Text: Under Secretary Dobriansky on U.S. Role in Global AIDS Struggle

22 June 2001

Text: Under Secretary Dobriansky on U.S. Role in Global AIDS Struggle

U.S. supports "integrated approach" to fighting virus

HIV/AIDS threatens global security, and demands global attention, said Under Secretary of State Paula Dobriansky June 22. Dobriansky spoke to the nonprofit Kaiser Foundation in New York City as the United Nations General Assembly Special Session on HIV/AIDS prepared to convene June 25-27.

Dobriansky told her audience that the U.S. supports an "integrated" strategy for combating the epidemic. "U.S. monies support education, prevention, research and treatment. The primary focus is on education and prevention as an effective means currently available for slowing the epidemic and saving lives, until we find a cure."

The United States also welcomes recent efforts to make more drugs affordable and available to the developing world from treatment of HIV, tuberculosis and malaria. She also advocated an aid campaign that will help improve overall health care infrastructure in the developing world. "Provisions of ARV's (antiretroviral drugs) must be accompanied by programs that train health care professionals, build laboratory services and improve drug management systems."

The Under Secretary for Global Affairs said the United States has been the largest bilateral donor in the disease-fighting effort, and will remain so in the future.

A plan to develop a global trust fund devoted to an anti-disease campaign is gaining momentum on the international level. Dobriansky said it should be a private, non-profit partnership, pursuing an integrated approach, focusing on best practices, promoting scientific and medical accountability, and respecting intellectual property rights.

Following is the text of the Dobriansky speech, as prepared for delivery:

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U.S. Department of State
Under Secretary for Global Affairs Paula J. Dobriansky

Remarks prepared for delivery
June 22, 2001

The Fight Against HIV/AIDS

Conference "Curtailing the HIV Epidemic: The Role of Prevention"

Hosted by The Henry J. Kaiser Foundation, Ford Foundation Auditorium, New York City

Thank you, Virginia, for that introduction. And thank you to the Ford Foundation, the Henry J. Kaiser Family Foundation and its president, Drew Altman, and the Bill and Melinda Gates Foundation and its president, Patty Stonesifer, for hosting and inviting me to this extremely important and timely conference. On behalf of the Bush Administration, I want to acknowledge the critical and invaluable work your three foundations have done in the field of HIV/AIDS. Your efforts are crucial to the public-private partnership that must be forged to deal successfully with the global HIV/AIDS pandemic. You are to be commended for your vital support.

I'm delighted to be among such distinguished guests and wish to acknowledge in particular the participation in today's conference of President Museveni from the Republic of Uganda and President Mogae from the Republic of Botswana. Their presence, and that of a number of ministers and officials from other countries, both here today and at the upcoming United Nations General Assembly Special Session reflects the seriousness and determination with which they view what is one of the most dire threats facing the world today -- the spread of HIV/AIDS.

Secretary Powell summed up the challenge we are confronting during his recent visit to Africa: "There is no war that is more serious, there is no war that is causing more death and destruction, there is no war on the face of the earth right now that is more serious, that is more grave, than the war we see...in sub-Saharan Africa against HIV/AIDS."

The human toll has been enormous. A recent Brookings Institution study described the HIV/AIDS threat this way: "More people have died from HIV/AIDS over the last twenty years than from any other disease in human history -- including the global influenza pandemic of 1918-19 and the Bubonic Plague."

Another report released this week by the International Crisis Group says that HIV/AIDS is "taking a toll as profound as any military confrontation around the globe, and it is a security threat to countries it assaults as well as their neighbors, partners, and allies."

The threat posed by the disease is all-encompassing. Last year, in its report Global Trends 2015, the National Intelligence Council stated, "AIDS, other diseases, and health problems will hurt prospects for transition to democratic regimes as they undermine civil society, hamper the evolution of economic institutions, and intensify the struggle for power and resources."

Clearly, HIV/AIDS is a global problem, and the United States is by no means immune from its ravages. The recent increase in infections in the U.S. after a period in which the rate had slowed is cause for concern in and of itself. Moreover, Americans -- whether tourists traveling overseas, military and diplomatic personnel stationed abroad, or even those who never leave the territory of the U.S. -- must realize that the spread of HIV/AIDS knows no boundaries.

