BG: Our trip to Africa ended today in Nairobi, Kenya, on a note of hope. Following our meeting with President Moi, we traveled to Kibera, a large slum in the southwestern outskirts of Nairobi, where one in five residents is infected with HIV. Kibera is home to thousands of impoverished women who subsist on Nairobi's sex industry. Its narrow streets teem with unattended children—5-year-olds leading groups of even younger kids—evidence of the country's 1 million orphans.
Nightly rains turned the dirt roads lined by open sewers into a winding mud slick, but we arrived at the Salvation Army's Kibera Community Centre to the joyous singing and dancing of a group of sex workers. These women receive HIV/AIDS prevention training through a program run by Dr. Elizabeth Ngugi of the University of Nairobi and Dr. Aine Costigan of the University of Manitoba. This pioneering program teaches the women how to talk with their male clients about HIV and to insist on condom use. An important part of the program also provides women with training and economic support to enable them to leave sex work.
At a town forum-style meeting we heard from Rukia, a former CSW who benefited from Dr. Ngugi's program, left the sex trade, opened a hair salon, and now helps provide a livelihood for several employees. We heard from Titus Ndungu, who was raised by former CSWs who care for AIDS orphans. Today Titus is a civil engineering student at Moi University and is a picture of hope for AIDS orphans across Africa and for the families who take them in.
Later we traveled to Kenyatta National Hospital in Nairobi, home to the Kenyan AIDS Vaccine Initiative. Dr. Job Bwayo runs the lab alongside a team of Kenyan researchers who are involved in a Phase 1 trial of a DNA vaccine—the first human trials of a vaccine designed specifically for a strain of HIV common in Africa. In his words, "Phase 1 gives us courage. This is a marathon, not a sprint, and Kenyans are good at the marathon."
KAVI is part of the International AIDS Vaccine Initiative, a global organization that is working to speed the development and distribution of preventive AIDS vaccines. Although the effort to develop an AIDS vaccine is now being discussed more actively, there remain significant scientific, political, and economic obstacles. Scientists agree that a preventive vaccine is the best hope for ending the epidemic, yet vaccine research and development commands only about 2 percent of the $20 billion the world spends annually on AIDS prevention, research, and treatment. There are many promising interventions that are short on resources, but in my view, vaccine research leads the list. An AIDS vaccine is my son's dream—his greatest hope. When he first learned that it was possible, he said, absolutely, we are the right group to take risks like this. It is exactly what should happen with foundation money.
Our trip to Africa has been very sobering. For me, it has also been a tremendous honor. Years from now, after we have conquered AIDS and lifted the crushing burden of disease in the poor world, people will ask, "How did this happen, and who led the way?" The name Jimmy Carter will be on the short list of those who were in early and strong. He is uniquely situated to speak and be heard because he is so respected and admired, especially here in Africa. In the words of a Nigerian pastor, "He is our brother. He cares for the poor, the sick, the downtrodden. We consider him one of us."
Early in the day, we met with President Daniel arap Moi, who showed great courage in declaring HIV/AIDS a national disaster in 1999. Today he leads a government with a comprehensive strategic plan for fighting HIV/AIDS that involves every ministry and agency. The trouble is that here in Kenya, as in so many African nations, the strategic plan is held hostage to financial constraints and the stigma of the disease.
We arrived in Africa last week with the conviction that greater awareness and more resources could help save millions of lives. The experience of the past five days has only strengthened that view. The developed world must dramatically increase its funding for HIV/AIDS. If we could communicate to the people in wealthy countries what we've witnessed—from the dismal scene of a mother slowly wasting away with four children sitting hopelessly by her bed, to the unfailing resolve of the many unsung heroes like Dr. Ngugi—I'm convinced they would be inspired to give whatever it takes, for as long as it takes, to stop AIDS.
I wish the American people could see first-hand how efficiently and enthusiastically health assistance is used here in Africa. Those who say that health aid is wasted should see a pregnant woman receive a dose of Nevirapine that will prevent her baby from being born with the virus. It is certainly true, as we've said all week, that developing countries need to make their own health spending a greater priority. They must be clear and transparent about how it's spent in order to give people confidence that the money is going where it ought to go. But developing nations simply do not have the resources to address a calamity of this magnitude.
There's a pervasive misperception among the American people that a large share of the U.S. federal budget is devoted to foreign aid. A poll some years ago found that Americans believe we spend about 15 percent of the budget on foreign assistance. Actually, we spend about 1 percent of the budget on foreign assistance, about half of 1 percent on development assistance—including urgent needs such as food aid and disaster relief—and less than one-tenth of 1 percent on international health. That's the equivalent of $6 a year from every American, or two pennies a day.
Governments must do more, and the U.S. government should set the example. But business and philanthropy also need to devote more attention and resources to global health. It's difficult to comprehend the difference the Bill and Melinda Gates Foundation is making with their commitment to fight AIDS, TB, and malaria. What they contribute each year to improve global health is larger than the entire annual budget of the World Health Organization. But the impact of their contributions must be measured in more than dollars. By declaring global health its No. 1 priority, the Gates Foundation is not only raising the visibility of the issue, but sending a message to anyone eager to advance human welfare that global health is not a lost cause, but a precious and far too-little-noticed opportunity.