Supporting National Strategies: Building on Successes of the President's Emergency Plan for AIDS Relief

Honorable Prime Minister, Honorable Patriarch, Ambassador Brazeal, Ministers and Ambassadors, Ladies and Gentlemen:

Good morning. On behalf of the President’s Emergency Plan for AIDS Relief, I’d like to extend a special welcome to our friends from our host country governments, partner organizations, and the other leaders on HIV/AIDS who have joined us today for our Second Annual Field Meeting.

I realize that simply attending this conference has involved a major effort for many of you. Please accept my thanks for making the journey here to Addis Ababa. You are honoring us with your presence, and in return we will do all we can to make this time highly productive for you.

I want to thank our hosts from the Government of Ethiopia. We very much appreciate your hospitality and assistance in making this meeting possible.

I also want to thank the United States Ambassador to Ethiopia, Ambassador Brazeal, and her team from the Embassy, for their extraordinary leadership and effort in making this meeting possible.

As I noted, this is the Second Annual Meeting of the Emergency Plan. We did not invite non-U.S. Government personnel to the first meeting last year, and it was nonetheless a very useful and successful meeting, in my view.

Yet the wider circle represented in this meeting sends a message to all of us, I hope -- that we are truly together in this mission. The success of any of us depends on the success of the rest of us.

As I reflect on the worldwide effort to defeat HIV/AIDS, there is a “big picture,” and it is certainly important to keep it in mind. What matters even more, perhaps, are the countless “little pictures” of responses to HIV/AIDS at the grassroots level. That is where the battle is won or lost, one human being at a time.

In my role, I have been privileged to witness many images, both hopeful and heartbreaking, and now they are part of me. I imagine that it is the same for you – although I know the tragic images are even more indelible for those of you who have lost loved ones to this remorseless killer.

One thing the images of hope have in common, I believe, is that they usually result from partnerships. Some hard-hit communities in the developing world have the resources within to meet their HIV/AIDS challenges, but many more do not. That’s where the rest of us come in. When we work together with communities, we have the ability to create those images of hope—those realities of hope.

Working in partnership in these early days of the President’s Emergency Plan, we have created many realities of hope. Let me take just a moment to review what I consider to have been some of the key steps along the way that have enabled us to do so.

At the core of our efforts is a dramatically heightened commitment to the prevention, care, and treatment of HIV/AIDS. President Bush’s unprecedented $15 billion promise is being kept.

This year the United States is committing more than twice as much to the global AIDS fight as all the world’s other donor governments combined. In fact, the Emergency Plan is the largest international health initiative any nation has ever directed at a single disease.

Those of you who have worked in hard-hit countries for years know that this funding increase is a tremendous step forward, and one that was long overdue. Of course, a dramatic increase in resources brings its own management and coordination challenges.

The adoption of the Five-Year U.S. Global HIV/AIDS Strategy was an important milestone in our response, signaling for the first time a unified American response that included all the agencies of the U.S. Government working throughout the world, and the partners who make the work possible.

Let me let you in on a little secret. When President Bush first summoned me to the White House and his staff shared with me their vision for implementation of the Emergency Plan, I doubted that the kind of interagency “virtual” organization they envisioned could be brought to pass. In fact, my doubts were so great that I sent word back that I wasn’t interested! The President persisted, and now I’m quite glad that he did, because the innovative model he envisioned really is working.

Another important decision when we developed our strategy was to adopt a field-driven approach. We devolved most of the responsibility for funding decisions and program management in the focus countries to our U.S. Government teams on the ground. We felt that would give us the best chance of identifying the right nongovernmental partners with which to work, as well as fostering the extremely close cooperation with our host government partners that was needed.

In my view, these early decisions helped create the environment for the success that has followed. I know you’ve seen the numbers from our first eight months of implementation. We are making progress together in providing treatment for those living with AIDS, and care for those infected and affected by HIV/AIDS. We have scaled up our programs under national strategies for orphans and vulnerable children, and for palliative care for HIV-positive people. We have dramatically broadened our prevention activities, reaching millions of people with life-saving information and interventions.

