Remarks at the 2006 Global Summit on AIDS and the Church

Ambassador Mark Dybul, United States Global AIDS Coordinator
Saddleback Church Campus
Lake Forest, California
November 30, 2006

AMBASSADOR DYBUL: Thank you Kay and Rick. In your HIV/AIDS work, you are modeling the values of humility, compassion, generosity, and service. The faith community must be at the heart of an effective response to this pandemic, and those fighting HIV/AIDS are privileged to have you as partners.

Ladies and gentlemen, we live in a time of a second black death – a rampant pandemic that knows no national boundaries, that respects no division of wealth or poverty. UNAIDS reported last week that approximately 40 million of our sisters and brothers are living with HIV and more than 25 million have already died from AIDS. Without massive intervention, some estimate that 70 million will die by 2020 – more than died in World War II. Beyond the 40 million living with the virus, many, many millions are living with the effects of this scourge. Today, 14 million of the world’s most vulnerable citizens – young children – are orphans because of HIV/AIDS. By 2010, there could be as many as 25 million, and orphan-run households are becoming commonplace.

Every one of these numbers is a family member, a loved one, a member of a community. In Uganda, I visited the dirt home of a 40 year old former teacher who is HIV-positive. We walked about a quarter mile from the potholed clay road that washes out with rain. His wife, who died a year earlier from AIDS, is buried in the family yard. With turkeys and chickens pecking about us, we sat under the shade of a tree, a few feet from the grave of his wife and mother of his four children, as he described the terrible pain of trying to explain to the children why their mom had wasted away, turning into a ghost before their eyes, and why he lost his job and livelihood as he began to waste away himself. Across the world today, this story is repeated. One person, one family, one community at a time, the losses are rending the social fabric of nations – and because Africa bears the burden of over 60 percent of all infections – an entire continent.

This black death of our time challenges us to decide who we are, as individuals and Americans, and who we want to be. President Bush boldly captured the generosity and compassion of the American people with the President’s Emergency Plan for AIDS Relief – also called PEPFAR. It has been said that where your treasure is there also will your heart be. Through PEPFAR, America is giving of its heart and treasure to serve our global sisters and brothers in this titanic struggle against HIV/AIDS. Under the leadership of President Bush and with the strong bipartisan support of Congress, we are doing it through direct US Government programs and as the largest contributor to the Global Fund to fight AIDS, Tuberculosis and Malaria. I am pleased to share the stage with Richard Feacham because our support for the Global Fund is an important part of PEPFAR.

When the history of global public health is written, the launch of PEPFAR –the largest international health initiative in history dedicated to a single disease - will be remembered as one of the boldest and most important actions - ever. More important than the quantum leap in dollars to 15 billion across 5 years was the insistence that those dollars achieve results – that we meet aggressive but realistic goals. We committed to support the prevention of 7 million new infections, to support the treatment of 2 million, to support care for 10 million, including orphans and vulnerable children. And to do it in a defined period of time.

But the billions of dollars, and the specific goals, can mask the deeper impact of PEPFAR, which can be measured in units of hope and faith:

Hope for and faith in the people of the countries in which we are so privileged to work.

Hope for and faith in the compassion and generosity of the American people.

Hope for and faith in the courage of people living every day with HIV and those living under the pall of the terrible disease.

It is now clear that this hope and faith was justified.

Individuals, communities and nations are taking control of their lives and are beginning to turn the tide.

Let me share with you the best news we have had on HIV/AIDS in a very long time. We are starting to see significant declines in HIV rates in several countries and stabilization of infection in others. And when we have looked, those changes are associated with significant behavior change. Data from Kenya, Zimbabwe, Botswana, Uganda and other countries show that young men and women are choosing behaviors that protect them against infection or reduce their risk of acquiring it. We know that the only 100 percent way to avoid HIV infection is to abstain or to be faithful to an HIV-negative partner. And the data are clear – we are seeing young people embrace and practice primary and secondary abstinence. We are seeing men dramatically reducing their number of partners and casual encounters. But some still engage in risky activity, or are in HIV-discordant couples, where – for example – the husband is infected while the wife is not. The data support the view that comprehensive prevention encompassing A (abstinence), B (be faithful) and C (correct and consistent condom use) – or ABC – is the most effective way to prevent HIV infection in generalized epidemics, such as those in Sub-Saharan Africa. ABC was developed in Africa by Africans, it is the official policy in many nations, and it has the full support of the U.S. Government.

But it is difficult for ABC to work in contexts of coercion and abuse of women. In parts of the world, 50 percent of first sexual encounters for women and girls have a component of violence. But here again, there is reason for hope and faith. We are beginning to see social norms changing: because of HIV, a church in Zimbabwe that taught polygamy now teaches monogamy. South Africa has developed an aggressive program to deal with gender violence. Young men are teaching their peers that men must respect women. There is so much more work to do, but the work has begun, and America is supporting it.

So to those who say it is not possible for human beings to change behavior, we respond with data. Data from around the world affirm something that has been an important American value since our founding: personal responsibility. Personal responsibility is not at odds with good public health, no, personal responsibility is good public health.

Ladies and Gentlemen, when you see the extraordinary changes in behavior taking place, you are lifted up and you quickly feel that "this yoke is easy and this burden is light."

Hope and faith have been justified not only in the area of prevention, but also in the areas of care and treatment.

When President Bush launched the Emergency Plan, only 50,000 people in all of Sub-Saharan Africa were receiving treatment. Through March of 2006, after only 2 years of implementation, the American people supported treatment for well over half a million Africans. And the American people have supported care for 3 million – including 1.2 million orphans and vulnerable children. Tomorrow some of those numbers will be updated. But mere numbers can numb us – they don't tell the story of what is really happening to people’s lives.

