's partly because the United States has done very little to publicize the success of PEPFAR, and partly because the Bush presidency was overshadowed by much more high-profile aspects of his foreign policy (such as the invasion of Iraq). Indeed, Bush still enjoys high popularity ratings in Africa, where he's widely regarded as one of the continent's great benefactors. (Meanwhile, the Obama administration's proposed PEPFAR cuts have triggered protests around Africa -- even in Kenya, where the president's family ties have ensured him plenty of favorable coverage.)
"Bush did more to stop AIDS and more to help Africa than any president before or since," says New York Times correspondent Peter Baker, who's writing a history of the Bush-Cheney White House that's due to appear in October. "He took on one of the world's biggest problems in a big, bold way and it changed the course of a continent. If it weren't for Iraq, it would be one of the main things history would remember about Bush, and it still should be part of any accounting of his presidency."
And yet no good turn goes unpunished. PEPFAR has also come in for criticism due to certain stipulations imposed on the program by conservative members of the U.S. Congress, who have pressured its administrators to promote abstinence and exclude prostitutes from treatment. But sources close to PEPFAR tell me that those restrictions have proven little hindrance on the ground.
In some ways, indeed, such complaints obscure the larger point. In an age of continuing partisan gridlock in Washington, what's really astonishing about PEPFAR is the way that it has continued to enjoy brought-based support from both Republicans and Democrats. Jack Chow, who served as special representative of U.S. Secretary of State Colin Powell on Global HIV/AIDS, notes that the idea of placing the United States at the forefront of the global war on AIDS was one area where both religious conservatives and socially active liberals managed to find common ground. "Bush wanted to do the right thing by fulfilling this humanitarian impulse," says Chow. "He didn't really do it for political purposes, in my opinion. I think he genuinely felt that the American response was slipping behind what was needed."
In so doing, Chow contends, Bush paved the way for an era in which global health assistance has become a prominent new instrument of U.S. statecraft. After all, spending so much money hasn't just boosted America's image among Africans; rolling back the widespread scourge of AIDS has protected social institutions in these countries from degradation and collapse, thus contributing to security and effective governance.
Surely this is the sort of business that America should be in. Yet the Obama administration is aiming to slash our commitment to this most potent form of smart diplomacy just at the moment when the possibility of wiping out this horrific disease is finally in sight. This is not the time to retreat.