In June of 2002, as the President met with Senator Bill Frist to defeat a Senate bill designed to dramatically increase the U.S. contribution to the Global Fund to Fight AIDS, TB, and Malaria to $500 million for fiscal year 2003, the President announced that he wanted instead to fund a major new bilateral initiative to provide that same $500 million over five years to substantially reduce the frequency of transmission of HIV from mother to babies during pregnancy, childbirth, and breastfeeding. Although the President vetoed partial funding of that mother-to-child initiative in a subsequent Supplemental Appropriation bill because he disliked other funding provisions, the President is reviving plans for his MTCT program in anticipation of his impending trip to Africa early next year.

With the African AIDS pandemic raging unabated ö 30 million people infected in sub-Saharan Africa out of a worldwide total of 42 million ö no one in his or her right mind is against increased funding, from whatever source, to save the lives of 400,000 children unnecessarily infected each year who would otherwise unnecessarily die a miserable death because of the complications of HIV infection. The pile of infant bodies in pediatric wards in African hospitals speaks for itself ö this horror must be avoided. However, as research and common sense shows, saving babies lives is not enough ö preventing transmission to infants while parents die is an equally horrifying half measure. Accordingly, the U.S. should, in addition to helping to fund prevention of mother-to-child transmission, fund its fair share of the global obligation to provide life-saving antiretroviral therapy to 3 million people in developing countries by the end of 2005 ö a modest and attainable goal set by the World Health Organization at the Barcelona AIDS Conference this past summer.

Why is preventing transmission of a deadly disease to children not enough or at least a good start? To begin with, if the child is born HIV-positive, that means that his or her mother carries the virus. That virus is like a ticking bomb, gradually reducing immunity to disease, gradually increasing susceptibility to opportunistic infection, gradually leading to multiple debilitating conditions, and finally leading relentlessly to death. If the mother is HIV-positive, it is very likely that the father is as well. So the young child, even if he or she avoids infection, is living in a family where the adults are dying.

The average person who contracts HIV in developing countries has eight to ten years to live. So the youngster will watch parents dying, tend to their needs, and eventually gaze upon their dead bodies well before his or her teenage years. Because parents will have lost their jobs, informal or formal, as they became more disabled, the child will live in an increasingly poor family. Moreover, child will be hungry, because parents can no longer engage in subsistence or family-plot gardening. The childās family will gradually sell scant productive resources, plows, sewing machines, even cooking utensils, in order to buy food and short doses of medicine to relieve pain and suffering. Children will be withdrawn from school because there is no money for school fees and no money for notebooks, pencils, and school uniforms.

The baby who is saved will become the toddler and preadolescent who brings water to parents who canāt get out of bed, who changes and washes soiled linens, and who takes primary care of other siblings in an increasingly dysfunctional child-headed household. A parent who is beloved, who cared enough to be tested so she might save her infantās life, slowly dies in the presence of her ćsavedä child. What heart-rending grief must that child experience, what trauma, remorse, and even shame.

At the end of the day, this ćinnocentä survivor faces life ill equipped to carry on. The child, now an orphan, has received little education, little parental guidance, inadequate nutrition, and scant social support by which to construct a future life. Given his or her abject poverty, the child may well have to turn to survival sex or brutish labor to earn daily bread. Children may be displaced from whatās left of their family homestead because relatives forsake the survivors and expropriate their meager inheritance. Or the child will be taken into an increasingly impoverished household of elder aunts or even more elderly grandmothers who struggle to make do for more and more orphaned children.

President Bush has chosen to ignore the moments beyond birth in this childās life. Having a dramatic moment to announced plans to save the lives of ćinnocentä babies is more important than the more heroic and costly task of saving families, of providing treatment therapies to mothers when they test HIV-positive, and of extending that same treatment to other family members whose lives hang in the balance. Itās not that treatment activists donāt want babies to survive, but we want the adults who nurture and raise them to survive too. And we shouldnāt limit treatment to families. Young people on the threshold of adulthood, those aged 15-24, carry the majority of the disease burden. Most of them are not yet married or partnered and many of them may not choose matrimonial life. Their lives are worth saving too because babies and families live in pluralistic communities where people live many-varied lives.

George W. Bush lost a sibling to pediatric cancer. If that cancer had been transmitted from Barbara Bush and if she had contracted it from George Bush, Sr., and if both of them needed treatment in order to survive, you can bet that family would have done anything in its power to ensure treatment of the parents as well as the prevention of pediatric transmission. Even more certainly than cancer, AIDS kills, and it is killing by the millions, 3.1 million in 2002. Our hearts as Americans cannot be so soft as to save the lives of babies and so hard as to let their parents die and create a continent of orphans, adding to the current total of 13 million. Our emotional opportunism and fiscal austerity cannot be so profound that we canāt share our life-saving therapies with our brothers and sisters halfway around the world.

George W. Bush, take a real AIDS program to Africa. Look beyond the babies to the sick parents and the suffering communities surrounding them. Commit to dramatically increased funding for global HIV/AIDS prevention, care, and treatment, to a program Americans can be proud of, one that will permit us to look in the mirror without millions of shadows haunting our conscience.

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