Vol.
12, Issue 2 
America Leads New Global Attack on AIDS
by Ambassador Randall L. Tobias, U.S. Global AIDS Coordinator, Washington, D.C.
Eight thousand human lives are lost to AIDS worldwide every day. The United States is meeting this severe and urgent crisis head-on with swift action and extraordinary financial commitment. Under President George W. Bush’s $15 billion Emergency Plan for AIDS Relief (www.state.gov/s/gac), the United States is currently preventing new infections, bringing lifesaving treatment to people with AIDS, and caring for those infected and affected by the disease, including orphaned and vulnerable children.
The United States will make available a total of $2.4 billion for the fight against AIDS this year – more than the rest of the world’s donor governments combined. In fact, America’s financial and political will bolsters internationally coordinated efforts.
The Global Fund to Fight AIDS, Tuberculosis and Malaria is a critical part of the U.S. strategy for battling HIV/AIDS, offering a vehicle for other donors to substantially increase their commitment to this fight, as the United States has done. America is asking the rest of the world to join in supporting the Global Fund, to which it is by far the largest donor nation. Since 2001, when President Bush made the founding contribution, the United States has seen the fund as both a valuable partner and an important vehicle to encourage greater investment of other donor countries, the private sector and individuals in the fight against HIV/AIDS.
With the hope of stimulating significant global investment to combat AIDS, Congress appropriated up to $547 million for the Global Fund in fiscal year 2004, provided that this sum did not exceed 33 percent of total contributions. Put another way, Congress asked only that the rest of the world’s donors contribute $2 for each $1 from America. The United States will continue to work with the Global Fund to challenge the rest of the world to take action and join America in its deepened financial and political commitment to the fight against AIDS.
Prevention, Treatment and Care Demand Attention
In tandem with its support of international efforts to reduce the spread of HIV/AIDS, the president’s Emergency Plan directly provides HIV/AIDS treatment, prevention and care in more than 100 nations. This includes an intense focus on 15 of the world’s hardest hit countries, which are collectively burdened with half of the world’s infections: Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam and Zambia. In each of these countries, U.S. personnel have collaborated with host governments, local community-based and faith-based organizations, international nongovernmental organizations, people living with HIV/AIDS and other stakeholders to design a Country Operational Plan that responds to the nation's particular needs. They have also worked with these nations to determine annual and five-year target numbers of persons to be reached by U.S.-funded prevention, care and treatment programs.
In addition, in these countries over the next five years, this Emergency Plan for AIDS Relief will:
- Support provision of lifesaving drug treatment to 2 million HIV-infected people
- Prevent 7 million new HIV infections
- Support care for 10 million people infected and/or affected by HIV/AIDS.
A major focus of America’s commitment is keeping HIV-positive people in developing countries alive with the lifesaving drugs that are widely available in the developed world. Roughly half of the president’s Emergency Plan dollars will be used to buy antiretroviral drug therapies, giving HIV-positive people in developing countries the strength to work, sustain their families and support their communities. To put this in perspective, at about the same time that the United States began to roll out its programs, the World Health Organization estimated that some 150,000 patients were then receiving antiretroviral therapy in all of sub-Saharan Africa – a fraction of the number who needed to be treated. Yet as of July 31, only a few months after U.S. Emergency Plan implementation, America had supported antiretroviral therapy for approximately 25,000 additional HIV-infected persons in nine countries, based on partial and preliminary reports. And that number continues to grow dramatically as the U.S. program rapidly expands – and as other patients receive U.S.-supported therapy through the Global Fund for AIDS, to which America is the largest donor. Some had questioned whether antiretroviral drug therapy could successfully be delivered in resource-poor settings on a large scale. Fortunately, the United States is making it clear that the answer is yes.
America’s commitment to those suffering from AIDS is to provide not just any drugs, but safe and effective drugs. From the beginning, U.S. policy has been to buy safe and effective drugs at the lowest possible price regardless of who makes them or from where they come. To rapidly provide drugs with quality assurance to those in need, the Bush administration has acted to allow any producer in the world to seek accelerated review of AIDS drugs from the U.S. Department of Health and Human Services’ Food and Drug Administration, which reviews drugs sold to American citizens. The president has made it clear that families in programs funded by the United States in the developing world deserve assurance that the drugs they use are safe and effective. America will not have one health standard for her own citizens and a lower standard of “good enough” for those suffering elsewhere.
Another key focus of the multifaceted U.S. approach to HIV/AIDS is preventing mother-to-child transmission of the virus. As of March 31 — in just 18 months — the United States had trained 14,700 health workers and built capacity at more than 900 different health care sites to prevent such transmission. This program also continues to grow at a rapid rate, offering services to mothers and children alike.
Investment in Infrastructure and Training Is Key
America has taken on an extraordinary and extremely difficult task. And the single greatest obstacle — faced by the United States, the Global Fund and everyone else — is a desperate lack of infrastructure and health care workers in the hardest hit nations. All the AIDS drugs in the world won’t do any good if they’re stuck in warehouses, unable to be provided to those in need because of under-developed distribution networks or a shortage of trained personnel.
It is increasingly clear that more must be done to build up the health care capacity of the highest-risk regions. Drug therapies must reach patients who have been isolated by geography, poverty or political neglect. Treatments must be correctly administered. And patient care must be followed, prevention pursued and whole communities rebuilt on a sustainable foundation. For this reason, a substantial portion of the U.S. funds is being invested in training health care workers, and in upgrading national and local public-health infrastructure. Improving capacity is essential if these countries are to take long-term ownership of their response to HIV/AIDS, as they must.
The United States is proud to be a leader in the fight to turn the tide of this devastating epidemic.