U.S. Efforts To Combat the HIV/AIDS Pandemic in AfricaRandall Tobias, U.S. Global AIDS Coordinator
June 13, 2005
(2:40 p.m. EDT)
MR. CASEY: Afternoon, everyone. Welcome to briefing number two on the day. It's a pleasure for us to have with us this afternoon the United States Global AIDS Coordinator, Randall Tobias, who is here to talk to you about our efforts to combat the HIV/AIDS pandemic in Africa. As you know, he was over with the President this morning for his meeting with African heads of state and they talked a little bit about that there, but we would like to have the opportunity for him to speak with you today, talk a little bit more in detail about what we're doing and specifically what his office and the President's initiative is doing to help combat this terrible problem.
AMBASSADOR TOBIAS: Thank you very much and good afternoon, everyone. I'm pleased to be here today to update the information that the President provided earlier today on the Emergency Plan for AIDS Relief. As the United States Global AIDS Coordinator, I am today here to represent the agencies that are implementing the Emergency Plan as a single, unified U.S. Government team, including the Departments of Commerce, Defense, Health and Human Services, Labor, State, the Peace Corps and the United States Agency for International Development.
For too long, AIDS sufferers in the developing world have had very limited access to life-extending anti-retroviral treatment, or ART. That has been more widely available in the West. It was estimated that only 50,000 of the 4.1 million Sub-Saharan Africans who could benefit from anti-retroviral drugs were receiving them at the end of 2002. However, in January of 2003, President Bush announced and launched the Emergency Plan for AIDS Relief with strong bipartisan congressional support. As results are reported from the field, it is increasingly clear that the launch of the Emergency Plan marked a turning point in the fight against HIV/AIDS. On the ground, the reality is changing and it is changing rapidly.
As the President referenced this morning, as of March 31st of this year, the Emergency Plan has supported anti-retroviral drug treatment for approximately 235,000 men, women and children through bilateral programs in 15 of the most afflicted countries in Africa, Asia and the Caribbean. And of that number, more than 230,000 of those being supported live in Sub-Saharan Africa. The goal set forth a year ago was to support treatment for more than 200,000 people in these 15 countries by June of this year; and so we didn't just exceed the goal by 35,000, we did it three months earlier than the goal. In my opinion, that is striking.
Looking ahead, these results indicate that the Emergency Plan remains on track, scaling up to meet the President's ambitious goal of supporting treatment for 2 million people in the first five years of the program. A particularly hopeful sign is that 57 percent of the persons receiving treatment are women and girls among the sites reporting gender numbers. The United States is the only major donor to track treatment support by gender and we will continue to work to ensure that women and girls have full access to prevention, treatment and care.
With these results, the U.S. continues to support treatment for more people than any other donor in the world through our bilateral programs alone. That is in addition to our support for the programs of multilateral organizations that have treatment programs, including the Global Fund to Fight AIDS, Tuberculosis and Malaria. The U.S. remains by far the largest contributor to the Global Fund, providing one-third of its current resources. It is thus important to remember that one-third of the support for treatment provided by the Global Fund comes from the American people, in addition to the bilateral results announced today.
Now, how are we achieving these results? Two weeks ago, we held our second annual Emergency Plan field meeting, this time in Addis Ababa, Ethiopia, bringing together the people who do the work on the ground: U.S. Government people, Ministry of Health officials in the countries where we are working, representatives of people living with AIDS, our international partners such as UN-AIDS, the World Health Organization and the Global Fund, as well as some of our bilateral partners among the donor nations and a number of NGOs.
Our purpose was to share lessons learned to find out what is working and what is not. The key to our success is clearly the work of the talented and dedicated people in country, including the people of the host government and nongovernmental sectors. The Emergency Plan is a vehicle for the American people to support their effort and the true credit for the success that has been achieved rests with those working on the ground. U.S. Government field staff work closely with partners and friends to implement each host nation's vision of fighting HIV/AIDS. The Emergency Plan is committed to working with national strategies to build capacity in country. Over 80 percent of our partners are, in fact, indigenous organizations. Only a locally-led response will be sustainable. The leadership and commitment to fighting AIDS in our host countries is strong and growing and that is one of the most encouraging developments taking place today.
Let me comment on the spectrum of services required for quality treatment that we support. With our support, host nations are providing services that achieve results while, at the same time, building the local sustainable capacity they need for national programs that will support their responses for the long term. The services and the capacity expansion include training for clinical and laboratory personnel; counselors for treatment regimen adherence, prevention and healthy living; support for physical infrastructure, including laboratory equipment; and distribution, logistics and management systems for drugs and other commodities.
It is all-important, as any clinician in the field will tell you, treatment requires far more than drugs alone and the Emergency Plan recognizes that. Treatment is so important because it brings hope that drives efforts in other areas, such as prevention, counseling, testing and care. The Emergency Plan is committed to integrating all of these because no one piece can stand alone.
We are committed to prevention. Our goal is to save lives before they are ever infected with the virus. The Emergency Plan will issue a program update on prevention activities including behavior change approaches, mother-to-child prevention activities, and safe blood and safe medical injections programs later this month.
We are committed to encouraging all people to get counseling and to be tested. Only by being tested and knowing your status is it possible to get help. And indeed, one of the big challenges facing us in the world is that as many as 90 percent of the people who are infected with HIV do not know that they are infected. The United States has supported HIV/AIDS counseling and testing services for over three and a half million people.
