My purpose this evening is very briefly to make a few comments about the visit to four countries in Africa that six Members of this body took during the last 2 weeks of August. The delegation was led by the majority leader, Senator Bill…
My purpose this evening is very briefly to make a few comments about the visit to four countries in Africa that six Members of this body took during the last 2 weeks of August. The delegation was led by the majority leader, Senator Bill Frist of Tennessee. It included the distinguished Presiding Officer, the Senator from Minnesota. I was there and three others. We visited four countries: South Africa, Mozambique, Botswana, and Namibia. It was an eye-opening and, for me, an eye-popping experience in many cases.
I have the privilege of serving as the chairman of the Subcommittee on African Affairs, so I am very interested in Africa. It was my second visit there in the last 3 years. Before I make a few comments about it, I want to simply observe how much we owe Senator Frist, our majority leader, for teaching us a great deal not just about Africa but about the HIV/AIDS problem which was the subject of our visit to Africa.
Senator Frist has been there a long time. When nobody else much was talking about HIV/AIDS, he was. He helped change some very important minds in this body. He has been an important adviser to the President of the United States and is an inspiration to us. When we left to come home after 10 days, he stayed for 5 days, went to Kenya and Sudan, and operated on people who have very little medical care, which he has done every year. We owe him a lot for his leadership on the subject.
Within a few weeks, the Congress will be considering the nomination of Randall Tobias to be the new AIDS czar, the person in charge of what we are going to try to do. Also, Congress will almost surely fund President Bush's recommendation that we spend $15 billion in 14 African and Caribbean countries to fight the disease which we call HIV/AIDS. It will be my purpose in our subcommittee and as a member of the Foreign Relations Committee and the Health, Education, Labor, and Pensions Committee, to make sure this taxpayer money, the largest public health expenditure ever, will be spent wisely. This evening, in summary fashion, while it is still fresh in my mind, I will make a few suggestions to Mr. Tobias, who is not yet confirmed by the Senate. I hope he will be. I know in this quiet time he is not allowed to do anything or say anything out of respect for the Senate, and it is a good time for him to make a plan for a fast start. If I were to make a plan for a fast start for Mr. Tobias, President Bush's designated AIDS czar, to be considered for confirmation by this body shortly, these would be my suggestions:
No. 1, I suggest Mr. Tobias go to Africa. I don't see how it is possible to understand the enormity of the disease if you do not go to Africa. The disease has delivered a death sentence to 29 million Africans, a number so large that it is hard to imagine. Go to Africa in order to make good spending decisions. Go to Africa in order to cut red tape. A commander of a major battle should be where the action is. While there, show some respect for the African way. We are very proud of the American way; the Africans are proud of their way. It is a little different.
When in Namibia, where we were, I suggest you play the Namibian national anthem and leave it to the local
mayor to say, as he said to us ``God bless America.''
No. 2, I suggest making needles and blood transfusions safe. It seems to me this is the surest, fastest way to save lives when dealing with HIV/AIDS. Senator Jeff Sessions of this body has made a project of reminding Members a number of people are infected by contaminated needles and by other unsafe health practices. The estimate would be that at least 175,000 people in sub-Saharan Africa this year will be infected with the HIV virus because of unsafe health practices. That means needles that are dirty, that have been used before, that have contaminated blood. That is just 5 percent of all of those in sub- Saharan Africa who will be infected, but it is a huge number of people, 175,000 people. By comparison, in the United States, only 40,000 people are infected with HIV/AIDS every year. In one hospital we visited in Namibia, health workers were recapping the needles they had already used and in the process risked pricking themselves with a used needle that could have infected blood on it.
A third suggestion: save the babies. This is also something that can be gotten off to a very fast start because it is already occurring. In Botswana, nearly 40 percent of pregnant women are HIV positive. One in three of the babies they bear will be HIV positive. Administering the drug nevirapine to the mother and then to the child after birth will reduce this risk to 1 in 10. Congress has already appropriated millions to start to create an AIDS-free generation. In Botswana, which only has 1.5 million residents, 100 babies are born each week infected with the HIV virus. In the United States, by comparison, less than 100 a year are born so infected.
