Opening Remarks, Chiefs of Mission Conference on HIV/AIDSAmbassador Randall Tobias, U.S. Global AIDS Coordinator
Remarks to the 4th Caribbean Regional Chiefs of Mission Conference on HIV/AIDS, British Colonial Hilton Hotel
October 3, 2005
Thank you very much. Honorable Prime Minister, Secretary Agwunobi, Ambassadors and guests, I am pleased to be with you this morning. Ambassador Rood, thank you for the invitation to join you to provide the U.S. Government perspective on the HIV/AIDS pandemic in the Caribbean and the world.
Imagine waking up one morning, turning on the radio, and hearing that twenty 747s around the world, each fully loaded with 400 passengers, had crashed, killing everyone aboard. Imagine what a devastating shock such a tragedy would be.
Then imagine waking up the next morning and hearing that the exact same tragedy had happened again. And waking up the morning after that, and the morning after that – every day, in fact, and hearing that 20 jet airliners had crashed, leaving no survivors.
Believe it or not, that is the toll AIDS takes every day around the world. 8000 people are dying every day due to this killer. This disease is a destroyer of individuals, families, and communities.
In trying to comprehend 8000 deaths a day, or 3 million deaths a year, it is easy for these numbers to become just statistics. But it’s important to remember that each one is an individual, with a name, a family, a story. Many of you have seen its devastating effects at close range.
We must never lose sight of the truth that the worldwide HIV/AIDS pandemic is, first and foremost, a human tragedy. At the same time, we must acknowledge the grave consequences it is bringing for social development, and for global security.
We have often been reminded in recent years that our world is smaller than many once thought. Without hope, people can be driven to extremes.
While some of our nations have national prevalence rates that seem low, those numbers can mask serious local epidemics. Over 3 million people in the Western Hemisphere are believed to be living with HIV/AIDS, and approximately 440,000 of those people live here in the Caribbean. There were approximately 340,000 new infections in the Americas last year, including over 50,000 in the Caribbean.
In fact, after Africa, the Caribbean has the second highest level of HIV prevalence in the world. In the Caribbean as in Africa, heterosexual activity is the predominant means of transmission. As in most of the world, women account for a growing share of those infected. The high degree of mobility of persons in the Caribbean – both within the region and beyond it – is one of the risk factors that increases vulnerability. And it is estimated that only 5 to 10 percent of those who need care and treatment for HIV in this region are currently receiving it.
Some people may have the impression that HIV/AIDS is really an African problem, and not a major problem in the Americas, but they are simply – and dangerously -- wrong.
President Bush believes that America has a special responsibility of leadership in responding to HIV/AIDS. The President’s Emergency Plan has now been up and running for nearly two years, and it is an extraordinary venture. It is the largest financial commitment any nation has ever made to an international initiative dedicated to a single disease.
Under the five-year strategy we’ve put in place, America is now fighting HIV/AIDS with programs in 123 countries around the world, with a strategic focus on 15 of those countries that together account for over one-half of the world’s 40 million HIV infections. We are committing intensive resources to show that this work can in fact be done in the most difficult places in the world, and that there is hope of winning this fight.
We have set ambitious five-year goals for these focus nations: support for prevention of 7 million new infections, support for antiretroviral treatment of 2 million people, support for care for 10 million people infected and affected by HIV/AIDS, including orphans and vulnerable children. The intensive, urgent Emergency Plan approach has yielded dramatic early results, while at the same time building capacity for a sustainable response for the long term.
The Emergency Plan commitment is to an integrated program of prevention, treatment, and care. The accomplishments of U.S. bilateral programs for antiretroviral drug treatment, or ART, have gotten a great deal of attention – and deservedly so. Yet we are also intently focused on prevention, because if we cannot get a handle on the number of new infections, we will never be able to treat and care for all the people who become infected. The numbers will simply be too large.
In addition to prevention and treatment, care is also central to our work. By care, we mean health care for people living with HIV, as well as services for orphans and vulnerable children. Our care efforts also include efforts to sharply increase the number of people who receive HIV counseling and testing, an area I’ll have more to say about in a moment. My point here is that prevention, treatment, and care must be integrated, and effective programs feature a balance of the three areas of focus.
In this region, the Emergency Plan works through a variety of bilateral, regional, and multilateral HIV/AIDS initiatives. The U.S. investment in our bilateral and regional programs in the Caribbean has risen from less than $35 million before the Emergency Plan to over $75 million in the current fiscal year – an increase of 115% percent in just two years. That is a clear statement of the importance the U.S. Government places on fighting the pandemic in this region.
One example of an effective bilateral program in the Dominican Republic is the CONECTA Project. It is part of an Emergency Plan effort to support the Ministry of Public Health’s initiative to provide comprehensive treatment and care for people living with HIV/AIDS. With support from the U.S. Government, the project has helped establish a national coordinating body and 17 HIV/AIDS treatment and care sites in public hospitals and health clinics.
In addition to our bilateral and regional efforts, the Emergency Plan also works in partnership with other nations through the Global Fund to Fight AIDS, Tuberculosis, and Malaria, to which the U.S. is the largest donor nation. The Global Fund is particularly central to our strategy for the Caribbean. To date, the Fund has approved two-year grants for the Caribbean that total almost $140 million.