Last year, I traveled with Mike Gerson to Namibia and met an HIV-positive woman and her HIV-positive little girl whom she had named “No Hope.” As you know, in many traditions names reflect the expectations of the parents for their child’s life and for that little girl there was no hope. Now, through partnership, the American people are supporting the Namibian people’s successful scale-up of care and treatment, and both mother and daughter are healthy and hopeful. Hope has been restored, and this mother and child have returned from the dead. In Africa, they like to call this “the Lazarus effect.”

Earlier this year, Mike and I visited an orphanage run by the Daughters of Charity in Ethiopia – a place for more than 400 HIV positive babies and young children found in garbage heaps, on the roadside or left at the orphanage door. Before PEPFAR support children were dying from AIDS every week. As we walked through the massive campus we saw a mural of Jesus and several children. The Sisters told us that those were portraits of children who had died and that others still came there to talk to and play with their friends on the wall.

PEPFAR stands for the principle that no child should have to play with a picture of a friend because of HIV/AIDS. The mural is still there, but now, through partnership, the American people are supporting the efforts of Ethiopians to treat and care for these children and the place is teeming with raucous, playing – that is to say, normal – children and no child had died from AIDS for months. Hope has been restored.

Ladies and gentlemen, when you see the mural in the orphanage, when you see what was, and when you see what is today – the living joy of playful, healthy children, you are lifted up and you feel, once again, that “this yoke is easy and this burden is light.”

Having spent so much time in the field, it is a special gift to be with you – members of the faith community - today. In certain places in Africa, faith-based organizations provide as much as 50 percent of health care. The faith community provides much of the care for the most vulnerable, especially orphans and those suffering and dying in their homes. Beyond health care, faith leaders deeply influence the values that inform personal behavior and so determine the future of this pandemic. You can go to many villages and not see a clinic or a government building, but you will almost always find a faith community.

I have been privileged to meet with rural pastors in their thatched churches far smaller than this stage, with missionaries and local people engaged in health care, with legions of volunteers who cite their faith as the reason they are there. I have met Patriarchs who are spreading prevention throughout their churches, and have learned of Imams and Buddhist abbots doing the same. I have met Bishops who have started clinics and hospitals that serve the poorest of the poor.

It is absolutely clear that we cannot succeed in the global struggle against HIV/AIDS without the deep involvement of faith- and community-based organizations. President Bush has led the effort to ensure that these organizations are not forgotten. Because, if these organizations are forgotten, many in need will also be forgotten.

And so we are enormously encouraged that 24 percent of our partners are faith-based organizations. More important than that number is the shift in approach by the US Government to welcome their participation. To encourage greater participation in PEPFAR so that we can meet our goals, President Bush launched the New Partners Initiative. He announced it last year on World AIDS Day, and tomorrow, on World AIDS Day, the first awards will be announced.

I know you were drawn here today by compassion and generosity, and you seek to foster those values among the people you serve. So I would like to share a few thoughts on ways to play our parts in this great work.

For starters, we can learn about global HIV/AIDS and include our faith communities in that learning. Awareness is the starting point for discernment and enlightened action. It also begins to break the vicious cycles of stigma and discrimination.

Awareness is also critical for our national commitment. PEPFAR is the first phase of the quantum leap in commitment by the American people on HIV/AIDS. As we look beyond the five years of the initial legislation, I have no doubt that we will again choose compassion and generosity over complacency and disregard. Remember, the Good Samaritan not only stopped on the road to Jericho, he returned to the inn to provide what more was required.

To those with a calling to commit further of their time and resources, one of the greatest challenges you can help to meet is health workforce. Africa and other places where we work are blessed with a wealth of dedicated individuals and deeply committed communities and leaders. But there is a crippling shortage of trained health workers and care givers.

While service delivery is important, the American people can do much more by committing the time and resources needed to train local people to do the work. When a local health worker, counselor or care giver is trained, that one pebble ripples throughout a community and nation. And focusing on training reinforces our commitment to partnership with local people, to building sustainable, country-owned programs.

Before closing, I want to mention that PEPFAR does not stand alone. President Bush has led a renaissance in international development with a focus on Africa, a renaissance based not only in a massive commitment of treasure, but in a change of heart. PEPFAR joins other Presidential initiatives – debt relief, enhancing and promoting trade, the Millennium Challenge Account, the President’s Malaria Initiative, the Africa Education Initiative, the Women’s Empowerment and Justice Initiative – in changing the paradigm for development. We are rejecting the old and flawed “donor – recipient” mentality and replacing it with “partnership.”

Partnership is rooted in hope for and faith in people. Partnership means honest relationships between equals based in mutual respect, understanding and trust, with obligations and responsibilities for each partner. Faith and hope in partnership is the foundation of PEPFAR’s success -- and of what Secretary Rice has called transformational diplomacy. And so our theme for World AIDS Day tomorrow is “the Promise of Partnerships.” And we are all privileged today to be with an important delegation from Rwanda. The American people are honored to partner with the people of Rwanda in their fight against HIV/AIDS and I hope you all get a chance to meet them this afternoon.

While there has been much success, much remains to be done. As President Bush said when he launched the President’s Emergency Plan for AIDS Relief, “Seldom has history offered a greater opportunity to do so much for so many.”

The black death of our time has called us to decide who we are and who we want to be. And the American people have answered the calling. So let us here today dedicate ourselves to faith and hope. Let us dedicate ourselves to the proposition so beautifully stated by President Bush: that where you live should not determine if you live or die from HIV/AIDS. Let us dedicate ourselves to transforming the world through the promise of partnerships. Let us lift up our global sisters and brothers in need, and in so doing lift up ourselves. Ladies and gentlemen, sisters and brothers, this yoke is easy and this burden is light.

Thank you.