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 You are in: Bureaus/Offices Reporting Directly to the Secretary > Office of the U.S. Global AIDS Coordinator > Press Room > Remarks and Presentations > 2005

Remarks at the Washington Rotary Club Luncheon

Ambassador Randall L. Tobias, U.S. Global AIDS Coordinator
Remarks to Washington Rotary Club
Washington, DC
November 9, 2005

Thank you very much for that warm welcome.  It’s a pleasure to be with you today, and to participate in Rotary’s celebration of its vital international efforts this month.

First, I want to acknowledge the many Ambassadors serving here in Washington who have joined us here today. I’m pleased to have this opportunity to acquaint you with the United States’ efforts to fight the global HIV/AIDS pandemic. I hope our time together will suggest ideas for deeper partnership on this critical issue.

Turning to the Rotary members present, I will add my voice to those of many others who have honored Rotary for your extraordinary commitment to international health and development.  Rotary has won wide acclaim for its efforts to eradicate polio, to make clean drinking water available, and to provide microcredit for fledgling entrepreneurs. You have taken on difficult missions – but ones that are critical to the development of our world.

The most striking feature of your international projects is your commitment to work in true partnership with communities in the developing world. You are raising funds here to support the projects that your fellow Rotary members in these places have worked with their communities to design.  As I describe the work of the President’s Emergency Plan for AIDS Relief, I believe you’ll see that there’s a lot in common between our approaches. 

Let me begin by asking you to imagine a scenario.

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, and each one is an individual, with a name, a family, a story. The worldwide HIV/AIDS pandemic is, first and foremost, a human tragedy. 

At the same time, we must acknowledge the grave consequences it brings for social development, and for global security.  Young adults embody human potential – the skills, experiences, and knowledge that lift societies out of poverty. But young adults in Africa and Asia and the Americas are the ones most likely to die of AIDS, and when they do, their children are unlikely to stay in school.   How can children reach their potential if they’re locked in a desperate struggle for their very survival?

So HIV/AIDS is not just a disease that is killing individual, families, and communities today, it’s a destroyer of hope for the future. We have often been reminded in recent years that our world is smaller than many once thought.  It’s not a good assumption today, if it ever was, that hopelessness in faraway places will not touch us here at home.  Without hope, people can be driven to extremes. 
In much of the world today, bringing hope simply must include aggressively confronting HIV/AIDS. This is a challenge for the whole world, and at this point, it is not one that we can leave developing nations to face on their own.  In President Bush’s view – and my own – the U.S. has a unique ability to lead the world in rising to this challenge – and we are doing just that.

The President’s Emergency Plan for AIDS Relief 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 health initiative focused to a single disease.  By the way, I understand that Rotary’s commitment to polio eradication represents the largest private-sector support of a global health initiative ever. I congratulate you on that achievement!

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. 

I am pleased to report that the U.S. has made very encouraging progress in the early years of this initiative. We are finding success in preventing HIV infection in the first place, and in helping those infected and affected by HIV/AIDS, including the vast numbers of children orphaned by this terrible disease. 

One area of our work that has been especially groundbreaking is antiretroviral drug treatment.  As you know, these drugs have long been available here in America and other developed nations, but generally not in the developing world.  However, through the President’s Emergency Plan, the U.S. has now made a major commitment to support treatment in some of the most remote corners of the world, and on a scale never before attempted. 

Let me try to put the numbers I’m about to cite in some perspective.  When President Bush launched the Emergency Plan in his 2003 State of the Union Address, it was estimated that of the 4.1 million sub-Saharan Africans who would benefit from anti-retroviral drugs, only 50,000 were receiving them.  On the ground, that reality is now changing – rapidly. 

As of the end of March, the Emergency Plan supported anti-retroviral drug treatment for approximately 235,000 men, women, and children, most of whom live in sub-Saharan Africa.  And that figure is now more than 6 months old.  We’ll be receiving reports from teams on the ground in the near future, and I believe they will reflect continued rapid growth in our efforts.

I can’t tell you how encouraged I am by that progress.  Many doubted that antiretroviral therapy on a large scale could ever be made to work in resource-poor nations. Well, that’s one debate that is now over. It’s working.

President Bush has described the impact of these antiretroviral drugs as a “Lazarus effect”:  someone on a seemingly irreversible course to death returns to health.  And it is a modern-day miracle.  In unprecedented numbers, we are now bringing that miracle to places where AIDS has eliminated hope. 

When people in these communities see their neighbors – their family members – who were at death’s door, recovering and once again living a full, productive life, that brings hope. 

After a trip to Africa this summer, David Brooks, the New York Times columnist, wrote the following:  “One woman (I met), Josephina, had been dying of AIDS. Her mother had already died. So had her sister and brother-in-law, and she was looking after their children. Then she got on the treatment program, and now she has the irrepressible joy of someone who has come back from death…You can imagine what this has done for the morale of the health workers.  You can imagine how it has helped them in their efforts to get more people tested for HIV.  Now a positive test is not a death sentence.  Something can be done. …I came …(to Africa) expecting despair, but now realize that we should be redoubling our efforts out of a sense of opportunity. I came here aware of controversies about abstinence versus condoms in AIDS prevention programs, about U.S. aid versus multilateral aid, and (I) now realize that all that nonsense is irrelevant on the ground.  This is a world of people trying everything, of doctors … many … backed by money from the President's Emergency Plan for AIDS Relief, finally doing the work they've always dreamed of doing.  We could be on the verge of a recovery boom.”

What David Brooks saw is something I have had the privilege of seeing many times in these last few years.

When people in these communities see their neighbors – their family members – who were at death’s door, recovering and once again living a full, productive life, that brings hope.