We are committed to care. The Emergency Plan has set a goal to support care over 1.1 million HIV-positive persons and AIDS orphans and vulnerable children by June of this year. This goal was actually exceeded back in September of 2004, nine months early. Updated care numbers from March will be available in the near future.
Clearly, I am very encouraged by the progress that is being made. The numbers are important, but that's because each number represents a human being. For them, these programs are turning the despair of suffering and death to the hope of health and life and it is a privilege to be a part of that.
And now I will be happy to take any questions that you may have. Yes.
QUESTION: Can I ask you what the long-term goal in the number of people that are being (inaudible) anti-retroviral treatments at the end of this program? I mean, right now we've got fifty thousand — two-hundred-fifty thousand. Where do you want to see it ending up?
AMBASSADOR TOBIAS: The goal that the President established at the beginning for the 15 focus countries — and I should note that the Emergency Plan is providing programs in 123 countries around the world — but in the 15 focus countries, the goal is to have 2 million people on anti-retroviral therapy by the end of the five years. And our benchmark on the way to building up, ramping up those programs, was to have 200,000 people on therapy by June of this year. So the fact that we have 235,000 on treatment by March is, I think, an indicator that we are on the roadmap — a little ahead of the roadmap.
QUESTION: What are the challenges in South Africa? I mean, South Africa is one of the more developed countries and yet it's dedicating much less resources than other countries which it surpasses in terms of economic growth. What are the challenges there?
AMBASSADOR TOBIAS: The biggest challenges in any country, and South Africa certainly it is a country where it's no exception, is building the infrastructure, both the physical capability and the human resources that are needed on the ground. South Africa has more of that than some other countries, but nonetheless, there's capability that has needed to be built. The second issue that is extremely important in every country is the issue of leadership, of strong national leadership stepping up to the issue. South Africa was probably later to come to that than some nations. We are working closely with the South African Government, encouraging them to be even more aggressive in their efforts. But we do have a good relationship with the South African Government as we implement our programs there.
QUESTION: Could you talk about a bit more about prevention and, you know, at some point, is there a plan for, you know, as the prevention increases that, you know, maybe you won't need to put as much money and resources into drugs?
AMBASSADOR TOBIAS: Well, prevention, treatment and care all have to go together. Historically, when prevention was the only tool, there was a big reluctance on the part of a lot of people to even get tested because if they got tested and found out they were positive, they really felt in many cases that it was a death sentence and the issues of stigma were so great that there wasn't a lot of incentive to get tested.
Now, there's a lot of emphasis and a lot of discussion about treatment, but we also need to remember that it is not our objective to get the whole world on treatment. And so if we don't successfully address the prevention issue, that's probably the — if you had to pick out a single key for the long term, it probably is prevention. And so the objective of the President's program, in addition to getting 2 million people on treatment in the five years, is to prevent 7 million infections that from the statistical projections would otherwise have occurred in that five-year period. And we are doing this in a number of ways.
The backbone that is increasingly identified by health care professionals around the world and the backbone of our prevention program is the so-called ABC approach that was developed in Uganda, a combination of abstinence, being faithful and the correct and consistent use of condoms. But in addition to that, we also need to be aware that in the world at large something slightly over 50 percent of those infected are women. In Sub-Saharan Africa, it's probably between 55 and 60 percent of those infected. And so there are other approaches, additional approaches to prevention, that address the specific needs of women: giving young girls the tools to avoid coercion; dealing with needs to change property inheritance laws so that women have inheritance rights and issues like that. Prevention is a very complicated set of issues, but extremely important.
QUESTION: I notice that Swaziland is not one of the countries included among the countries being targeted by the United States and yet it's surrounded by countries which are, you know, benefiting from the program. Is there any consideration being given — because there are reports that it may be one of the first countries in the world — I don't know how exaggerated these are — to possibly being wiped out or, you know, it has the highest rate of HIV infections in that region. Is there any consideration being given to perhaps focusing more attention on Swaziland?
AMBASSADOR TOBIAS: Well, Swaziland is, in fact, one of the 123 programs — countries where we have programs. I don't have the numbers in front of me but we can give you — get you — the numbers. But Swaziland is receiving more money this year than they did the previous year. And both Swaziland and Lesotho, who geographically have the same situation vis-à-vis being kind of surrounded by South Africa, have programs that are coordinated very closely with our program in South Africa because, as your question suggestions, this is a virus that does not necessarily respect political boundaries and we need to be sure we are addressing the virus in a very integrated way.
I might tell you that the working definition that we use for a focus country is a country that has a program to do a nationwide scale-up of prevention, treatment and care and where the United States has provided sufficient financial resources to be a significant player, a significant driver, in that country's nationwide scale-up. And those are the 15 so-called focus countries. But there are 108 additional countries where we are, in some cases, providing more absolute dollars than we are in some of the focus countries and Swaziland is a country that we are very focused on.
QUESTION: So is this briefing today in tandem with the visit of the five African presidents and prime ministers, and will there be new information coming out at the end of this month in reference to the program?
AMBASSADOR TOBIAS: About every six months we gather data and so we are now in the process of finalizing the data through the end of March. And the President made reference in his meeting with the five African leaders this morning to the fact that we have 235,000 people now on treatment. That's up from 155,000 that we were supporting on treatment at the end of September, and so the purpose of this briefing was just to follow up with a little more detail from the fact that the President made that announcement this morning.
Any other questions?
QUESTION: Thank you.
Released on June 13, 2005