If these two-year grants are successful, the five-year total available from the Global Fund will be approximately $225 million. Given that the United States provides about one-third of the money for the Global Fund, between 45 and 75 million dollars of the Global Fund’s investment in the region comes from the American people.
Our support for Global Fund grants is not limited to financing them, however. We are also providing much-needed technical assistance to help make the money work on the ground, and in the coming year we intend to provide even more of that kind of support. I think it will be tremendously helpful to Fund grantees. It is by leveraging these funds and ensuring their success that we will be able to bring programs to scale in the region, reaching thousands in need of prevention, treatment, and care services.
Of course, whatever the level of U.S. financial and technical support in a given nation, the opportunities for leadership are vast. As you well know, the barriers to a comprehensive HIV/AIDS response in the Caribbean are serious. Yet as Chiefs of Mission, you are ideally positioned to help the Emergency Plan support host nations in overcoming those barriers and saving lives.
Stigma is one of those barriers, in nearly every nation. The need for leaders to stand with people living with HIV/AIDS against stigma is enormous, because it undermines all elements of our response. For example, stigma keeps people from seeking HIV counseling and testing. Without learning their status, they cannot begin lifesaving treatment or take the right steps to avoid becoming infected or infecting others.
An example of leadership in this area is an organization of HIV-positive people known as “POZ” that is an Emergency Plan partner in Haiti. People from POZ make presentations to the local citizenry explaining the facts about HIV, and what antiretroviral treatment can mean. They’re breaking down the barriers of stigma that keep people from accessing life-saving treatment. That’s leadership, and the United States is proud to support it.
There is also a great need for leadership to empower women, who too often lack the power to protect themselves. The U.S. is partnering with programs in many nations to help women live lives free from violence, sexual coercion, and double standards of behavior for men that subject women to elevated risk. Leadership in this area is critical if we are to reduce the number of new infections.
There is also an important opportunity for leadership in helping host nations ensure that responses are truly multisectoral. For our host governments, that means involving not only the Ministry of Health, but all the other governmental sectors that have contributions to make.
Governments may also need to do more to embrace civil society organizations as full partners in the national response. For example, associations of people living with the virus have tremendous contributions to make. Perhaps you, as Chiefs of Mission, can draw upon your relationships to help them work with those leading the national response.
I’m glad that the private sector is a focus of this week’s conference, because in many places its potential is overlooked. This region has a vibrant business community, and companies have capabilities that governments simply don’t have. Many of you know business leaders in your host nations well – are there opportunities to get them involved in working with the U.S. Government, or with a Global Fund grantee, or with the host government?
Just a few weeks ago, a partnership was created among the AIDS Responsibility Project, the Futures Group, Merck, and the Emergency Plan to begin to build a business coalition against HIV/AIDS in Jamaica. This is linked to similar projects going on elsewhere in the Caribbean and in Mexico. I very much hope that we will all look upon public-private partnerships as a growth area in this region!
I would also like to highlight the role of Chiefs of Mission in organizing the internal U.S. Government response to the pandemic. Part of the idea of designating certain nations, such as Haiti and Guyana, as focus countries was to generate best practices that could then be applied in other nations. One of those best practices has proven to be the assembly of an Emergency Plan team that brings together representatives from all the U.S. Government agencies working on HIV/AIDS in country. Such a team can be deeply involved not only in running bilateral programs, but in working closely with Global Fund grantees.
In the focus countries, these teams have come together to develop one, integrated HIV/AIDS strategy, in concert with host governments and other partners. This has proven to be another best practice. With all agencies working off the same page, toward the same mission, our contribution is greatly amplified.
Our leadership capabilities are also magnified—when we all speak with one voice, people listen. If organizing such a team and developing a coordinated strategy sounds like a lot of work, it is – just ask your colleagues from the focus countries! But I believe it will soon repay the investment by fostering a focused, strategic approach.
I know that an important tool for many of you in raising the profile of HIV/AIDS issues has been the Small Grants Program, formerly known as the Ambassador’s Self-Help Fund. To support you in your leadership efforts, I have approved a 50% increase in the amount allocated to this program for the coming year.
The maximum amount available to each embassy or consulate will now be $30,000. Because goals and accountability for achieving them have been such an important part of Emergency Plan success, programs funded must have definable objectives relating to prevention, treatment, or care, and we will be eager to hear the results achieved through the grants.
My hope is that this funding will enable you to reach out to new, local partners, with a special emphasis on community-based groups, faith-based organizations, and persons living with HIV/AIDS. I look forward to receiving your proposals!
Caribbean nations face a wide variety of HIV/AIDS challenges. Some have relatively high rates of prevalence, while others are markedly lower. Even where the prevalence is highest, however, the virus has not become generalized throughout the population to the degree it has in the extremely hard-hit nations of sub-Saharan Africa.
That means that we have the opportunity to make a tremendous difference by intervening now, before that happens. Working in partnership with our host nations, the Emergency Plan has begun to offer millions the hope of a life free of HIV/AIDS.
I am deeply grateful to each of you for your leadership in this fight.
Thank you very much.
Released on October 11, 2005