Los Angeles Times - February 15, 2008
Edmund Sanders, edmund.sanders@latimes.com

URANGA, KENYA - This western Kenya village was slowly dying five years ago.

One in three people was HIV-positive, then a virtual death sentence. Coffin-makers couldn't work fast enough and the nearby hospital overflowed with HIV patients. No family went untouched, but stigma was so severe that few got tested and the word AIDS was rarely uttered.

Today, with an influx of U.S.-funded antiretroviral drugs, prevalence rates have dropped to single digits. The AIDS ward has shut down. And for the first time, people who once spent their days waiting to die are living openly and actively with the disease.

"The drugs restored my hope," said Conslate Otieno, 30, a homemaker and mother in Uranga, near the Kenyan city of Kisumu. After losing her infant to AIDS in 2004 and learning she was HIV-positive, Otieno feared she would not have more children. But with drugs to keep her disease in check, she and her husband, who is also HIV-positive, had two more children, both HIV-negative.

"And I don't worry that I won't be around to take care of her," Otieno said, cradling her 4-month-old baby, Josephine.

The turnaround in Uranga and hundreds of other African villages is due largely to the President's Emergency Plan for AIDS Relief, known as Pepfar. Launched by the Bush administration in 2003, the program has pumped $18 billion into treatment and prevention of AIDS in the developing world, mostly in Africa.

President Bush is to leave tonight for a six-day African tour that analysts say will serve as a "victory lap" to highlight U.S. efforts to alleviate AIDS and malaria.

Though some have questioned the spending of billions of dollars to fight AIDS abroad or objected to Pepfar's mandatory emphasis on abstinence, the program's delivery of sorely needed AIDS drugs to people who previously had no hope of affording them is so widely supported that it has drawn praise for Bush from such unlikely backers as rock star Bono.

"This will rank in the top tier of his legacy issues," said J. Stephen Morrison, executive director of the HIV/AIDS Task Force at Center for Strategic and International Studies, a Washington think tank.

Since the program's launch, the number of sub-Saharan Africans receiving AIDS drugs skyrocketed from 50,000 to 1.4 million. In Kenya alone, Pepfar is credited with saving more than 57,000 lives.

Recipients in Africa often never realize the drugs are supplied by the United States. But African governments, which often oversee distribution, say Pepfar assistance has been instrumental in helping them combat a disease that is still killing about 4,400 people a day around the continent.

In Kenya, Pepfar funds more than 70% of the nation's supply of AIDS drugs, which are distributed at no charge, according to the Kenya National AIDS Council.

"I don't know what would have happened without Pepfar," said Alloy Orago, council director. He said the U.S. funding has freed the Kenyan government to devote more of its resources to other programs, including free primary education.

Despite a nationwide drop in prevalence, AIDS remains Kenya's No. 1 killer, claiming more than 80,000 people a year.

But health experts say Pepfar's success has defied critics, who said Africans would be unable to adhere to the strict treatment guidelines of AIDS drugs or that developing nations would be incapable of absorbing a big influx of foreign aid. In short, the program has shown that sometimes throwing money at a problem can work, according to Warren W. "Buck" Buckingham, head of Pepfar in Kenya.

"Pepfar has proven that increased resources can be used effectively and rapidly," he said.

Though Pepfar is set to expire in September, strong bipartisan support makes it likely that Congress will approve Bush's request to extend the program with an additional $30 billion.

For Africans receiving the lifesaving drugs, Pepfar has brought the same kind of second chances seen a decade ago by AIDS patients in the U.S. and other Western countries, when people who had cashed in their life insurance and quit their jobs suddenly found they could resume normal lives.

Availability of treatment is also chipping away at the stigma of AIDS on a continent where many still believe the disease is a curse or result of witchcraft.

The number of HIV support groups is rising. Testing centers have opened in tiny villages. In December, an AIDS activist became the first openly HIV-positive candidate for Kenya's parliament, though she was defeated.

Few places in Kenya suffered as much AIDS devastation as here in the Siaya district, near the border with Uganda. The percentage of the population that is HIV-positive peaked at 38% in 2002.

"You saw sick people everywhere, on the roadside, in the market, at church, on the bus," said Joshua Ondiege, HIV coordinator at Siaya District Hospital. The hospital was reduced to an AIDS morgue, with four or five deaths a day.

"Doctors did little to help because they felt these people were just going to die," he said. "They felt it would be wasting resources to treat them."

Antiretroviral drugs were available, but only at private facilities and at prices far out of reach for most in Siaya, where two-thirds of the population lives on less than a dollar a day.

Today the percentage of Siaya's population that is HIV-positive is about 8%, according to the AIDS council, and many of those receiving drugs are experiencing what local experts call the Lazarus effect, named after the Biblical figure who rose from the dead.

After watching her husband waste away in 2002, Pamela Atieno, 31, was so ill last year that she gathered her two children at her hospital bed to say goodbye. She feared they were destined to join 1 million AIDS orphans in Kenya.

But to her amazement, she started improving after just a week on drug therapy.

"I got a new life," she laughed. "Now I'm fat again."

Others said the experience of surviving an illness that killed so many friends and family members has left them with a sense of empowerment.

Jennifer Masolo, 42, lost her husband to AIDS in 1995 and kept her own HIV-positive status a secret for years, with no outside support. When she first tested in 1995, the clinic handed her the results in a sealed envelope and told her to open it when she was alone. Upon learning her status, she contemplated suicide.

But the arrival of drugs changed her attitude. Now she runs an AIDS support group in Uranga that draws about 160 people a month. She speaks to schools and local groups.

After she was rejected by her parents and her husband's family, Masolo borrowed money and built a house for herself and four children.

"This has taught me to do things on my own," she said. "If I want something done, I do it myself. I have a lot more confidence."

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