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Welcome to "Ask the State Department" -- an online interactive forum where you can submit questions to State Department officials.

Dr. Mark Dybul discussed the United Nations General Assembly High-Level Meetings on HIV/AIDS held on May 31 - June 2, in New York. The event took place Friday, June 2.

Dr. Mark Dybul, U.S. Deputy Global AIDS Coordinator
Dr. Mark Dybul, U.S. Deputy Global AIDS Coordinator Biography


Event Date: June 2, 2006

Dr. Dybul:

Thanks to everyone for joining me today and for your interest in global HIV/AIDS. I hope you'll excuse the brief answers on a very busy day; I'm in New York for the United Nations High-Level Meeting on HIV/AIDS. I think most here would agree that the high point of the week was the address by our First Lady, Laura Bush, this morning. She called for an International HIV Testing Day to highlight the critical importance of HIV testing in the fight against the pandemic -- a call which was greeted by enthusiastic applause from the delegates. Anyway, let's see how many questions I can get to, with apologies in advance that my time is short.


Carrie writes:

I am proud that my tax dollars are going towards programs like PEPFAR.

Isn't the US giving more money to HIV/AIDS than any other country in the world? Isn't PEPFAR an unprecedented program that is getting results and saving lives?

Thank you for your service to our country. I greatly appreciate you making yourself available to talk with us today.

Dr. Dybul:

Carrie, thanks. I do think the American people can be very of what our nation is doing to fight global HIV/AIDS. I've had the opportunity to see "your tax dollars at work" in some of the poorest places in the world, and the effect is simply extraordinary.

Let's talk about how things have changed in recent years. In 2001, the majority of international partners - both governments and health officials - were saying that antiretroviral treatment (ART) in Africa was not possible or cost-effective. In 2003, President Bush led the world in declaring a moral imperative to provide life-saving treatment to those in need. In his State of the Union address, the President declared that in "an age of miraculous medicines," no one should have to hear the words "Go home and die."

At the time of the announcement of President Bush's Emergency Plan for AIDS Relief, only 50,000 people in all of sub-Saharan Africa were receiving ART.

Mrs. Bush announced this morning that the United States, in partnership with host nations, is now supporting ART for about 561,000 men, women, and children in our 15 PEPFAR focus nations. It's the beginning of a transformation.

In terms of resources, as Peter Piot of UNAIDS has said: "You know, in Europe they don't like to hear it, but in fact we owe a lot to US President George W. Bush. In his State of the Union of 2003, he promised 15 billion dollars to the fight against AIDS in developing countries. And what's at least as important: he kept his promise and we received the money. The volume of the amount has completely changed our financial position."

Dr. Piot is exactly right -- talk is one thing, but action is what really matters. So Carrie, I think you, and all Americans, can be quite proud.


V.J. writes:

I am so glad the United States is committed to fighting the global war on HIV/AIDS. How much money does the U.S. plan to spend next year to continue its efforts?

Dr. Dybul:

V.J., thanks for your support for what the U.S. is doing -- public support is a key foundation for it. In terms of funding, USG resources have significantly increased, from $800 million in 2001 (the last budget of the prior Administration), to $2.4 billion in 2004 (the first funded year of President Bush's Emergency Plan), to $2.8 billion in 2005, $3.2 billion in 2006, and the President's request (currently being debated in Congress) for $4 billion in 2007. The U.S. is on track to meet or exceed the President's $15 billion commitment over 5 years.


Randy writes:

What the goals of this meeting and how are we going to get more countries to donate more $ to this epidemic?

Dr. Dybul:

Randy, thank you. The purpose of this week's UN meeting is to look at the progress the world has made in the 5 years since the UN General Assembly Special Session on HIV/AIDS (UNGASS) in 2001. As noted above, the U.S. contribution to the fight since then has been remarkable -- if the President's funding request for next year is approved by Congress, that will mean our global AIDS commitment will have increased almost five-fold over the last year of the prior Administration. But your second question is a crucial one. Over the same period as the large increase in US support, resource-poor countries themselves have significantly increased their commitments. However, the global response has still not been sufficient.

In 2004 (the most recent estimates), when the USG commitment was $2.4 billion, UNAIDS and the Kaiser Family Foundation estimated that the USG was providing approximately half of all resources from international partner governments. As the USG has dramatically increased its contribution from 2004 to 2007, we have not seen a similarly urgent response from much of the rest of the developed world.

Here at the UN, we have talked about the disproportionate contribution of the American people to the fight against global HIV/AIDS with a sense of dismay. This is a global epidemic that requires a global response and the rest of the world must step up its commitment. We're doing everything we can think of to impart that sense of urgency to others in a position to act.


