[Congressional Record Volume 149, Number 119 (Wednesday, September 3, 2003)]
[Senate]
[Pages S11021-S11023]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           HIV/AIDS IN AFRICA

  Mr. ALEXANDER. 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

[[Page S11022]]

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

[[Page S11023]]

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.

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