Decision Points

seen hug an African with AIDS. I was surprised. I remembered that Mother had made international news when she hugged an HIV-infected baby in 1989. Her act dispelled the myth that the disease could be transmitted by incidental human contact. I was proud to carry on her legacy by reducing the stigma associated with AIDS. I hoped in some small way to restore the dignity of suffering people. Above all, I wanted to show that the American people cared.

    At the TASO AIDS clinic in Uganda.
White House/Susan Sterner

    One highlight of our Africa trip was that our daughter Barbara joined us. In Botswana , she, Laura, and I went on safari in the Mokolodi Nature Reserve. We were hoping to relax, get some fresh air, and see some wild animals. To feed the appetite of the traveling press, the White House staff decided we should have a photo op.
    As always, the preparations were meticulous. A press truck full of cameras and reporters was prestationed in a clearing. As our vehicle rounded the corner, the press was lined up for a perfect shot of us observing several elephants. Apparently, the elephants were not given the script. Shortly after we arrived, a randy male elephant mounted one of his female counterparts on live international TV. Our advance team turned pale under the hot African sun. Laura, Barbara, and I burst out laughing.
    The trip was Barbara’s first to Africa, and it touched her deeply. After graduating from college and volunteering on my 2004 campaign, shewent to work for a pediatric AIDS clinic at the Red Cross War Memorial Hospital in Cape Town, South Africa. Inspired by her experience, she later founded a nonprofit, Global Health Corps . Based on a model similar to Teach for America, her organization sends recent college graduates to clinics in three African countries and two American inner cities. They support care for patients with AIDS and other diseases, strengthening the health infrastructure and helping people live with dignity and hope.
    Jenna also discovered a passion for working with AIDS patients. She volunteered for UNICEF in several Latin American countries. When she got home, she wrote a wonderful book, a bestseller called
Ana’s Story
, about a girl who was born with HIV.
    Laura and I are very proud of our daughters. They have become professional women serving a cause greater than themselves. They are part of a larger movement of Americans who devote their time and money to helping the less fortunate. These good souls are part of what I call the armies of compassion. Many come from faith-based organizations and seek no compensation. They receive payment in another form.

    One of the most important early decisions on PEPFAR was who should run it. I wanted a proven manager who knew how to structure an organization that would focus on results. I found the right man in an experienced Indiana businessman, former Eli Lilly CEO Randall Tobias .
    Randy’s first reports were discouraging. A year after I signed PEPFAR, fewer than one hundred thousand patients were receiving antiretroviral drugs. “That’s it?” I snapped. “We’re a long way from two million.”
    Randy assured me PEPFAR was on track. The most important tasks during the first year were to get partner countries to devise their strategies, mobilize manpower, and start establishing infrastructure. Once we had this foundation in place, the number of people receiving drugs would ramp up dramatically.
    By the fall of 2005, our African partners were fully engaged. Faith-based and other groups supported by PEPFAR, both African and American, helped staff clinics and spread prevention messages to millionsacross the continent. Orphans and the dying were receiving compassionate care. Some four hundred thousand people were taking antiretroviral drugs. We were on pace to reach our goal.

    Unfortunately, AIDS wasn’t the only disease ravaging Africa. By 2005, malaria was killing approximately one million Africans a year, the majority of them children under the age of five. Transmitted by a mosquito bite, malaria accounted for 9 percent of all deaths in Africa, even more than AIDS. Economists estimated that the disease cost Africa $12 billion a year in medical expenses and lost productivity, a crippling blow to already fragile economies.
    Every one of those deaths was unnecessary. Malaria is treatable and preventable. The United States had eradicated malaria in the 1950s, and there was a well-established strategy for battling the disease. It called