From both a security as well as a humanitarian standpoint, we cannot sit idly by. HIV/AIDS is wreaking havoc on the populations of many countries hit hard by its spread. Most people who become infected are young and entering the most productive stage of their lives. The cycle of sickness and death is already shredding the fabric of society in Sub-Saharan Africa, with other regions soon to follow. It has lowered life expectancy in many countries, stunting social and economic development and overwhelming already struggling health care systems.

Similarly, the virus is taking a toll on the armed forces of many nations. Young, mobile soldiers are especially prone to being exposed to -- and transmitting -- HIV/AIDS. This will have a major impact not just within a nation's military but on countries' ability to meet international peacekeeping responsibilities.

HIV/AIDS is a threat to security and global stability, plain and simple. Together with malaria and tuberculosis, HIV/AIDS has caused 25% of deaths worldwide. Twenty two million people have died due to AIDS since its onset two decades ago. Another 36 million people worldwide are currently living with HIV/AIDS, more than 5 million of those were infected last year alone. In sub-Saharan Africa, the part of the world most devastated by the disease and home to 70% of the 36 million HIV/AIDS cases, AIDS is now the leading cause of death. But the problem is not unique to Africa, of course. India, Russia, and the Caribbean, in particular, are among many countries and regions struggling with the disease.

It is worth remembering that behind every statistic is a human face. In many cases, the victims are the family breadwinners. But the victims are also the families left behind, including the estimated 13 million children orphaned by the disease. A Council on Foreign Relations study released earlier this year, Why Health Is Important to U.S. Foreign Policy, said that by 2010, HIV/AIDS is expected to create over 42 million orphans worldwide. Unsuspecting mothers transmit the virus to their babies. And due to a lack of education and awareness, others engage in risky behavior that exposes them to this deadly disease.

Nkosi Johnson's name may not be familiar to most Americans, but in South Africa, he was seen as a hero; he was the Ryan White of South Africa. Born with the HIV virus, Nkosi became one of his country's leading advocates until his sad death on June 1. Given little chance at birth of surviving more than a few years, Nkosi lived a full life for 12 years, becoming a human face that his countrymen could associate with HIV/AIDS. He fought a valiant campaign to remove the stigma associated with people afflicted with HIV/AIDS. Nkosi achieved international prominence last year for his speech before the 13th International AIDS conference. "Care for us and accept us," he said. "We are all human beings...Don't be afraid of us -- we are all the same!" It is incumbent upon all of us in this room and all of us around the world to remember Nkosi's poignant words. Sadly, there are millions of others like Nkosi Johnson in the world today, and we must never forget or overlook them.

Prevention, of course, is one of the keys to stopping the virus' spread, but treatment is also vital, so that we reduce the suffering of those living with HIV/AIDS. The U.S. supports an integrated approach to fighting the virus. U.S. monies support education, prevention, research, and treatment. The primary focus is on education and prevention as an effective means currently available for slowing the epidemic and saving lives, until we find a cure. As President Bush said last month, "Prevention is indispensable to any strategy of controlling a pandemic such as we now face."

In the last decade, we have learned that, where there is national leadership, public education, testing and counseling in countries such as Uganda, Senegal, and Thailand, there is impressive progress. Developing countries, after all, must do their part in fighting HIV/AIDS. President Museveni has been a leader in the fight against AIDS through his prevention efforts. Uganda's HIV infection rate in the general adult population has dropped from 14% in the early 1990s to less than 10% today. President Mogae, recognized internationally for his efforts to fight HIV/AIDS, was just yesterday in Washington discussing with Administration officials strategies for combatting the disease.

Prevention works. In the U.S., despite the recent rise in infection rates, it is prevention that has significantly slowed the spread of HIV/AIDS. The key is to follow a multi-faceted approach. Young adults must be given tools and knowledge that promote responsible behavior. Health care professionals must be trained to educate the public and to care for the healthy as well as the sick, and to teach others. We must also address through education the problem of stigma -- which prevents many people in countries across the globe from seeking HIV testing and care. Again, we must not let the progress Nkosi Johnson and others have made be in vain.

