*EPF308 05/05/2004
New U.S. AIDS Emergency Relief Plan Off to Strong Start
(Global AIDS Coordinator Tobias at meetings in three focus countries) (880)

By Charlene Porter
Washington File Staff Writer

Washington -- Global AIDS Coordinator Randall Tobias reports that people in 14 focus countries are already receiving help and treatment as a result of the President's Emergency Plan for AIDS Relief (PEPFAR), a major initiative that received its first funding from the U.S. Congress just months ago.

Tobias noted this progress upon his return from an April 20-May 1 tour of three African nations involved in the program.

"It is possible in a relatively short period of time to visit places as I just did and see programs that [PEPFAR] has already funded, where people are already receiving help," said Tobias in a Washington File interview. "I feel very good about that, about the speed with which we have gotten started."

The first round of funding -- $350 million -- in the five-year, $15 billion plan was distributed to agencies and organizations that provide services in all 14 countries in late February. Another installment of $450-500 million will be distributed within the next several weeks, Tobias said.

The overall program goals are to treat 2 million people, prevent 7 million new infections, and provide assistance to 10 million HIV-infected people and orphans affected by the disease. It is the largest and most rapidly moving global AIDS initiative in the world in terms of how quickly money is being placed in the hands of service providers, according to a spokesman in the coordinator's office.

"On the treatment front, we're going to see a very rapid increase from almost zero to where we very quickly reach the limitations of the system," said Tobias. Those limitations stem from the lack of health care infrastructure in most of the target countries.

The World Health Organization (WHO) collects data that show the shortages of skilled medical professionals in the PEPFAR focus countries. For example, Haiti has 8.4 physicians per 100,000 people; Zambia has fewer than seven while developed countries have in the range of 300-400 physicians per 100,000 people, according to the WHO data (available at http://www3.who.int/whosis/health_personnel/health_personnel.cfm ).

Tobias described the health care infrastructure problem as "a huge limiting factor" in attempting to scale up efforts to improve treatment and care of people living with HIV/AIDS. "It's the human resources of medical professionals, plus the physical infrastructure of clinics, hospitals, testing facilities, laboratories and that kind of thing," he said.

The lack of health care and the means and abilities to provide it are problems that have been recognized for a long time in the developing world, but Tobias says the magnitude of those problems as obstacles to providing treatment to people with AIDS in epidemic countries is not fully recognized.

"It doesn't do any good to get drugs there unless you have medical personnel and infrastructure to get it delivered," Tobias said, adding that he does see a growing level of attention to these needs by leaders in the focus countries.

"We're seeing more and more leadership at all levels," Tobias said. "There is momentum that is building, and I think it will become more contagious." The roles leaders must play in combating the disease has often been identified as another critical issue in improving the response to the epidemic.

Tobias practices what he preaches to demonstrate how leaders, especially national and local political figures, must act because leadership in the midst of an epidemic cannot be limited to conventional or legislative actions. On his trips to clinics in focus countries, he makes a point to be tested for the HIV virus in view of television cameras and other media. He did just that on a visit to a testing facility in Ethiopia on this recent trip, and the next day he urged an audience in Addis Ababa to do the same.

"I challenged every one in the audience to go get tested and tell somebody you got tested, and have them tell somebody you got tested, because that's how we'll begin to get rid of the stigma," Tobias remembered. "The mayor got up, said he was going to get tested, and asked the TV cameras to go with him. That was enormously important for the message it sends."

Besides his stops in Ethiopia, Mozambique and South Africa on the late April trip, Tobias also attended a meeting of the Global Business Coalition on HIV/AIDS in Berlin. The Global AIDS coordinator says that greater involvement of the private sector in combating the epidemic is another key element in achieving success.

"The good news is that the corporate sector -- particularly a lot of the multinational companies -- have begun to step up to this issue in a major way," Tobias said. "The bad news is there's much, much more to be done."

Effective companies are providing care and treatment for infected employees and prevention counseling for the uninfected, Tobias said. He said companies are also lending their professional expertise to local prevention efforts, citing the efforts of the Coca-Cola Corporation, which has assigned its marketing departments in Africa to help develop prevention messages for community groups working to stop the epidemic.

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

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