Four, make inexpensive drugs widely available. There is no vaccine and no cure for HIV/AIDS. We sometimes talk around that. There is no vaccine and there is no cure, but there are medicines that prolong life. These antiretroviral drugs are cheaper than ever.
In Namibia last week we were told that the cost was $160 per person per year, dramatically more inexpensive than they have ever been before. In South Africa, we were told the availability of these treatments can decide whether 5 million infected South Africans will die in the next 5 years of HIV/AIDS or whether they might die in the next 20 years. That is the choice for just one country.
No. 5, encourage rapid tests and routine tests. Most Africans who are infected with HIV/AIDS do not know it. They are reluctant to find out because of the stigma attached to having it known you are HIV infected. New rapid tests report results in 20 minutes. Citizens can find out the results in a single visit. The inexpensive treatments, the $160 treatments, provide a new incentive to take the tests. Not a lot of Africans want to take a test and be told they would die of HIV/AIDS when there is no treatment. There is little incentive to get that bad news. Now there is incentive to get immediate news with the possibility of treatment.
Next, teach the ABC's--that stands for abstain, be faithful, and use condoms. Using this approach the country of Uganda in Africa has reduced its infection rate from 20 percent to 8 percent; 90 percent of AIDS is transmitted by sexual intercourse, something many Africans and many Americans do not know.
Janet Museveni is the First Lady of Uganda. She visited with many of the Senators earlier this year and talked about her ABC plan. She encourages A and B more than C. This is her quote: ``I am not comfortable,'' says the First Lady of Uganda, ``with the thought that the extinction of an entire continent could depend upon a thin piece of rubber.''
No. 7, form an AIDS corps. We heard everywhere we went the greatest need is for manpower and training. Hospitals need doctors, clinics need nurses, nonprofits need counselors to recruit patients and to hold the hands of those who are dying.
Create a private sector clearinghouse for Americans to go to Africa from 3 months to 2 years. Connect the volunteers with structures in Africa. I have introduced a bill to create an AIDS corps and I worried about whether volunteers should go for 3 months or for 1 year or for 2 years. There are plenty of options. I hope Mr. Tobias, if confirmed, will take all of the efforts already underway to take volunteers who are willing to go to Africa and connect them with one of the outstanding programs we saw there. There is plenty to do and a great many Americans who want to go, and they would be welcome.
No. 8, dig some water wells. In Mozambique, 3 of 4 children's deaths under the age of 5 are caused by diseases carried by unclean water. Since AIDS destroys immune systems, victims of all ages live longer with clean water.
One nonprofit agency, Living Water International was the name, I believe, showed the visiting Senators a well that was dug in a rural area for just $2,800. We saw there two boys who were filling 10-gallon water cans, five of them, which they would carry each day in a wagon to their home which was 6 miles away. That was their job every day: 6 miles to the well, fill up the cans, 6 miles back.
Forty percent of rural Africans do not have this much access to clean water.
Here are my last two suggestions. Focus on logistics. We saw faith- based and nonprofit organizations impressively active everywhere we went: The Salvation Army in Johannesburg, the Catholic AIDS organization in Namibia, Harvard, and Baylor, and the Gates Foundation in Botswana. A surprising number of talented U.S. Government people are already on the ground. The country director in Namibia for the Centers for Disease Control is a pediatrician who has been there for 12 years in Africa. He knows a lot about what to do. So my suggestion to Mr. Tobias is, while you are making your 10-year plan in this first few months, ride the horses that are already running in Africa. Accelerate what is already happening. There is a lot going on and the challenge is not to plan, the challenge is how do you get it done.
Finally, move fast, but do not spend too fast. I imagine we are going to have a pretty good debate about that in the Senate. I have already heard some people say let's spend $2 billion and others say let's spend $2.5 and others say let's spend $3 billion. The fact is, we are going to spend $15 billion of taxpayers' money in fighting HIV/AIDS in 14 countries and the Caribbean. We are going to do it over 5 years. We need to keep in mind that the African system cannot absorb too much money too quickly. There are treatment guidelines to prepare and to teach. They are very complicated. There is a staff to recruit. There are patients to find and persuade. There are health organizations to establish.
