Ambassador Tobias Addresses 72nd Annual Conference of Mayors on U.S. Global HIV/AIDS Efforts

The HIV/AIDS crisis is incredibly complex, so the world’s response must have many, many facets. Reducing stigma is important, making testing available is important, providing drugs is important. But today I want to highlight one element that is the foundation for all of the others. And the good news is that, even if you don’t consider yourself an expert on HIV/AIDS, it’s something all of you as mayors are experienced at providing. It’s leadership.

Early and effective leadership by high-level political leaders can contain and even roll back epidemics -- as we have seen in a number of places in Africa and elsewhere. But where leaders have been silent, inactive, or worse, HIV continues to spread despite the best efforts of communities and contributors. Leadership spurs action and magnifies its effects. Leadership is simply essential if we are to change the course of HIV/AIDS.

We have seen examples of dynamic leadership throughout the countries most severely affected by this virus. At the top, heads of state like President Museveni of Uganda have led the way in combating stigma, denial, and misinformation through forthright discussion of the disease. They have led citizens to do what many thought impossible -- to change the behaviors that cause HIV to spread.

But it is not only heads of state in severely affected countries who make the difference -- it’s your counterparts, those who have leadership responsibilities at all levels. And I’m not referring only to political leaders, of course. In these hard-hit places, all who lead and influence people or organizations have the capacity, and the duty, to make a dramatic difference in stemming the tide of the epidemic and supporting treatment and care for those infected and affected by AIDS.

I tell that story as an example of the power of indigenous leadership to change the way people look at this epidemic. Leaders in these countries can accomplish much that we simply cannot do from a world away, and we need to support and encourage them in every way we can. I’m so pleased to be joined on today’s program by Mayor Mfeketo of Cape Town, one of the true leaders of this fight at the community level.

Of course, with a global crisis of the magnitude of HIV/AIDS, only a global response will suffice. As the leader of the United States, President Bush saw the need for our country to lead a global effort to defeat this killer. The President had a bold vision: to turn the tide of this global pandemic. He proposed "a work of mercy beyond all current international efforts to help the people of Africa." This was the beginning of his Emergency Plan for AIDS Relief.

In the past, we in the developed world had displayed ignorance, or even apathy, about the global dimensions of the AIDS crisis. Over time, awareness grew and we became empathetic, which is certainly an improvement over apathy. But it’s really not enough. So President Bush led us into the era of action. He insisted that we stop talking about the reasons why we couldn’t do anything to stop AIDS, overcome those things, figure out what we could do, and do it -- right away. Sometimes leadership has to be bold, and I’m glad the President decided not to be bound by a "business as usual" mentality.

I was honored that the President asked me to lead his Emergency Plan. We developed a 5-Year strategy, and here is its very first goal: across the world, the United States will encourage bold leadership at every level to fight AIDS. At this point, we are several months into the first year of implementing this strategy. The President charged us with doing things in creative new ways, and I am very, very proud of what we’ve been able to do.

The major challenge is one that you, as mayors, will understand well: the need for human capacity and infrastructure that can accommodate our investment. As you know, ignoring those limitations means wasting money and failing to solve problems. In the context of places like Africa, the Caribbean, and Southeast Asia, there is a desperate lack of health care workers and infrastructure. African leaders understand this, just as you do: all the AIDS drugs in the world won’t do any good if they’re stuck in warehouses with no place to go to actually be part of the delivery of treatment to those in need.

Let me cite an example. In the U.S., we have 279 physicians for every 100,000 people. In Ethiopia, there are only 2.9 physicians for each 100,000 people. A physician there told me that there are more Ethiopian-trained physicians practicing today in Chicago than in all of Ethiopia. In Mozambique, there is a total of 500 physicians to serve the needs of a population of 18 million.

Obviously, without making progress on the capacity issue, our ability to deliver prevention, treatment, and care is quite limited. That’s why, especially in these early years, we are making a tremendous investment in training and infrastructure. Improving capacity is essential for the President’s Plan to be sustainable in these countries for the long term.

But despite these challenges we face, the President’s Emergency Plan is already producing results, and laying the groundwork for more. Based on our progress to date, we believe we will meet the following targets for the program’s first year:

• 200,000 people will receive life-extending antiretroviral treatment.
  
• Over 1 million people, including 600,000 orphans, will benefit from care that will help them mitigate the impacts of HIV/AIDS.
  
• And millions more people will be exposed to potentially life-saving prevention messages.

Most importantly of all, roots have been set down for sustainable, long-term programs to allow each country to wrest its future back from the jaws of AIDS.

Another area of American leadership is the international effort to fight HIV/AIDS. The President’s plan aims to increase the overall chances of success by pursuing multiple approaches to this complex emergency -- supporting and partnering with individuals, community and faith-based organizations, host governments, and multilateral institutions like the Global Fund and the United Nations.

President Bush took the lead in founding the new Global Fund, and America is by far the world's largest contributor to it -- making 36% of all pledges to date. We are encouraging the rest of the world to do more -- much more. This year America is spending nearly twice as much to fight global AIDS as the rest of the world’s donor governments combined.

American leadership in this fight cannot come from Washington alone -- and that’s why I’m honored to be among you today. So many of you have been effective leaders in combating HIV/AIDS in your own communities for many years. I am delighted that many of you are now taking the next step -- becoming leaders in the global fight.

I want to recognize Mayor Garner for doing so much to make the global AIDS fight a major agenda item of the U.S. Conference of Mayors. He asked himself how he could make a difference in his sphere of influence -- and as you can see by looking around you, his sphere is a big one! He organized a mission of mayors to visit Africa, as you’ll be hearing shortly. I was honored to have him join me on a trip that Secretary Thompson and I led to Africa last year, and Mr. Mayor, I thank you for your valuable contribution there. And I also want to thank Mayor Garner, and all of you, for seeking ways to establish sustainable ways to assist the effort for the long term.

Ongoing relationships have the power to sow real change, and you have the opportunity to build relationships between your communities and the places of greatest need abroad. Sister city relationships, "twinning" of health care facilities in your cities with those overseas -- these are things many of you have begun, and I hope many more of you will also pursue them.

I understand there are more than 1,100 Mayors in this Conference. My vision is that the struggle against global HIV/AIDS will not be carried forth by only a handful of you with a special interest, but that all of you will find ways to get your communities involved. Think what the impact could be if there were 1,100 sister cities in the countries that are suffering so much from the HIV/AIDS pandemic -- benefiting from the support you can bring.
If leading such an effort sounds like a lot of work, it probably is. But I can’t think of any area in which your leadership can have a greater human impact. And I want to offer you my assistance, and that of my office. We want to be a resource for facilitating your work to combat global HIV/AIDS.

As all of you know, with leadership comes controversy, and in this area of HIV/AIDS, I’ve found that there is sometimes an awful lot of energy wasted on questioning not only the policies but the motives of those who have taken up this fight. In my view, however, America’s compassionate action is something of which we can all be proud. It’s time for all of us, within America and throughout the world, to come together to conquer this disease.

HIV/AIDS -- and the denial, stigma, and complacency that fuel it -- are the real enemies, and we must direct our energies at them, not at one another.

On Wednesday I was privileged to accompany President Bush to Philadelphia, where he gave a major address on HIV/AIDS at an African-American church. It was an emotional time for many there, because many in our own cities have suffered from the tragedy of HIV/AIDS. But I was so impressed by the desire there to see America continue to lead the struggle against this disease -- not only at home, but around the globe. Something the President said there struck me. He said, "Let's go where the problems are the toughest. Let's bring America to where people suffer the most." Well, that’s what we’re doing.