Next time you hear someone decry the 1% of our national budget that we spend on foreign aid (not the 25% many people think we spend), please consider this:
The Coffin-Maker Benchmark
MASERU, Lesotho
IF you worry that foreign aid is an utter waste, just chat with some
mortality experts here in southern Africa — the coffin makers.
They’re miserable.
These coffin makers in the street markets are idle partly because
American spending on programs to fight AIDS around the world means that
vast numbers of people are no longer dying at a young age. So coffin
makers sit dejectedly beside stacks of lumber, waiting for business.
“Before, a lot of people were dying of AIDS,” said Moeketsi Monamela, a
33-year-old coffin maker here in Maseru, the capital of the mountainous
kingdom of Lesotho. A half-dozen years ago, he sometimes crafted 20
coffins a month, he said. Now, he typically sells five or six.
“Now there is medication, so fewer people are dying of AIDS,” Monamela
explained. “I’m not very happy because this is my future.”
Realizing that this did not sound quite right, he started again:
“Although the medication has affected my business, I’m happy because I
don’t want to see people dying of AIDS.”
In this election year in the United States, there’ll be bitter debates
about what should be cut from budgets, and one thing Democrats and
Republicans seem to agree on is that foreign aid is bloated.
Polls indicate that 6 out of 10 Americans favor cutting foreign aid.
A World Public Opinion poll
in 2010 found that Americans believed that foreign aid consumed
one-quarter of federal spending. They said it should be slashed to only
10 percent.
In fact, all foreign aid accounts for about
1 percent of federal spending
— and that includes military assistance and a huge, politically driven
check made out to Israel, a wealthy country that is the largest
recipient of American aid. True humanitarian aid constitutes roughly
half of 1 percent of the federal budget — and sometimes gets remarkable
results, as is happening with AIDS.
My trips to southern Africa used to be heartbreaking. Funerals were
constant, schools were emptied of teachers, and hospitals lost their
doctors to the virus. In the countryside, children starved because
adults were too sick to farm. In Swaziland in 2006,
I came across a 12-year-old orphan girl who had become head of her household after AIDS had wiped out the adults.
Yet now the picture is starkly different. On my annual win-a-trip journey with a university student — this year it’s
Jordan Schermerhorn
of Rice University — we’ve been seeing how assistance changed the
course of the AIDS epidemic in Lesotho and Malawi. Global AIDS deaths
are decreasing steadily from
the peak in 2004.
New infections are down. About half a million mothers with H.I.V.,
which causes AIDS, used to infect their babies in childbirth each year,
but now a simple treatment regimen aims to eliminate that by 2015.
The progress is the result in large part of
Pepfar, or the President’s Emergency Plan for AIDS Relief, and
the Global Fund
to Fight AIDS, Tuberculosis and Malaria (which the United States
supports). To his great credit, President George W. Bush started Pepfar
in 2003; it’s the best thing he did.
With the help of Pepfar and the Global Fund, antiretrovirals, which are
powerful AIDS drugs, are now available free in needy countries. AIDS
will still kill millions of people, and there are already shortages of
medications, but the tide is turning.
“As a bottom line, millions would not be alive without Pepfar, while, at
the same time, millions more in their families have been saved from
poverty because mothers and fathers are productive again,” notes Dr.
Peter Piot, the former executive director of the United Nations program against AIDS and the author of
a sparkling new memoir, “No Time to Lose.”
“If we have reached a turning point in the global AIDS response, it is
also largely due to Pepfar,” Dr. Piot added. “There are probably very
few examples in international aid that can demonstrate such dramatic,
direct impact.”
In Bobete, in rural Lesotho, we visited a clinic run by
Partners in Health, the aid group founded by
Dr. Paul Farmer of Harvard.
The clinic tests virtually all pregnant women in the area for H.I.V.,
and those with the virus are given treatment so that they will not pass
it along to their babies.
Those who need them get free antiretrovirals and treatment for
tuberculosis (which often accompanies AIDS). With treatment, patients
are able to continue to work and support their families.
It’s true that AIDS treatment has worked better than Pepfar’s prevention
strategies, such as promoting condoms and discouraging multiple
partners. Prevention by
supporting male circumcision
in hard-hit countries seems more promising (circumcision greatly
reduces the rates of H.I.V. transmission through heterosexual sex).
Lesotho is hoping to circumcise 80 percent of sexually active males within five years, up from less than 20 percent now.
In the Malawi village of Makaluka, a woman named Gladys Daniel told us
that everyone knows how AIDS is spread, but that about half the
villagers still sleep around, usually without condoms. “Our husbands can
have multiple partners and put us in danger,” she said.
It turns out that her concern was not theoretical. “I know my husband
has a partner,” she said, adding that her husband steals money from her
to pay his girlfriend for sex. With risky behavior like this, some 2.7
million new infections still occur annually around the world. So
although the progress is immense, there’s still a long war to be fought
against AIDS — and if funds are slashed, the world will slip backward.
AIDS programs are just one of many foreign aid successes. Here in Lesotho, the United States used
the carrot of Millennium Challenge grants
to nudge the government to end a ban on letting women purchase property
or borrow money from banks by themselves. Child mortality rates are
plummeting because of money spent on clean water, vaccines and
hospitals.
Granted, aid is often misspent, just as it is by the military and
everybody else. Yes, the war on AIDS took many wrong turns (as
documented in the recent book “
Tinderbox”).
But when you hear candidates in this campaign season in the United
States declare that money for foreign aid should be slashed, remember
that modest sums have saved lives on an unprecedented scale. When
there’s a depression in the coffin-making industry, that’s a tribute to
foreign aid that Americans can take pride in — and should support.
