MICHELE NORRIS, host:
Next week, First Lady Laura Bush travels to Africa. There, she'll assess the progress of the President's Emergency Plan for AIDS Relief, also known as PEPFAR.
The plan was created back in 2003 when the president pledged $15 billion over five years for AIDS relief, with most of the money going to Africa. Now, he's asking Congress for $30 billion more through 2013.
It's by far the largest amount any country has spent on fighting a disease outside its borders. This morning, I sat down to talk with Laura Bush at the White House in a formal room displaying the china of previous first families.
She acknowledged the huge problems facing Africa, the need for infrastructure and clean water and the challenge of fighting AIDS in a place where infections are outpacing treatment. Every year, three million Africans contract HIV. Still, Mrs. Bush remains optimistic.
Ms. LAURA BUSH (First Lady): I think we do actually see really good numbers. We know what it takes in the United States. We've worked on this issue ourselves for years. We know it's a combination of education, prevention, treatment, which is very important. And in a country, like many of the countries that are targeted in Africa, where there is not right infrastructure, it's difficult to get treatment out into the bush to all the people that need it.
But on the other hand, I think we're obligated to do as much as we can do to reach as many people as we can, and to use every one of the strategies that we know work - both education, reaching treatment, the prophylactics, antiretroviral prophylactics for pregnant mothers. I've seen some terrific programs in Africa that counsel mothers, and so, you know, that's part of the goal of it.
NORRIS: Some are critical, saying restrictions on how U.S. money can be spent are hindering efforts. Under what's known as the ABC plan - that's abstinence, be faithful and use condoms - condoms are distributed to high-risk groups, such as prostitutes and truckers, but not to young people in school. They get abstinence education. Also, Congress requires that one-third of the money spent on prevention be put toward teaching abstinence and fidelity - two things Mrs. Bush supports.
Ms. BUSH: In countries where there are gender issues and where girls feel like they have to comply with the wishes of men, I think abstinence becomes even more important - abstinence education. We need to get the message to girls everywhere, not just in Africa, that they have a choice, that they can be abstinent and make choices for themselves that keep themselves safe.
So I think in these countries, for one thing, we also know that abstinence is the 100 percent safe way to know you won't acquire HIV, and when you're in a country where your chances - where 30 percent of the population are HIV positive or more - as in some of these countries - then abstinence becomes even more important.
NORRIS: Now, the Institute of Medicine has recommended that Congress lift this earmark. They're suggesting that Congress remove these legislative requirements that one-third of the money go toward abstinence programs. They say that much more flexibility is needed on the ground, that people on the ground know best how the money should be spent in preventive efforts. What do you say to that?
Mr. BUSH: Well, I think that's certainly up to Congress and in the reauthorization that will come with, hopefully, with the extra money that that certainly is something that can be looked at.
I do think that each one of these parts of the ABC program are important. And I will say, ABC was developed by Africans. Many African governments support the ABC program, and the United States government stands with them.
And you're right, it is the people on the ground who know the best. That's what PEPFAR does and USAID, we work with groups, African groups that are on the ground, that are already successful, that already have a reach to a lot of people and know what each one of these different communities want and need, what addresses their needs in the best way. And so that sort of flexibility that's part of PEPFAR is what does make it successful.
NORRIS: You could, though, make a strong argument that they have some flexibility under PEPFAR but that they need much more.
Ms. BUSH: Well, I think that there is a lot of flexibility under PEPFAR, actually, and the percentage of money that goes to abstinence programs is quite small compared to the large amounts of money that go to the antiretroviral, the treatment, for instance.
But each one of the parts of ABC are important. And the United States government, through our programs, both PEPFAR and USAID programs, have a huge portfolio of strategies that we are using to try to reach as many people as possible.
NORRIS: First Lady Laura Bush, thank you very much for sitting down to speak with us.
Ms. BUSH: Thanks, Michele.
NORRIS: The first lady will begin her trip to Africa on Monday. You can hear Mrs. Bush discuss the role of her daughters in public life at npr.org.