One image of hope that affected me profoundly comes from some youth and young adults I met recently in South Africa. NOAH is a nongovernmental initiative to care for vulnerable children in South Africa. Each “NOAH’s Ark” trains volunteers from the community and provides a resource center for kids, located at or near a primary school. Every site is different, but the one I visited outside Durban offers meals, counseling, help with school fees, life skills training, and assistance in getting government services. To my surprise, this Ark provided computer training, thanks to computers donated by private businesses. And the children even get to work on the little garden in the back!

In addition, NOAH volunteers also make the rounds of the community, stopping by to make sure that children are going to school, and that the families are getting by. In all I saw, the love was obvious. I met some young adults who are heads of households, raising their younger siblings. Without help from NOAH, they told me, they just couldn’t make it.

I’m pleased that the U.S. is able to support communities in creating NOAH’s Arks. When people see that those who are infected with HIV, or who lose parents to AIDS, are well cared for, that brings hope. There’s so much more to do, but it is a promising start, and it comes from working in partnership.

As you know, the Emergency Plan is also working with our partners and host governments to make drug treatment available in the developing world on a scale never before attempted. I think it’s fair to say that there was a lot of doubt about whether treatment could successfully be delivered in resource-poor settings on a large scale. But it is becoming very clear that, if we all come together to make it happen, indeed we can do it. Success today is the best foundation for hope for the future.

One of my images of hope comes from Tanzania, where I met Irene. She an 11-year-old girl who’s receiving treatment at the U.S.-supported PASADA clinic operated by Catholic Relief Services. I asked her if she’s careful to take her medicine – and she told me, in her language, that she does it faithfully every day at 7 in the morning and 7 at night!

Another woman’s face comes to mind when I think of the impact of our work together to support treatment. In Haiti, I met a young woman who is being served by a program that focuses on women in prostitution – a program conducted by a nongovernmental organization and supported by the Emergency Plan under Haiti’s national strategy.

This woman came forward to offer heartfelt thanks because ART provided by the program is keeping her HIV-positive sister alive. When I think of the benefits of partnership, I think of that woman’s gratitude.

Prevention is another area in which we consider it essential to work in support of national strategies. Working within national strategies ensures that our approach is based very specifically on what works for the culture and circumstances of each place we are working, with the individuals and groups we are targeting. Our prevention strategies are informed by the experiences of a number of countries around the world that have achieved successes in HIV/AIDS prevention. Implementation on the ground is being developed in consultation with the people and governments of our host nations, and is being carried out by effective partners.

One prevention image that has stayed with me is that of the “Men as Partners” initiative in South Africa. Once again, partnership is a key element of the effort, as American resources combine with several community organizations and a national strategy to make the program a reality. The program helps men to look inward and see whether they are engaging in behavior that puts the women in their lives at risk of infection, such as promiscuity or violence against women.

What’s more, the men actually take responsibility for helping other men change their behavior. I came away from my time with the men with a deeper understanding of the social forces that put women at such high risk, and with tremendous admiration for these men who are willing to be leaders in bringing about change. I’m glad that our partnership is helping to provide a forum for these men to make their courageous choices.

All that we have been able to accomplish, to me, is a direct result of the contributions of host governments, nongovernmental organizations, U.S. personnel – and of course, people in the communities we serve. Where we collaborate in true partnership, success follows.

I am grateful for the spirit of partnership of our host governments. I hope that my comments today will reiterate our commitment to support national strategies. In so many nations, the capacity to deliver health care is severely limited by a history of poverty and neglect, war and political instability. Our ability to put resources to work in a nation is constrained by its health care infrastructure and supply of trained health workers.

Without local capacity, nations cannot fully "own" the fight they must lead against HIV/AIDS. This is why we have invested so much in support of your national strategies to improve health systems and expand capacity. Of course, our capacity-building work is not primarily about making it possible for the United States or other outside organizations to do more in the future. Rather, the Emergency Plan is building capacity so that national programs can achieve results, monitor and evaluate their activities, and sustain their responses for the long term.

