By Tom Still

ARUSHA, Tanzania – Even if former Wisconsin Gov. Tommy Thompson skips a second term in the Bush administration, his legacy at the Department of Health of Human Services will include some worthy accomplishments: the first remaking of Medicare since 1965; keeping human embryonic stem cell research alive when others might have banned it; and improving the agency’s ability to respond to disasters, both natural and manmade.

In Africa, however, Thompson may be remembered simply as an American who cared.

Away from the glare of press coverage that normally accompanies international meetings, Thompson recently chaired a fractious but productive conference of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The three-year-old fund is a public-private partnership created by the United Nations to develop better treatment and prevention protocols in some of the world’s poorest nations. Since its first meeting in January 2002, the Global Fund has pledged about $3 billion in aid to 128 countries.

The late November meeting in Arusha, near the northern Tanzanian landmark of Mt. Kilimanjaro, was the fund’s first gathering in Africa. It was attended by the presidents of Kenya, Tanzania and Uganda, among other African leaders, and was briefly visited by United Nations Secretary-General Kofi Annan. Africa is ground zero for AIDS, and 60 percent of the Global Fund’s effort is focused on fighting that disease. About two-thirds of the fund’s spending on AIDS, tuberculosis and malaria takes place in Africa.

The numbers explain why the Global Fund has such a huge stake in Africa. Of the estimated 40 million or so people worldwide who are infected with the HIV/AIDS virus, about 27 million live in Africa – and most of those south of the Sahara desert. Mosquito-borne malaria is a constant scourge, and TB is easily passed from one unvaccinated person to the next.

Collectively, those three diseases help to keep the continent in poverty, and have all but stymied social and economic progress. In fact, veteran foreign-service officers who have lived in Southeast Asia, Central America and Africa said during Thompson’s Arusha visit they have seen progress in most places over the past 10 years – but precious little advancement in Africa.

“It’s like a war,” Thompson said of the fight against AIDS and other diseases in Africa, “only this war is taking 3 million lives a year.”

The toll of this silent conflict can be seen in cities such as Arusha and Moshi and smaller villages along the Tanzanian-Kenyan border. To the casual observer, there seem to be more children and older adults, and fewer younger adults. The statistics bear out the visual evidence: One in 11 people in Tanzania are infected with the AIDS virus, and most are adults in their 20s, 30s and 40s. Throughout Africa, there are 11 million AIDS orphans – much of the world’s total.

The challenges for Tanzania, Africa and the world are immense. Unless AIDS is controlled or, ultimately, cured, the continent will remain locked in poverty. A generation of largely parentless children can only add to the political instability that wracks many African nations, and which cannot be ignored by the United States or the West.

Thompson understands that reality, and has been an advocate for U.S. involvement in the fight against AIDS. Billions of additional American dollars have been pledged to the Global Fund, mainly on the promise that private, faith-based, public health and government efforts will come together to make a difference.

Thompson was the first U.S. Health and Human Services Secretary to spend a World AIDS Day in Africa (2003) and was unopposed when he ran for chairman of the fund. His receptions weren’t always warm, however. In July 2002, Thompson’s speech on AIDS to a crowd in Barcelona, Spain, was drowned out by protesters who questioned the scale of the U.S. commitment.

It may be years before Thompson’s work in Africa yields results. However, a public health infrastructure that varies according to the needs of each nation is beginning to emerge. If new prevention and treatment networks take root in Africa, Thompson can draw some satisfaction in knowing he was there when it started.

Still is president of the Wisconsin Technology Council. He recently returned from a one-week trip to Tanzania.