For example, perhaps the most impressive program we saw was operated by a mining company, Anglo-Gold in South Africa. They are taking this seriously in a country where the Government is taking it less seriously. They are making an all-out effort to identify the 25,000 employees infected with HIV/AIDS that they have, one-third of their total employment, and give them a chance to have the treatment that will prolong their productive life. They set a goal of recruiting 1,000 people in the first year to do this, but try as they might they only could recruit 622. So, we need to be aware that we may have to ramp this program up as we go and we ought not to waste money in the first year that would be better spent in the third, fourth, or fifth year.
You saw it as I saw it, Mr. President. Botswana's life expectancy has dropped from 72 years of age to 34 years of age because of HIV/AIDS. In Namibia, teachers miss school to visit sick colleagues and attend their funerals. Two or three generations of South African children will grow up without parents. In Windhoek last year, a local journalist told me, ``Please get it across, how much we appreciate President Bush's $15 billion grant. It puts a human face on America.''
I hasten to say we in the Congress are a little jealous of our prerogative to make that grant. But the AIDS authorization bill passed unanimously. It had support of Democrats as well as Republicans as well as the President, and it is something we should be proud to work on.
If I could make these three final observations. I was thinking, flying home, that if a diabolical person, an evil person, had to think of a way to destroy a country, that this would be
what he might do. No. 1, invent a new disease that had never been heard of before for which there is no vaccine and no cure, that pronounces a death sentence. No. 2, think of a way to transmit that disease that involves the most powerfully reliable human impulse, which is sexual activity. And, No. 3, introduce that disease into countries that are the poorest in the world and have almost no health structure to deal with the disease and in which the discussion of sexual activity is taboo.
That is exactly what has happened with HIV/AIDS. As I look back on those four countries we saw--South Africa, Mozambique, Botswana, and Namibia--these are four countries, with a little exception for Botswana, where 30 years ago they were under some kind of colonial rule. Then the people who are in power in the government today fought against that rule for their freedom, they were guerrillas and they were at war. Then typically there was a civil war to decide who of the winners would govern. And now they are in charge in all four of those countries. They are doing well, in terms of their governance. They are building their democracy very well. And the governance is something they can be proud of.
But all of a sudden out of left field comes this AIDS, just as they are reaching their freedom and just as they are in charge. We saw the wife of Nelson Mandela, Graca Machel, who said to us: It took us aback. We weren't prepared. We weren't ready for it.
It seems like a cruel, terrible trick to play on people who for 30 years have struggled to gain their freedom and find themselves in charge of their own destiny.
Finally, I think we saw a good deal of hope. We saw leaders who, in spite of the terrible odds they face, are committed to fighting it. We saw people from all over the world, really, who were there, volunteering their help. We saw faith-based organizations holding hands, taking care of orphans, finding patients.
My sense of Africa is that for a long time it has generally been ignored by our country. Presidents have sometimes gone but only as an afterthought. I suspect Africa presents such challenges today, not just with HIV/AIDS but in other ways, that it will begin to attract some of the brightest, most intelligent people in the world, many of them Africans who have left to go to other parts of the world, and I believe they will come home.
I saw this morning on C-SPAN the discussion about Ghana and the energy minister who was born in Ghana and was educated in Minnesota. He was the managing partner of Deloitte and Touche for all of Africa, and he decided to go back to Ghana and help build that country.
America was built that way, by people who saw great challenge here and came to help build the country. I suspect Africa may be that sort of challenge. I am glad our President has devoted himself in such a strong way to it. I hope he continues that over the next several years. I believe if he does, when he goes back to Crawford, TX at the end of 8 years, it will be one of the great accomplishments of his administration.
I hope the Senate continues to put partisanship aside and to support the $15 billion and do it in an orderly way. I commend our leader for his insistence on it. I was privileged to be a part of the delegation that went for 2 weeks and it will certainly redouble my interest and attention to our responsibilities to the people of Africa.
I thank the Senate for giving me the opportunity to present this.