Governmental leaders have the ability to do some things that the rest of us cannot do – and it’s not always a matter of formal programs, either. As we all know, increasing the number of people who receive counseling and testing is essential if we are to more effectively prevent infections and provide treatment to people who need it. But testing is so often shrouded in stigma.

When I visited Addis Ababa just over a year ago, I got tested, as I often do on my travels. Much more importantly, however, Mayor Okubay also got tested, and he did so in a very public way. In the wake of his decision to do so, a veritable stampede of other political leaders followed suit! I understand that the First Lady has now also chosen to be tested and to announce it publicly. We don’t know how many ordinary people have been influenced by the courage of these leaders, but in a nation this populous, I’d bet that the number is very large. What a change in just a year!

I want to thank our hosts in the Government of Ethiopia for fighting stigma and helping their people take ownership of their national response to HIV/AIDS in this way. Perhaps their actions will spur some creative thinking for the rest of us!

Nongovernmental partners who can extend the reach of our efforts are also critical to our strategy. There’s a particular need for the community-based partners that can reach people that host governments and donors could never find on their own. And we are grateful for the large NGOs that have worked hard to identify and bring on board community-based sub-partners.

Fully 80% of our more than 1,200 partners working on the ground were indigenous organizations including faith- and community-based partners. That hasn’t been easy to do, but we are committed to bringing even more new and indigenous partners into the Emergency Plan. Their involvement is an important part of a nation taking ownership of its HIV/AIDS response.

Faith-based partners, especially community-based ones, also play a key role, as they often represent a highly motivated source of services with access to extensive networks of people. Some of the images that come to mind are those of children I met in Ho Chi Minh City, Vietnam last summer. Many of those children are living with AIDS, and are being cared for in a home run by a Buddhist monk. He talked with me about the children's desperate need for treatment, but it was also apparent to me that these children are finding hope and some relief through his program.

A development from the past year or so that is highly promising for partnership at the country level, but that must receive even greater focus in the coming years, is implementation of the “Three Ones” agreement. Under that agreement, key donors and multilateral organizations have agreed to support One national plan, One national coordinating authority, and One national monitoring and evaluation system in each of the host countries in which we work.

The most important message we donors sent through the Three Ones, to me, is this: this fight is not really about us! It’s your nation, and our job is to work in support of your national response. Each outside donor, including the U.S., provides support subject to its own national laws and policy. We will work with you to identify areas of your national strategy where we are able to offer needed support.

I know building coordination at the country level is challenging, but it’s something we must do. I have really appreciated the willingness of key technical staff from the Global Fund, UNAIDS, and WHO to join us for discussions on how to improve our country-level coordination. These multilateral partners have been kind enough to travel to our offices in Washington for these discussions, and I understand that the relationships built there have already led to heightened cooperation in a number of countries.

The four short days before us represent a unique opportunity for us to discuss the lessons we have learned to date. I hope our guests will be candid with those of us in the U.S. Government – and I hope we will be with them as well! My hope is that so much useful information will be shared this week, and so many vital new connections made, that our partnerships will look very different in six months than they look today. So let’s make the most of this time together.

In the final analysis, true partnership depends on trust. Let me tell you a story from my most recent trip to South Africa. The Emergency Plan supports a program to train traditional healers to provide antiretroviral therapy along with the care they provide. From our perspective, it’s a way to get lifesaving treatment to HIV-positive people who would otherwise be difficult to reach.

After the ceremony that formalized this arrangement, I was invited into the hut of the leader of this organization of healers. In a gesture of hospitality, she offered me a chicken.

I was touched by this, and I knew better than to refuse such a gift, so I accepted it. Once I had done that, however, I asked her if she had a patient who was sick to whom I could give the chicken. She said that she did, but that she was concerned that she would not then be able to prove to me that she actually gave the chicken to one of her patients. How could I be sure that she wouldn’t just eat it herself?

“Well,” I said to her, “if we’re going to work together, we’re going to have to trust each other.” When my answer was translated into her language, she laughed, and I joined her.

My friends, thank you for the trust you have placed in the Emergency Plan. I look forward to deeper trust, and deeper partnership, in the days to come.

Thank you very much.