*EPF305 07/14/2004
U.S. AIDS Ambassador Calls for Unity Against Epidemic
(Focus must stay on saving lives, Tobias says) (1240)

By Charlene Porter
Washington File Staff Writer

Bangkok, Thailand -- U.S. Global AIDS Coordinator Randall Tobias called for unity in the search for solutions to the world's AIDS epidemic July 14, facing down protestors who attempted to disrupt his speech before a crowd of several hundred at the XV International AIDS Conference.

"Perhaps the most critical mistake we can make is to allow this pandemic to divide us," Tobias told the audience. "We are striving toward the same goal -- a world free of HIV/AIDS. When 8,000 lives are lost to AIDS every day, division is a luxury we cannot afford."

"We may not agree on every tactic employed by every donor," he said, "and we may have passionate opinions about how things can be done better, but we must work with each other to find the best solutions, while knowing that every person in this fight simply wants to save lives."

Tobias, the U.S. AIDS ambassador, made his call for unity even as a group of about 40 protesters chanted derogatory remarks for about 10 minutes before members of the audience and conference officials restored order.

Such protests have become routine at this conference. Many of the demonstrators are people living with HIV/AIDS who say they do not believe the global community is responding rapidly enough to the plight of HIV-infected people around the world. A French government official and a pharmaceutical company executive faced similar disruptions in attempts to speak at other conference events this week.

U.S. officials participating in the meeting say the protests against the U.S. government campaign against AIDS and its newest program, the President's Emergency Plan for AIDS Relief (PEPFAR), are based in misinterpretation and mischaracterization.

In his speech, Tobias faced those challenges squarely. "I want to get something straight about the U.S. position on prevention, because there seems to be a lot of confusion and misinformation," he said.

He explained one key U.S. strategy for AIDS prevention known as ABC. "Abstinence works. Being faithful works. Condoms work. Each has its place," Tobias said. "Preventing AIDS is not a multiple-choice test -- there is no one right answer to preventing the spread of this pandemic. Those who want to simplify the solution to just one method -- any one method -- do not understand the complexity of the problem."

The U.S. global AIDS coordinator also emphasized that the United States will make people living with HIV/AIDS full partners in the global effort, saying their involvement is vital to success.

"For that reason, we will soon be launching pilot programs in a number of countries that will allow small groups to apply directly to the U.S. Embassies' country teams for rapid approval on small grants," Tobias said. "The idea of this program is to ensure that small and effective organizations that are doing some of the best work on the ground can get money fast to address urgent needs within their communities."

Tobias also addressed criticisms of the PEPFAR plan based in the mistaken belief that the ABC prevention strategy is its sole approach for addressing the spread of the AIDS epidemic.

"[O]ur approach must be based very specifically on what works in each place we are working, with the individuals and groups we are targeting," Tobias said. "For instance, unlike most of our other focus nations, Vietnam's HIV/AIDS epidemic has been fueled by intravenous drug use. As we develop our country plan, we will be looking at ways to educate those who inject drugs about the added risk of HIV/AIDS, and exploring means to support drug abuse prevention and treatment."

Fourteen African and Caribbean nations were first named as the focus nations of the five-year $15 billion PEPFAR initiative. President Bush announced the inclusion of Vietnam, the first Asian nation, in June. The 15 nations together are home to approximately half of the estimated 38 million HIV-infected people in the world.

Distribution of aid under the plan began earlier this year, and over the next 12 months it is projected that PEPFAR will help provide antiretroviral (ARV) treatment for 200,000 people who need it and care for 1 million people. Tens of millions will be the beneficiaries of prevention messages and support for improved medical practices, according to U.S. State Department documents issued in June.

Another important element of PEPFAR, Tobias said in his AIDS conference speech, is the sense of urgency behind it. "Within days of receiving funding, we were traveling by motor scooter to deliver antiretroviral drugs to people in their homes in rural Uganda," Tobias said. "Within weeks, we were doubling the number of patients on ARVs in urban Uganda. We put 500 people on therapy at just one site in Kenya. One of our treatment partners has begun therapy for another 500 hundred patients in just two countries, and they are enrolling more patients at a rate of 220 per week."

Delivering as many ARV drugs as possible to as many people as possible is another issue which has stirred significant controversy in the AIDS community. The health crisis has allowed developing world pharmaceutical companies to receive waivers on patent protections held by developed world pharmaceutical companies in order to produce more affordable drugs.

The United States has established an expedited regulatory procedure for manufacturers to submit the so-called generic drugs to the U.S. Food and Drug Administration so that they will undergo the rigorous review that ensures the safety of medicines on the U.S. market.

"It is a moral imperative that families in programs funded by the United States in the developing world have the same assurances as American families that the drugs they use are safe and effective," Tobias said. "America will not have one health standard for her own citizens and a lower standard of ����good enough' for those suffering elsewhere."

Critics have alleged that the United States is not allowing purchase of the generics with PEPFAR dollars in order to protect the interests of western pharmaceutical companies. Tobias said quality is the issue, not patent protections or profits.

"I have consistently and repeatedly expressed our intent to provide, through the emergency plan, AIDS drugs that are acquired at the lowest possible cost, regardless of origin or who produces them, as long as we know they are safe, effective, and of high quality," Tobias said.

The U.S. AIDS ambassador closed his remarks with a plea that other governments follow the lead of the United States and rise to the global challenge of the epidemic. "This year America is spending nearly twice as much to fight global AIDS as the rest of the world's donor governments combined," he said. "By its actions, the United States has challenged the rest of the world to take action."

Tobias looked to the future and expressed the hope that the 2004 International AIDS conference will mark the beginning of "an era of compassionate action" in the global response to the epidemic.

"May we all come together," Tobias urged, " in a spirit of heightened commitment and cooperation, to focus our energies on doing what we must to win this fight -- on behalf of the people of the world who so desperately need our help."

(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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