Byliner: AIDS Policy Director Calls for Integrated Attack on Disease

05 December 2001

Byliner: AIDS Policy Director Calls for Integrated Attack on Disease

Evertz emphasizes care, treatment and prevention

(This byliner was originally published in the December 2001 Global Issues Electronic Journal "Health Systems for HIV/AIDS and Other Diseases." No republication restrictions.)

U.S. Targets Global AIDS Pandemic

By Scott Evertz
(The author is director of the White House Office of National AIDS Policy)

In response to the unique challenges presented by the HIV/AIDS pandemic, President Bush has initiated an innovative and integrated approach to setting our priorities and implementing our agenda. First and foremost, domestic and international issues will be coordinated and integrated to present a holistic approach to the problem. This approach is mirrored medically in our commitment to an integrated attack on the disease through care, treatment, and prevention. The administration recognizes that the United States, in order to help its own citizens, must be part of a larger, global solution, and that any successful attack on HIV/AIDS must be accompanied by a general effort of nations to improve the overall health and well being of their citizens. While the war on terrorism obviously occupies many of our immediate thoughts, the global fight against HIV/AIDS remains part of the important work of America, and that work continues.

The Bush Administration Approach

In April 2001, President Bush launched his campaign against HIV/AIDS by naming me the Director of the White House Office of National AIDS Policy (ONAP) and expanding our mandate. The mission of the office now includes the international and national security aspects of the pandemic, and coordination of international and domestic policy relating to U.S. efforts to combat the disease abroad. Our office is the principal entity in the U.S. government responsible for the overall formulation, support, and coordination of policy on HIV/AIDS.

In order to better coordinate the administration's international and domestic fight against the HIV/AIDS pandemic, and to implement our policy decision that international and domestic efforts should be integrated, President Bush established a Presidential Task Force in May 2001 to ensure the most effective response by the United States to the growing threat of the global HIV/AIDS pandemic. The task force is co-chaired by Secretary of State Colin Powell and Secretary of Health and Human Services Tommy Thompson, and includes high-level representatives from all major foreign and domestic affairs agencies.

The task force held its first meeting in July 2001 at the White House. In addition to the improved coordination it provides, the task force is a physical manifestation of the importance this administration places on this issue. The task force will forge new domestic partnerships to work with our international partners on this issue.

Important elements of our fight against HIV/AIDS are our own civil society institutions and nongovernmental organizations (NGOs). As part of this effort, President Bush has continued the Presidential Advisory Council on HIV/AIDS, retaining several existing members, as well as adding several new appointees. The advisory council serves as a main channel for advice and communication with all those elements of U.S. society most interested in and affected by HIV/AIDS. The newly constituted council will, for the first time, also provide views and ideas on the international aspects of our campaign against HIV/AIDS, and we hope other countries will learn from our experience and establish mechanisms to ensure broad public participation in and support for their own national campaigns to combat HIV/AIDS.

U.S. Leadership on the Global Fund to Fight HIV/AIDS, Malaria, and Tuberculosis

Internationally, we have moved aggressively to use this new structure to help mobilize the global fight against HIV/AIDS. In June 2001, the United Nations held a Special Session of the General Assembly to debate and address the global problem of HIV/AIDS. Under the personal initiative of Secretary-General Kofi Annan, and with strong support from the United States, the nations of the world have undertaken to establish an independent mechanism to raise and coordinate the distribution of massive amounts of new and existing resources to combat the pandemic worldwide. The United States, at the direction of the Bush Administration, has been at the forefront of this effort, and has made an initial commitment of $200 million in the first year of the fund. This is the largest commitment to the fund to date.

As this article goes to press, we are negotiating with the affected countries (both donors and recipients) and organizations for the establishment of new, innovative, accountable, and transparent mechanisms for the disbursement of global assistance to fight HIV/AIDS, malaria, and tuberculosis. We are committed to this new fund using an integrated approach of care, treatment, and prevention. While the fund will be used to support direct programs to combat HIV/AIDS, malaria, and tuberculosis, obviously, the general health care infrastructure of the affected nations will also be a matter of concern. Our commitment to the success of this fund is one of the cornerstones of our international strategy.

The United States also continues to lead the world in medical research efforts, not only on HIV/AIDS directly, but on many other emerging and re-emerging infectious diseases. As we work against the HIV/AIDS pandemic, we remain mindful of the value of the hundreds of collaborative research efforts around the world sponsored by the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). The Bush administration has proposed and supported increases of several hundred million dollars in the current budgets of these key institutions.

Continuing U.S. Bilateral Efforts

While we are fully committed to the multilateral, global effort to combat HIV/AIDS, we believe that direct, bilateral programs must be enhanced and coordinated on a global basis. The United States has consistently been the largest provider of bilateral international assistance in the fight against HIV/AIDS, and is likely to remain so. The United States has bilateral cooperative programs with dozens of countries around the world, including 25 in sub-Saharan Africa alone. Yet, as we work around the globe, we never forget that international health begins at home.

Recognizing the inherent connection between America's health and the health of our neighbors, President Bush sent Health and Human Services Secretary Tommy Thompson and me to the U.S.-Mexico border region in October 2001 to work with our southern neighbor on general health issues of mutual concern, including HIV/AIDS. We visited clinics that care for a cross-border population and met with Minister of Health Julio Frenk of Mexico to discuss the need for an improved health care infrastructure on both sides of the border. This visit is another example of how we are working to put our policies into practice.

Here in Washington, D.C., it has been my pleasure to participate in several international visitor programs for groups especially interested in issues related to HIV/AIDS. These meetings and discussions have helped educate me as to what caregivers and policy makers are facing around the world in the fight against the pandemic. Such programs are an important part of our direct, bilateral efforts in the international fight against HIV/AIDS. Importantly, the respective experiences of our domestic programs can be shared, adapted, and transferred to each other as a new tool against the disease. Once again, our openness to such opportunities is a reflection of our belief that you cannot separate the disease into foreign and domestic compartments. ONAP will continue to make a special effort to be available to our foreign colleagues for the sharing of experiences and ideas.

Conclusion

At least 40,000 people become newly infected with HIV/AIDS in the United States every year, and while our principal task must be to bring better care, treatment, and prevention to our own country, I am committed to that same goal for those millions afflicted around the world. Here at the White House we will work for the best possible cooperation and coordination among not only our own government, but with like-minded colleagues around the globe. For us, an enduring lesson of the HIV/AIDS pandemic is that the health of the world is the health of America.

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