Statement of the United States of America at the 2008 UN General Assembly High Level Meeting on HIV/AIDS

Ambassador Mark Dybul, PEPFAR Coordinator
Statement of the United States of America at the 2008 UN General Assembly High Level Meeting on HIV/AIDS
UN General Assembly
June 11, 2008

The United States welcomes this opportunity to express its commitment to effective partnerships in the fight against HIV/AIDS.

We thank the Secretary-General and his staff for their hard work in putting together an excellent report. We also thank Executive Director Peter Piot of the Joint United Nations (UN) Programme on HIV/AIDS (UNAIDS). Dr. Piot has led UNAIDS since its creation, and has been a catalyst for the great progress we have begun to make in recent years, which is being considered at this meeting.

A New Era in Development
Since we gathered for the UN General Assembly Special Session in 2001, the world has transformed its response to the global HIV/AIDS pandemic. At that time, many doubted whether prevention, treatment and care could ever successfully be provided in resource-limited settings, where HIV was a death sentence.

Today, while much remains to be done, the skeptics have been proven wrong. Millions of people are on life-saving anti-retroviral treatment in developing countries, and many millions more have benefited from prevention and care programs.

Over the past five years, the American people, through the U.S. President’s Emergency Plan for AIDS Relief, have provided $18.8 billion in support for HIV/AIDS prevention, treatment and care – well over the $15 billion originally committed. With this support, the American people have partnered with the people of developing countries around the world to turn the tide of their epidemics as we work together toward concrete, numerical goals: treating two million people, preventing seven million new infections, and caring for 10 million people, including orphans and vulnerable children.

But we make a mistake if we overlook the lessons of this success beyond the fight against this one disease. This unprecedented progress on HIV/AIDS must be understood as part of a larger global health and development agenda. It represents what President Bush has called a New Era in Development, with resources and commitment not seen since the Marshall Plan.

These 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 we 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 the 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, together, 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.

Lessons Learned from HIV/AIDS Responses
At the heart of support for country ownership is support for local people, families, and communities. It is ordinary people, working in their own communities, who 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, they have created new models and lessons learned for development overall.

Perhaps the most important lesson they have taught us is that seemingly ordinary people who appear to be without hope can do extraordinary things with a little support.

When we have put our trust in these countless heroes and foot soldiers of compassion – from government and non-governmental organizations, faith- and community-based organizations, and the private sector – that trust has been repaid many times over. Persons closest to their communities have taken ownership of their lives and combated HIV/AIDS one person at a time. Persons living with HIV/AIDS have contributed so much by standing up to be counted with courage and strength. All have demonstrated that people everywhere regardless of social, economic or HIV status care about and have pride in themselves, their families, their communities and their nations. We must believe in them because, as one community health worker put it, that they do what they do “out of love.”

Five years ago, skeptics said treatment was not possible in resource-poor settings, and we have proven them wrong. Now, the skeptics say we cannot build health systems by focusing on specific diseases with definable outcomes. They are distracting us with sterile debates about "vertical" and "horizontal" programs - and once again we are proving them wrong. We are proving them wrong by going about the serious and sober work of building health systems for chronic prevention, care and treatment – human resource systems, logistics, communications and supply chain systems. The data are showing that these structures and foundations are contributing to health and development in general – enhancing antenatal care, sexually transmitted infection screening, and other areas of work.

By saving lives through HIV prevention and treatment, these heroes provide the greatest possible hope for orphans – preventing them from ever becoming orphans, and so give them a greater chance for life and happiness. But they 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 all these labors in the most important of general health outcomes – decreases in infant mortality and increases in life expectancy.

Reflecting the need to continually strive to develop best practices to improve our efforts for health and development, approximately 1,700 HIV/AIDS implementers joined together in Kampala, Uganda, last week to share lessons learned in the fight against HIV/AIDS. They included representatives from international businesses and some of the largest Governmental health initiatives ever created – but also from small, local organizations that are working to change their own communities. They came together as equals with the understanding that everyone has something to teach and everyone has something to learn.

Knowing Your Epidemic
As we look forward, perhaps the greatest need – and opportunity – we face 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. We must address sexual behavior as we addressed 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.

Once again, we must target our support to the community level, empowering local people and the community- and faith-based organizations that best ‘know their epidemic’ – and know how to engage people in responding to local drivers of infection such as sexual coercion, violence and rape. Together we can push prevention to the next level and ensure that we begin the generational approaches that will lead to an HIV-Free Generation.

Conclusion
As President Bush often says, to whom much is given, much is required. So let us rededicate ourselves to meeting the commitments we have made, and most of all, to support the leadership of the people of developing nations in a spirit of partnership. They have taught us that, working together, everything is possible.