Walking Together, Walking Far: How a U.S. and African Medical School Partnership Is Winning the Fight against HIV/AIDS

4. “Seldom Has History Offered a Greater Opportunity”

“Seldom Has History Offered a Greater Opportunity” 51 4 “Seldom Has History Offered a Greater Opportunity” On June 7, 2001, Representative Henry Hyde, then the chair of the International Relations Committee of the U.S. House of Representatives , convened a hearing to discuss his new global AIDS bill, which included a pilot program for purchasing and delivering antiretroviral drugs. But the hearing on the Global Access to HIV/AIDS Prevention, Awareness, Education and Treatment Act started on a sour note with the testimony of Andrew Natsios, recently confirmed as President George W. Bush’s administrator for the U.S. Agency for International Development (USAID), and a veteran of USAID from the George H. W. Bush administration. Natsios told the committee that the United States was better off focusing on the prevention aspects of global AIDS, since treatment of the 25 million people infected with HIV in sub-Saharan Africa was virtually impossible: People [in Africa] do not know what watches and clocks are. They do not use Western means for telling time. They use the sun. These drugs have to be administered during a certain se- 52 walking together, walking far 52 walking together, walking far quence of time during the day. And when you say, “take it at ten o’clock,” people will say “what do you mean ten o’clock?” They don’t use those terms in the villages to describe time. They describe morning and afternoon and evening. So that’s a problem. Natsios’s testimony stoked immediate controversy. Advocates pointed out that he was wrong in several of his stated premises for pessimism about treatment, which included a supposition that the antiretroviral medicine needed to be frozen and that there are no roads in Africa. Several African advocacy groups and members of the Congressional Black Caucus called for Natsios to resign. In his excellent book, The Invisible People: How the U.S. Slept through the Global AIDS Pandemic, the Greatest Humanitarian Catastrophe of Our Time, Greg Behrman reports that United Nations secretarygeneral Kofi Annan intentionally arrived forty-five minutes late for a subsequent meeting with Natsios. “I’m sorry,” the Nobel laureate from Ghana said with undisguised sarcasm. “I’ve been having trouble telling time.” But however clumsy he was in stating his rationale, Natsios’s gloomy view of the possibility of treatment accurately reflected much of the conventional—and fatalistic—wisdom about how the international community and the United States should approach the HIV/AIDS pandemic. Two months before Natsios’s testimony, the Washington Post quoted an unnamed global health official reflecting on the crisis and saying, “It’s so politically incorrect to say, but we may have to sit by and just see these millions of [HIV-infected] people die.” Even a year after Natsios’s testimony, the prestigious British medical journal Lancet published an article by AIDS researchers saying that any new funding to address the HIV/AIDS crisis must be allocated to prevention efforts instead of antiretroviral treatment for those already infected. The reluctance to support treatment had bipartisan roots, as global AIDS had not been a priority for the Clinton administration either. “It is hard to explain that moral failing [during the Clinton presidency],” Allen Moore, formerly the legislative director for Senator Bill Frist and now a senior fellow at the Global Health Council, said in a 2007 address to the Johns Hopkins Bloomberg School of Public Health. “Some of it was ignorance; some was “Seldom Has History Offered a Greater Opportunity” 53 indifference; some was politics. There was no call to action by the President nor was there any bi-partisan political consensus to move forward aggressively.” At the time of Natsios’s testimony in mid-2001, the second President Bush seemed no more willing than Clinton to pursue a course that would include AIDS treatment in sub-Saharan Africa . “I don’t know [Natsios] very well personally,” says Dr. Joe O’Neill, who would become director of Bush’s Office of National AIDS Policy a year after the testimony. “But his statement reflected his agency. USAID was just not interested in HIV treatment.” Remarkably, it was just nineteen months later, in the State of the Union address he delivered at the U.S. Capitol on January 28, 2003, that Natsios’s boss, President Bush, dramatically announced the largest commitment ever by one nation toward a single international disease—and HIV treatment was the very core of Bush...