Every day hundreds of Kenyans from every walk of life visit the Hope Center at the Coptic Hospital in Kenya's capital, to meet with doctors and receive life-prolonging HIV drugs, compliments of the U.S.A.
Before U.S. President George W. Bush started his signature HIV program, the people at Hope Center would have died within a few years because the drugs were either too expensive, unavailable or doctors didn't know how to prescribe them. Since 2003, the number of Kenyans on antiretrovirals provided by the U.S. has risen from 343 to 70,000, providing them with a chance to work, raise their children and fight the epidemic.
The U.S. program known as the President's Emergency Plan for AIDS Relief "was a new experience and in Kenya it expands quickly and strongly, it was beyond the expectation of anyone, and in Kenya, there is nothing that works like this," said Dr. Aida Samir, chief executive officer at the missionary hospital.
Kenya is the second largest recipient of funds from the program, best known as Pepfar, which has promised to spend US$15 billion between 2003 and 2008 to fight AIDS. Out of the 19 countries with Pepfar programs, Kenya's US$200 million program is widely considered the most successful and sophisticated.
Pepfar provides funding, advice and monitoring to 275 treatment sites in Kenya, where in 2001, according to the most recent figures available, 700 people a day were dying from AIDS or HIV-related diseases. In addition to providing treatment, Pepfar also funds care and support services, as well as prevention programs in coordination with the Kenyan government.
"The rate of scale up is really mind boggling," said Warren Buckingham III, the Pepfar director in Kenya. "It shows that with goodwill and adequate resources, there is practically no limit to how much a developing country can do to take care of its citizens."
Buckingham said in 2007, Pepfar plans to ensure that, for the first time, all 1 million pregnant women in Kenya who visit a clinic before giving birth will be tested for HIV. Whoever tests positive will be given drugs to protect the child from the virus, he said.
"It has changed my life, I can live healthy and I don't fall sick," said one patient who now works at Coptic Hospital, but asked not to be named to avoid being shunned. "Now I give back."
But while the treatment program is widely praised, critics of Pepfar complain that not enough is being done to prevent people from contracting HIV.
Richard Holbrooke, former U.S. ambassador to the United Nations who now leads the Global Business Coalition on HIV/AIDS, added the treatment program might not be sustainable, because the number of people with HIV continues to grow. According to the U.N. agency on AIDS, there will be 4.3 million new infections in 2006.
"If the number of people who need antiretrovirals increases every year, it becomes a bottomless pit," he said during a visit to Nairobi, where he publicly received an HIV test. "We have to turn the corner, the actual number of people with the disease needs to go down."
U.S. Rep. Barbara Lee, a Democrat from California, condemned a provision in Pepfar that requires that 33 percent of all money committed to prevention programs be spent to promote abstinence. She told reporters Wednesday that she would introduce the Pathway Act, which would eliminate the restriction, which she said had more to do with conservative ideology than scientifically proven successful programs.
"The Pathway Act seeks to correct these policies and ensure we fund the strategies that work," she said.
Two methods of prevention, which will likely receive scientific backing in 2007, are male circumcision and microbicide gels. Buckingham said that under the current legislation, Pepfar money could not be spent on either.
"This epidemic keeps changing," he said. "We need to tweak the legislation to reflect the changing environment."
Pepfar officials argue a three-pronged HIV prevention strategy, emphasizing abstinence, fidelity and condom use, offers people the best options in how to protect themselves from AIDS.
Back at Coptic Hospital, Samir and her senior HIV project manager, Nadia Kist, have put up tents to deal with the overflow of HIV patients under their care.
"It doesn't seem real, the transformation," said Kist, who has worked with the Coptic program since it began in 2004 with 300 people, but now serves 5,300. "It was almost people banging down the doors, coming by the thousands, it's really miraculous."