*EPF411 02/06/2003
Bush HIV/AIDS Initiative Sends Clear Message of Commitment Abroad
(Top HIV/AIDS officials describe $15 billion program at FPC briefing) (1450)

By Susan Ellis
Washington File Correspondent

Washington, D.C. -- President Bush, in his recently announced Emergency Plan for AIDS relief --- a five-year, $15 billion initiative to fight the AIDS pandemic in the most afflicted countries of Africa and the Caribbean -- has sent a clear statement to the world that "HIV is here; that we have to do something about it; that treatment is possible and we're calling upon other developed countries of the world to join us," the director of the White House Office of National AIDS policy told an international audience February 6.

Dr. Joseph O'Neill said "It's tremendously important for development, delivery and prevention messages to make people aware that this (the President's expanded AIDS budget) is actually out there." He was speaking to the news media from around the world at the State Department's Foreign Press Center in Washington, and was joined by Dr. Anthony S. Fauci, director, National Institute of Allergy and Infectious Disease at the National Institutes of Health (NIH); and Dr. Jendayi Frazer, senior director of African Affairs, National Security Council.

The following countries will be the focus of the Bush AIDS initiative: Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia.

Dr. Fauci said the U.S. does not intend to repeat mistakes of the past. "If you take a western model and superimpose it on a country, you generally run into a number of problems. No-one feels that one size fits all countries. That would be naive, inappropriate and doomed to failure." Instead, they looked at the Uganda model, he said, noting that "Uganda is a bit more advanced in this particular area than many, not all of the countries."

He credited Dr. Peter Mugenyi and his colleagues in Uganda with invaluable assistance, and said "When you go around to many of the other countries, although they do not have the high-tech health care infrastructure (of Uganda), there is some semblance of a low-tech network model that isn't identical to Uganda; but it can be, we think, readily adaptable to that, starting with a central medical center and then going progressively out with lower and lower technology to primary, secondary and tertiary satellite clinics or health care facilities."

Fauci continued: "We then went to the Caribbean and looked at the program in Haiti that's run, for example, by Professor Jean Pape with help from (Dr.) Paul Farmer at Harvard; and we found that, much to the amazement of many people, they were successful in implementing a modification of the program."

The "critical issue," as Fauci termed it, is that although not one size fits all in the matter of AIDS programs, "the broad philosophy of utilizing the kinds of infrastructures that already exist, as rudimentary as they may be, are (still) amenable of being enhanced by resources. Wherever we went we found that people said 'we feel that we can do it. The only thing we really need is resources to be able to treat people, because many of them can't afford the drugs.'

"In fact," Fauci added, "Even in Uganda, the only people who are getting treated now are people who can themselves afford the drugs."

What the physicians and other specialists must develop over the next year, before the first of the new monies are allocated, he said, is "an in-country model that can be flexible and adaptable."

Asked when AIDS sufferers in the targeted countries could begin to feel an impact from the new funds, Fauci said: "We already have a billion [1,000 million] dollars a year going into HIV/AIDS (treatment) so they're already starting to see some of the benefits. The increases will start in Fiscal 2004, so the president's program...will be (a) $10 billion new money commitment beginning with $2 billion in 2004, and then going up to a total of $15 billion over a five-year period. All the funds will go toward drugs for treatment, but other programs such as that at USAID, for example, will address nutrition and other facets of the AIDS problem, he said.

He said the President's program will be administered through a special ambassadorial-level person at the State Department, and that the Department of Health and Human Services (HHS) and the U.S. Agency for International Development (USAID) "will play a significant role" because of their experience and input into the program. "But the accountability and leadership of it will be a direct report to Secretary of State Colin Powell."

There also will be, Fauci emphasized, "very heavy use of in-country people, local people. We won't make the mistakes of past of dumping in a program that has not been conceived of or tried by in-country people."

Asked about what special attention will be paid to women AIDS sufferers who comprise about 55% of those afflicted in Africa, Dr. O'Neill said their care and prevention is "critically important. At the very core of this was an approach directed at recognition of these tremendous needs. The first move that was made in the direction of this program was in fact the Maternal Child Transmission Initiative. And we're very clear that it was not just intended to care for women at the time of birth but provide ongoing care for women that would be called MCTC-Plus. This was very much in the forefront of our minds in designing this program and we look forward to working with people who are concerned about these particular issues to make sure we get it right."

Asked by a reporter from Mauritius how unaffected countries such as hers could prepare for the future threat of AIDS, O'Neill said "by drawing local attention to the fact that treatment is possible and a priority. It's tremendously important for development, delivery and prevention messages in making people aware this is actually out there. If people have hope, they will get tested and come in for treatment, if treatment is available."

He said President Bush has spoken on this subject, and that the program is going to "build a tremendous amount of training material, infrastructure -- a huge focus on the whole issue in Africa that can't help but benefit other countries not part of the (initial) fourteen."

O'Neill stressed that the new initiative is "not taking money away from the existing over $1 billion [1,000 million] investment that the Administration is making in global AIDS (expenditures) that covers 50 or 51 other countries."

Dr. Fauci stressed the importance of hope and treatment for AIDS in getting it beaten. In Haiti, he said, "Dr. Pape has been working fundamentally in the research arena and then realized that you cannot conduct research, as we know very clearly in this country, without addressing the very compelling issues and problems of prevention and care. So he has with his colleagues together with Dr. Paul Farmer from the Harvard School of Public Health...gone out into the bush and gotten anti-HIV drugs to individuals in the rural areas of Haiti. So in a country where...there was an inadequate health care system and it looked like you couldn't you couldn't treat people with HIV, which is very often the misperception that has stalled a lot of the efforts" to treat HIV-affected people," he was able to do so.

It is important "to put together on the same scale, treatment and prevention," he said, "because in this country before we had anti-retroviral drugs at all, it was very difficult to get the message of prevention to (AIDS victims) because you didn't have anything to offer them. But we found out that as soon as you had prevention, you got people to talk about HIV and to determine if they were infected. They knew that if they turned out to be infected, you had something to offer them. There was a great incentive to come in and get involved in the program.

Fauci said, "We found the same situation in Haiti and they've been quite successful. With minimal resources; the same sort of thing that we've seen now in Uganda, and there are programs in Kenya getting off the ground now, and in a variety of other countries.

"So we feel that by linking those three -- and that's the reason those three are inextricably linked in the program -- getting people into care, treating people and then hopefully you will spread the prevention methods --. That there will be a double and triple-barreled benefit," he concluded.

(The Washington File is a product of the Office of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)

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