Elliot writes:

I understand that the U.S. is objecting to listing vulnerable groups in the UN declaration is that true and why?

Thanks.

Dr. Dybul:

Elliot, I'm glad you asked, because that's been widely reported -- and it's absolutely false. Absolutely false as in 100% not true. Not sure how to be any clearer than that! If you look at the documents PEPFAR has produced over the last few years, you'll see that they are full, not only of mentions of vulnerable groups, but of detailed description of how we support programs that work with them! For example, take a look at our policy guidance on the ABC approach to prevention -- it's on our website, www.pepfar.gov. We have no problem talking about vulnerable groups! The environment at these huge meetings is chaotic, so I have to believe that those who've misdescribed the US position are simply confused.


Val writes:

Can you explain the ABC policy? I don't understand why this is the policy the United States has adopted. It seems like there are better policies for combating HIV/AIDS.

Dr. Dybul:

Val, let me answer as a physician with many years of experience in HIV/AIDS treatment and care. To date, ABC is the most successful foundation for prevention of transmission in generalized epidemics of the type found in sub-Saharan Africa.

For context, today the U.S. supports the most diverse portfolio of HIV/AIDS prevention strategies of any international partner: the ABC strategy to prevent sexual transmission, the expansion of programs that focus on mother-to-child transmission, on blood safety and safe medical injections, on intravenous drug users, on HIV-discordant couples, on women, on men, and on alcohol abuse, among other key issues.

ABC (Abstain, Be faithful, correct and consistent use of Condoms) is good public health, based on respect for local culture - it is an African solution, developed in Africa, not in the U.S. It provides comprehensive information so people can decide how to protect themselves.

In the early 1990s, Uganda became the world's leading example of a country with an HIV/AIDS epidemic, generalized throughout the population rather than concentrated in subgroups, in which many people changed their sexual behavior to protect themselves, so that infection rates dropped.

However, new evidence shows that in additional nations in Africa and the Caribbean, people have changed their behavior to avoid HIV, causing infection rates to drop.

I've already quoted Dr. Peter Piot, the highly respected head of UNAIDS, once. He has said that in Kenya and Zimbabwe, "[T]he declines in HIV rates have been due to changes in behaviour, including increased use of condoms, people delaying the first time they have sexual intercourse, and people having fewer sexual partners." Put another way, A, B, and C behavior change all occurred.

This exciting new data -- drawn from nations where the U.S. supports major prevention efforts -- refutes the critics in the U.S. and Europe who argue that providing people in the developing world with information for behavior change is wasted effort. This evidence is a powerful confirmation of the ABC strategies of our host nations, and of our support for these public health strategies.

Many thanks for the question.


Alicia writes:

I understand that PEPFAR is only 5 years, what will happen after that?

Dr. Dybul:

This will have to be my last answer -- you raise an important issue so I'm glad we had time for it. Here's how I'd put it. With the strong support of the American people and Congress, President Bush's Emergency Plan was the first quantum leap in America's leadership on global AIDS.

This is a commitment from which we will not turn away.

Because each day 8,000 people die from AIDS and 14,000 become infected with HIV, an emergency response was needed. PEPFAR was developed as a five-year catalytic program, intended to support national scale-up of prevention, treatment and care. National scale-up requires both an emergency response to provide services and capacity-building for country-owned, sustainable service delivery. PEPFAR thus supports emergency service delivery by supporting local capacity-building.

Although PEPFAR was announced as a 5-year program, it is understood that continued USG resources will be necessary beyond 2008. All ongoing programs are reviewed periodically by Congress as they progress, and this will be true of PEPFAR as it continues beyond 2008. The exact blueprint and dollar amounts of continued USG leadership on global AIDS will begin to become known after the President offers a proposal, which will not be before 2007.

So all of us are continuing to work with the understanding that the USG will remain committed to supporting global HIV/AIDS programs and that plans for beyond 2008 will not be available until some time in 2007.


Dr. Dybul:

In closing, I'd just like to take a moment to pay tribute to all the people who are doing the work in the field to help people build a future free of HIV/AIDS. The week after next, we're holding a major meeting in Durban, South Africa of HIV/AIDS program implementers, providing an opportunity to share lessons learned so that PEPFAR and other programs can be continuously improved.

It all starts with people, and I take inspiration from the commitment and dedication of people -- both Americans and people of the hardest-hit nations -- on the front lines. There can be value in international discussions at places like the UN, but what really matters is the work of people in the field, and to any HIV/AIDS program implementers who are reading this, thank you.


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