Of course in encouraging people to get tested and seek care, we must do our best to provide the help that we can. For 36 million people already infected around the world, focusing on prevention will not help. Our humanity demands that we seek to alleviate these people's suffering, even though no cure currently exists. Because AIDS is characterized by a breakdown of the immune system, the danger for those with HIV/AIDS is caused not by the HIV virus directly, but by secondary infections. We can prolong life and improve the quality of life by treating these infections.

Furthermore, the most advanced programs to treat infections can potentially be applied at large scales because of their low cost. For example, for pneumonia, antibiotics are 90% effective and cost an average of 27 cents per individual. A six-month course of tuberculosis medication, in a program that addresses the development of drug resistance, costs just $10 per individual.

We welcome efforts to make drugs for HIV/AIDS, tuberculosis, and malaria more affordable in developing countries. At the same time, it is important to remember the critical role of intellectual property protection in encouraging innovation and the extensive research needed to develop new medications and, ultimately, a vaccine and cure.

The price of HIV/AIDS treatment has declined rapidly in the last year, from $10,000 per person per year in the U.S. to under $1,000 per person per year. This increased availability of affordable treatment for the developing world is a promising step, welcomed by the entire international community. However, even at these reduced prices, international aid can only reach a small fraction of the HIV-infected people in the developing world.

Anti-retroviral medications for the treatment of HIV/AIDS can inhibit the effects of HIV and extend a patient's life for a few precious years. However, without a cure, the virus eventually develops resistance to whatever drugs we apply, and the patient begins losing the battle with opportunistic infections. HIV/AIDS cannot be stopped with today's drugs; it can only be slowed down. Provision of ARVs must be accompanied by programs that train health care professionals, build laboratory services, and improve drug management systems.

In this connection, we welcome Pfizer, Inc. for its announcement earlier this month of a visionary program to establish a center to train African doctors to administer the most current HIV/AIDS drugs available. Pfizer's announcement comes on the heels of its decision to expand its giveaway of Diflucan, an anti-fungal drug used to treat infections in HIV/AIDS patients, to more than 50 developing countries. Merck, too, deserves recognition for its large HIV/AIDS program in Africa and for agreeing to forego profits on all anti-retrovirals in a number of developing countries. And Bristol-Meyers Squibb should be cited for its $115 million "Secure the Future Initiative," which supports orphan and home-based care for women and children with HIV/AIDS in sub-Saharan Africa.

The problems with treatment underscore the need for continued research for a cure and a vaccine. As part of the Bush Administration's integrated approach for dealing with HIV/AIDS, a continued program of research is a necessary complement to prevention and treatment efforts. It is only with a cure that we can once and for all wipe out this menace to the world.

Because the HIV/AIDS scourge is so devastating and widespread, and because the countries hardest hit are among those least equipped to combat the disease on their own, the global community has a responsibility to help. And the response must indeed be an international effort -- from both government and non-government sectors.

In announcing the U.S. contribution of $200 million to the global fund to fight HIV/AIDS, malaria, and tuberculosis last month, President Bush said, "We must all show leadership and all share responsibility....Not only governments but also private corporations, foundations, faith-based groups and non-governmental organizations should participate.

Last week's summit between the U.S. and the European Union offered promise. In a joint statement issued after the summit, the parties agreed on "the need for an integrated and comprehensive approach to confront the diseases HIV/AIDS, malaria and tuberculosis, particularly in Africa, emphasizing prevention in a continuum of treatment and care, and spurring research and development." The statement also expressed support for the global fund.

As an American, let me say that I find it heartening to see broad public support in the U.S. for confronting HIV/AIDS in places like Africa. A Kaiser survey done last year showed 64% of Americans polled supporting the use of federal funds to help solve the problem of HIV/AIDS in Africa. Thirty three percent of those strongly support such efforts. Large majorities of those polled strongly supported both prevention and education as well as treatment and care. Such a balanced, integrated approach fits in well with the Bush Administration's policy and programs in dealing with HIV/AIDS.

The Bush Administration has made the fight against HIV/AIDS a top priority and is taking the lead on this issue. The United States has been, and will continue to be, the largest bilateral donor in the fight against HIV/AIDS, TB, and malaria, providing nearly 50% of all international HIV/AIDS funding. Since 1986, the U.S. has dedicated over $1.6 billion, primarily through the U.S. Agency for International Development, for the prevention and mitigation of the HIV/AIDS epidemic in the developing world, four times the amount of the next largest donor country.

