Ambassador Mark Dybul's Opening Remarks at the 2008 HIV/AIDS Implementers’ Meeting

Ambassador Mark Dybul, PEPFAR Coordinator
Opening Remarks at the 2008 HIV/AIDS Implementers' Meeting
Kampala, Uganda
June 3, 2008

Your Excellency President Museveni and Madame Museveni;

Your Excellency Minister Beatrice Wabudeya, co-chair of this meeting;

Your excellencies the Ministers and dignitaries of the Government of Uganda and other governments;

Distinguished speakers – also close friends – and co-sponsors of the meeting: the Global Fund, UNAIDS, UNICEF, the World Bank, the World Health Organization and the Global Network of People Living with HIV/AIDS;

The U.S. President’s Emergency Plan for AIDS Relief is privileged to be your partner.

Ladies and Gentlemen:

Allow me to begin by thanking President Museveni and the Government and People of Uganda for their warm hospitality, friendship and kindness in hosting us in their wonderful country.

It is appropriate that the International HIV/AIDS Implementers’ Meeting be here in Uganda:

• Land of the White Nile;
   
• And magnificent national parks and wildlife;
   
• And land of generous and warm people;
   
• But also land of one of the first, effective responses to stem the tide of HIV under the inspired leadership of President Museveni;
   
• Land that developed the effective prevention approach know as ABC – abstain, be faithful – or zero grazing – and correct and consistent use of condoms;
   
• Land of Peter Mugenyi and Sam Kibende who may have brought the first ARVs into Africa in the dead of night;
   
• Land of TASO who showed the world that a few determined people, mostly women – can change the world.

And so, it is right that the global HIV implementers meet in Uganda to share lessons learned – to be like the mythological Janus, simultaneously looking backward and forward, so that working together we can save and improve even more lives.

Looking backward, you, the global implementers of HIV/AIDS and your partners, have proven the skeptics wrong. You have irrevocably shattered the pernicious and paternalistic myth that people in resource-poor countries could not manage complex, chronic prevention, care and treatment programs on a national, in fact continental, scale. And in so doing, you have created new models and lessons learned for development overall.

You have proven the skeptics wrong because you believed in people. You knew what the skeptics did not – that seemingly ordinary people who appear to be without hope can do extraordinary things with a little support.

And so you have trusted countless heroes and foot soldiers of compassion – from government and non-governmental organizations, faith- and community-based organizations, and the private sector. Because you knew that persons closest to their communities could take ownership of their lives and combat HIV/AIDS one person at a time. Because you knew that persons living with HIV/AIDS had much to contribute by standing up to be counted with courage and strength. Because you knew that all people regardless of economic means care about and rightly have pride in themselves, their families, their communities and their nations. You believed in them because you knew, as one community health worker put it, that they would “do it out of love.”

And you proved the skeptics wrong by bypassing the sterile debates on “vertical” and “horizontal” programs that so captivate many international meetings and documents.

By going about the serious and sober work of building health systems for chronic prevention, care and treatment – health systems, human resource systems, logistics, communications and supply chain systems. The data are showing that these systems are contributing to health and development in general – that the structures and foundations you have built are enhancing antenatal care, family planning, STD screening, and others.

You knew that by saving lives through HIV prevention and treatment, you would provide the greatest possible hope for orphans – you would prevent them from ever becoming orphans, and so give them a greater chance for life and happiness. But you have also given hope to those already orphaned or made vulnerable by HIV/AIDS through education, food and shelter and a place to call home. So, it is not surprising that we are starting to see the fruits of your labors in the most important of general health outcomes – decreases in infant mortality and increases in life expectancy.

As one part of our Janus role, looking backward, isn’t it a great feeling to have proven the skeptics wrong – by saving and improving millions upon millions of lives?

But we must also fulfill the other part of our Janus role and soberly look forward to the challenges and opportunities we face. Perhaps the greatest is to take the next quantum leap in prevention. We need to acknowledge that HIV prevention is chronic disease management, just as treatment is. We must walk with people from a very young age to the time they are beyond risk, keeping messages and methods fresh and alive – to tackle sexual behavior like we tackled smoking behavior – to make it “cool” and a part of societal expectations for individuals to practice sexually and socially responsible behavior, to make gender violence and gender inequality not only “uncool” but totally unacceptable. We need to develop combination prevention to parallel the intensity, focus and success of combination antiretroviral treatment, integrating social and behavioral change with proven scientific and medical methods.

And so it is appropriate that we are here in Uganda – the birthplace of effective approaches to change social and sexual norms and behaviors – to push to the next level and ensure that we begin the generational approaches that will lead to an HIV-Free Generation.

Perhaps our greatest challenge is to embrace our role as part of a larger global health and development agenda – part of a New Era in Development with resources and commitment not seen since the Marshall Plan. Your efforts have been the first in the history of global public health to build and maintain the infrastructure to prevent, treat and care for a chronic disease. That infrastructure can – and must – be a platform for an expansion of general health and development. And the lessons you have learned implementing HIV/AIDS programs are relevant to health and development as well.

We have a responsibility to make sustained progress towards fulfilling the promise of Paris declaration and Monterrey consensus: to promote and support country ownership. Moving past a failed and flawed era of donors and recipients, we are entering a new era in development based on partnership between equals – in fact, one in which international partners must acknowledge their role as the junior partner to the countries we are privileged to support. That does not mean there is one approach to financing, it means there is one national strategy for development and health – a strategy that incorporates and supports all sectors – and that we all support that national strategy through varied but coordinated mechanisms. As we have taken on the mantle of leadership in new models of effective implementation in development and health– we should take on the mantle of leadership, pushing all of development towards country ownership.

As we step forward to meet the challenges before us, let’s do so with even more enthusiasm and hope. Let’s rededicate ourselves to save and improve even more lives.

Above all, let’s dare to keep dreaming. Because the greatest lesson we have learned these past five years is that dreams come true.