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After a standing ovation, Bush announced that PEPFAR, the President's Emergency Plan for aids Relief, had achieved a treatment milestone ahead of schedule: More than 2 million people, mostly in Africa, were receiving HIV-fighting drugs. Before PEPFAR started, only 50,000 people were being treated with life-sustaining drugs in the worst-hit nations. Now, Congress and the United Nations, among others, back the President's plan, and in coming years, the U.S. may spend $48 billion to fight HIV.

Leaders sensed that Bush's moral single-mindedness had finally paid off. Michael Gerson, former speechwriter for Bush and now a Washington Post columnist, told CT, "The same focus that critics call 'stubbornness' is also the reason we have such successful initiatives against HIV/AIDS, malaria, and tuberculosis in Africa."

At the beginning of the Bush years, few imagined that a multibillion-dollar program to fight a sexually transmitted disease would become a key legacy of Bush's. But early on, the President told cabinet members that he wanted to do something about HIV/AIDS in Africa. Fighting terrorism had been more urgent at first. By 2002, more evangelicals were speaking out publicly about HIV/AIDS. Conservative senators Jesse Helms and Bill Frist said it was disgraceful that nothing was being done. Rock star Bono lobbied the President.

Gerson says Bush eventually overrode advisers who said it "would be problematic to be announcing a lot of money for foreigners." Instead, the President directed aide Joshua Bolten to plan "something game-changing" for Bush's 2003 State of the Union address. During that speech, Bush mapped out a plan to spend $15 billion over the coming five years to fight the virus. To the shock of many health professionals, Bush explicitly endorsed Uganda's faith-inspired approach to preventing HIV, known as abc, "Abstain, Be faithful, or use a Condom."

Evangelicals were galvanized. They had slowly become engaged in a broader set of international issues, and now saw greater collaboration with the government as an unprecedented opportunity.

Over time, Bush's rationale for fighting the virus became ever more biblical. In his successful 2007 push for increased funding for PEPFAR, Bush quoted Deuteronomy by saying, "I have set before you life and death. … Therefore, choose life."

In mid-2005, Bush launched the President's Malaria Initiative (PMI), committing the federal government to spend $1.2 billion by 2010 to fight malaria, which kills 1.2 million each year. pmi also includes new money to fight tuberculosis.

Internationally, hundreds of faith-based groups and thousands of churches in the developing world receive support through PEPFAR and pmi. The combined total spending for these programs is at least $63 billion. Bush's goal of a better, safer world is becoming a reality in terms of freedom from disease. Federal agencies use new faith-friendly networks of hospital, clinics, and village churches.

Such programs have provoked hot reactions from the political Left. Pro-choice activists such as William Smith, vice president for public policy at the Sexuality Information and Education Council of the U.S., lamented, "It will take several years to get countries" to accept abortion-friendly policies again and get rid of abstinence programs.

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February 2009, Vol. 53, No. 2