The President's budget for the next fiscal year seeks $480 million for the international fight against the HIV/AIDS epidemic, an 8% increase over last year's amount and a 113% increase from FY2000. It also provides $2.5 billion for HIV/AIDS research by the National Institutes of Health, an increase of $258 million, as well as a rise in the Center for Disease Control's domestic and international HIV/AIDS programs from $848 million this year to $871 million next year. And this is all in addition to the $200 million we are providing to the global fund.

Underscoring the Administration's commitment, the President this spring took two important steps: first, he expanded the mandate of the Office of National AIDS Policy to better facilitate both domestic and international policy efforts on HIV/AIDS; second, he created a high-level task force on HIV/AIDS headed by Secretary Powell and Secretary of Health and Human Services Tommy Thompson. The task force, supported by the Office of National AIDS Policy and including the White House Domestic Policy Advisor and the National Security Advisor, coordinates the Administration's proactive activities and responses to all aspects of the domestic and international HIV/AIDS crisis.

A critical part of the international campaign against HIV/AIDS, tuberculosis, and malaria is the global fund, proposed by Secretary General Kofi Annan and strongly supported by the U.S. Our support for this effort was evidenced by the President's announcement May 11 in the Rose Garden with Secretary General Annan and Nigerian President Obasanjo that the United States will commit $200 million in seed money, with "more to follow as we learn where our support can be most effective."

The U.S. Government, the first contributor to the fund, believes this approach represents a unique opportunity for international public-private partnerships that will provide grants for prevention, treatment, and care. The Administration will work with G-8 and private foundations, corporations, faith-based groups, and other organizations to generate additional support for this global effort. We welcome Tuesday's announcement by the Gates Foundation that it will commit $100 million to the fund.

The Administration is working with the international community to ensure that the global fund is:

-- a public-private partnership;

-- pursues an integrated approach to fighting HIV/AIDS, TB, and malaria, emphasizing prevention in a continuum of treatment and care;

-- focuses on "best practices" by funding methods that are proven to work, then scaling up;

-- promotes scientific and medical accountability, incorporating review by medical and public health experts; and

-- respects intellectual property rights to preserve the incentive for new drug development.

Again, this is a global trust fund, not a U.S.-only effort. The United States is prepared to lead the way, but it cannot do this alone. The EU statement, offers by the French Government, the Gates Foundation, and corporations like Credit Suisse Group which announced a $1 million contribution two weeks ago, and the support by foundations like those hosting today's conference are critical to making the global trust fund work.

Next week's meeting of the UN Special Session is an opportunity for all attendees to demonstrate their solidarity in the fight against HIV/AIDS. Our hope is that it will marshall resources for the global trust fund and lay the groundwork for an aggressive, multifaceted approach in dealing with this scourge. We appreciate the role played by the UN, the Secretary General, and by Dr. Peter Piot, Executive Director of the Joint UN Program on HIV/AIDS.

The Secretary of State has asked me to spearhead the Department's international work against HIV/AIDS. This involves working with my colleagues at USAID, HHS, CDC, NIH, and other agencies as part of an interagency team. The State Department brings to the table its expertise in dealing with other governments and people and developing strategies for advancing important issues.

Next week's UN meeting is an important step, but it's only the beginning. Much work remains to be done, and I can't think of a greater, more important challenge. HIV/AIDS is a global pandemic, requiring a global commitment and response. It goes hand in hand with the campaign to stamp out poverty and other social problems. As Helen Epstein, writing, in the latest issue of the New York Review of Books, noted, "AIDS is as much a symptom of social crises as it is a cause of them."

Nearly 38 years ago, Martin Luther King, Jr., in his famous "I Have A Dream" speech on the steps of the Lincoln Memorial, speaking of the urgent need to end racial injustice, warned, "This is not the time to engage in the luxury of cooling off or to take the tranquilizing drug of gradualism." Similarly, now is the time to work feverishly to do what we can to eradicate HIV/AIDS, malaria, and TB. Human beings are the world's most precious resource and we must do everything possible now so that future generations can enjoy a better life, free of the scourge of these horrible diseases. The actions we take now will affect mankind forever. We are, after all, our brothers' keepers. Thank you.

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