Clearly, I believe that the results the Emergency Plan is achieving are critically important. But it’s also important to take note of how it is achieving them:  by supporting the people of our host nations as they design programs to respond to their own HIV/AIDS epidemics.

HIV/AIDS is going to be a tragic fact of life in our host nations for the foreseeable future. So our starting point for the Emergency Plan is the conviction that national responses must be sustainable. By sustainable, I don’t mean that the United States, or other donors, must be able to continue to respond to the pandemic with the intensity and resources we’re now applying.  What I mean is that the nations hit hardest by the pandemic must be increasingly able to sustain their own responses, rather than relying entirely on outside donors.

A response can only be truly sustainable if the local population owns it.  These are their countries, their communities, their families.  No outsider, even one with tremendous resources and great intentions, can ever own the reality of a particular society in the same way that its people themselves can.

It would certainly simplify our own task if we just went into countries, built brand new clinics from the ground up, staffed them with Americans, enrolled people, and then provided them with all the prevention, care, and treatment they ever needed.

The President’s Emergency Plan rests on a different model, one of partnership.  The people in our host nations identify their needs, and then we work with them as partners in building the capacity to meet those needs as part of a comprehensive national HIV/AIDS strategy. 

Now, let me focus for a moment on what I mean when I say we support national responses.  The United States has joined with the other major HIV/AIDS donors to agree that in each country in which we work, we will work in support of a single national strategy.  In nations that did not yet have such a strategy, we have worked with the host government and others to develop one.

Successful strategies, for an issue as complex and multifaceted as this one, must be multi-sectoral.  Clearly, if sustainability is the goal, simply writing checks to governments isn’t the answer. To be sure, host governments have vital leadership roles to play – and if they fail to do so, the national response is terribly handicapped. Some of our Emergency Plan support does go to host governments that are engaged and demonstrating leadership.

Yet most of our support does not go to governments.  In many nations, civil society institutions in particular are weak – not only on HIV/AIDS, but across a range of issues.  So supporting the development of the local non-governmental and private sectors is crucial if we are serious about sustainable national responses.

We are working with the community- and faith-based organizations that are often closer to the people than a government can ever be.  Among the most important of these are the groups of men and women living with HIV/AIDS, many of whom are demonstrating real courage in the face of stigma and discrimination. And the private sector also offers unique strengths that must be part of a comprehensive response. We therefore seek to support all these sectors, and to help all of them grow their nation’s capacity to respond. When societies develop their own leadership and capacity to meet their challenges, that breeds hope for tomorrow.

Let me talk about one project that is a model for moving toward sustainability. In the late 1980s, a small band of Indiana University School of Medicine physician-faculty members persuaded their colleagues to help address unmet healthcare needs in Africa. 

Instead of setting up a freestanding project, an enlightened decision was made to support a new Kenyan medical school, which an existing university there was launching.  IU initially provided support for a curriculum and faculty development, and the Moi Medical School graduated its first class of physicians in 1997, thus growing Kenya’s capacity to serve its own people.

The President’s Emergency Plan now provides the resources for a dramatic expansion of the partnership’s HIV/AIDS work.  The Indiana-Kenya partnership has established adult and pediatric HIV/AIDS centers, building capacity for care in a network that spans much of western Kenya.

This partnership has focused on sustainability: today’s Kenyan patients are being treated by Kenyan health care providers, who were largely trained by other Kenyans, who are products of the IU-Moi partnership.

What IU is doing in Kenya is what we want all our U.S.-based partners to do:  hand the work off to indigenous organizations.  They are demonstrating that we in the developed world can help our host nations develop their own capacity – if we’re actually serious about that goal.

Increasingly, we are. I should note that this sustainability focus I’m describing is not limited to America’s HIV/AIDS work. The Emergency Plan is part of President Bush’s broader effort to establish and meet “transformational development goals.”  In our development assistance, we are building partnerships with governments that commit to the essential criteria of governing justly, investing in people, and promoting economic growth.

This Administration is applying this transformational strategy across a range of development initiatives, and I think this leadership is great news for the developing world. And as we’ve seen in the HIV/AIDS context, this vision is spurring new action from both recipients of aid and those who deliver it. We really are helping people around the world to have a more hopeful vision of their future. It’s an exciting time.

Of course, when I talk about sustainability to a Rotary audience, I feel a bit like I’m preaching to the choir. For decades, Rotary has chosen the road less taken in international development – the road of partnership.

Rotary Clubs here in the U.S. have worked in partnership with Rotary Clubs and other civil society organizations in the developing world, providing the resources to support their strategies.  As a result, you have not only made a tremendous financial commitment -- you’ve done it in ways that have helped communities build the capacity to respond to the needs of their own people.

In looking over the projects that the Washington Rotary Club supports, I was pleased to see that several of them focus on HIV/AIDS – and on sustainability. For example, I see that your sister Rotary Clubs in Nairobi, Kenya have established a partnership with a village to create households for its children orphaned by AIDS, under the care of loving “housemothers.” Kenyans have designed the project, and you are stepping forward with funds to match those of the Rotary Clubs in Nairobi.

Another example is in South Africa, where you are partners with Circle of Life, a community-based NGO, to create a drop-in center for AIDS orphans and other vulnerable children in a community with an HIV prevalence rate of 29%.  I was struck by this line in the program description: “The total value of the program is estimated at about 200,000 Rand spread over three years, after which Circle of Life will assume responsibility.”

That’s exactly the model that we’re trying to build into the Emergency Plan, one that promotes sustainability. So you can see why I consider Rotary and the Emergency Plan to be kindred spirits!

Our world faces daunting challenges, but we also live in an exciting time. I am grateful for your interest in and support of the President’s Emergency Plan for AIDS Relief. Even more, I thank you for your leadership and compassion as we work together to build a hopeful future.

Thank you very much.

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