InterAction Annual CEO Retreat

Thank you, Dr. Gupta, for your introduction, and in particular, for the important work you have done to raise the profile of women. Thank you to all of you here tonight, with organizations on the frontlines of the battle against HIV/AIDS.

You in the NGO community were among the first responders to the crisis of HIV/AIDS, assisting people and communities devastated by AIDS, and generating international momentum against the disease.

I have just returned from a four-country trip to Africa, and was struck in every country -- Zambia, Rwanda, Kenya, and Uganda -- by the amazing work being carried out by NGOs.

Regardless of barriers imposed by stigma, silence, ignorance, lack of leadership, or limited resources, I saw yet again the results that NGOs have achieved in the battle against HIV/AIDS, and the new possibilities for intervention that have been illuminated.

I stand before you today as the first United States Global AIDS Coordinator, with the awesome responsibility of leading a 5-year, $15 billion effort to combat global AIDS. The President’s plan represents the largest commitment ever by a single nation for an international health initiative. There’s been nothing like it for any humanitarian purpose, perhaps since the Marshall Plan.

In part, President Bush’s decision to launch this initiative is a testament to your work. You brought voice to the devastation of this pandemic, you helped develop strategies to combat the disease, you provided armies of men and women serving people and communities in need.

I know that many of you are familiar with the statistics on the global devastation of HIV/AIDS. They bear repeating in affirmation of our commitment, and in recognition of the people who suffer the greatest burdens of this disease. Forty million people are infected worldwide. And tragically, most do not know they are infected. Far too few people are being tested, and that must be changed.

This is a disease that is 100% preventable, so Prevention is the chief weapon in the spread of HIV and it must be our number one priority. And testing -- knowing one’s status and what to do about it -- is one of the keys to prevention.

When this epidemic was first addressed in the United States, it was thought to be largely a disease of gay men. Knowing one’s status was thought to be the beginning of living with stigma -- and a certain sentence of death. That is no longer the case. While stigma is still a huge issue around the world, outside the U.S., this is largely a heterosexual disease. And with the availability of antiretroviral drugs, it is now possible for someone living with HIV/AIDS to live a normal productive life, and to eventually die of something else.

That’s what is possible. To make it a reality will require an almost unimaginable effort, and that’s what we are now about. During 2002 alone, 3 million people died from the complications of AIDS, leaving behind anguished loved ones, abandoned children, ravaged communities. At the same time, 5 million people became newly infected. Do the math. We are losing the war. At the current pace, we’re headed for the destruction of the world -- with a great deal of human tragedy and political and social destabilization along the way.

In claiming the lives of societies’ most productive populations -- adults ages 15-45 -- HIV/AIDS threatens a basic principle of development -- that each generation do better than the one before. HIV/AIDS has deepened poverty, reduced life expectancy, diverted state resources, and left a generation to grow up without the love, guidance, and support of parents and teachers. This year, however, may bring the hope of a new approach.

The global community is coming into alignment to focus on HIV/AIDS as never before, with every sector --public, private, religious, non-governmental, multilateral -- making contributions to the fights against HIV/AIDS. Lessons have emerged and leaders are beginning to take heed: We now have effective methodologies for combating HIV/AIDS, including effective prevention and behavior-change strategies that have been proven to work, approaches to fighting stigma and discrimination, and proven programs that partner government with civil society.

We know that global and national leadership is essential, that early and effective action can contain and even roll back epidemics and reduce the burdens of disease on families, communities, and nations. But we’re also mindful that the statement by the late Tip O’Neal that “all politics is local” applies equally to public health. The battle against infectious diseases, including HIV/AIDS will, in the end, be won or lost in the small places -- places so small you may not find them on any map of the world.

I was in one such place last week, a tiny farm settlement in Uganda just outside a small town called Tororo. There, the Centers for Disease Control of the Department of Health and Human Service is partnering with a community based AIDS support organization called TASO to provide AIDS patients with safe water, an antibiotic to prevent opportunistic infections, and antiretroviral drug therapy. While I was there, I visited two of those patients and their families, in their homes -- mud structures with straw roofs and dirt floors. Community health workers visit each patient weekly, on small motorcycles, to monitor their condition and their adherence.

Their progress since beginning treatment is amazing. And their adherence to the therapy regimen is nearly 95% -- much higher than our experience in the United States. ARV therapy can be effectively administered in very primitive places. Where there used to be a “treatment versus prevention” debate, today few dispute that these are not “either/or” issues.

Clearly, prevention must be our number one priority in order to stop the spread of the disease. That has been the approach in Uganda, and it works. I’ve visited their primary schools to see how they do it. It is straight forward, relatively inexpensive, and enormously effective. But where a life can be saved, it must be saved. That’s why treatment is also an imperative. At the same time, the implementation of life saving antiretroviral treatment provides the incentive for people to be tested and to learn their HIV status. And that, in turn, contributes to prevention efforts.

The United States has stepped up to the challenge of global HIV/AIDS with President Bush’s Emergency Plan for AIDS Relief. As President Bush has stated, and as you in the NGO community have always understood, “in the face of preventable death and suffering, we have a moral duty to act, and we are acting.”

The President’s 5-year initiative is targeted to preventing 7 million new HIV infections, providing treatment medicines to 2 million HIV-positive individuals, and caring for 10 million people living with HIV/AIDS and children orphaned by the disease. The Plan offers $9 billion in funding to 14 target countries in Africa and the Caribbean, representing 50% of the world’s population of people living with HIV/AIDS. It includes $1 billion in contributions to the Global Fund, bringing total U.S. contributions to $1.6 billion -- more than one third of all pledges to the fund to date. And it provides $5.0 billion to continue our bilateral assistance to nearly 60 other countries worldwide. The plan begins in the year 2004 with well over $2 billion in funding, steadily increasing to reach the total of $15 billion over the 5 years.

The House passed our appropriations bill yesterday, but the Senate has yet to act. The money for this program is embroiled in the omnibus appropriations bill, and as of this afternoon, it appears unlikely we will have any funding before mid to late January. But we have no time to waste in a fight against an epidemic that claims 8,500 lives daily.

A fundamental principle of the plan is to develop sustainable prevention, care, and treatment programs for HIV/AIDS. We know that such programs will depend on effective partnerships among donors, governments, non-governmental organizations, and the private sector. And we know that one of the greatest sources of field knowledge, innovation, and leadership in the fight against HIV/AIDS is in the NGO sector. Therefore, a key partnership in achieving the goals of the President’s Plan is that of the U.S. Government and NGOs.

Although my organization is in its formative stages, we have been able to move forward with development of a strategy and guiding principles such that we can take immediate action against this disease upon receipt of funding from the Congress.

I feel strongly that the implementation of our programs must be field-driven, such that they can be responsive to the specific circumstances and available human and material resources in each country, and can benefit from the innovations of field staff and communities.

I’ve asked the U.S. Ambassador in each focus country to take the lead in pulling together all of the resources of our government in the development of an integrated plan to implement the President’s initiative in that country, and to provide leadership to all elements of the U.S. Government on the ground. We’re well along in that process, and I’m very pleased with the work that is underway in most of these countries.

In developing our plans, we need to take a fresh look at the evidence based results -- at what has worked and what has not. Albert Einstein once said that the height of stupidity is doing the same thing over and over again, and expecting different results. To do this job effectively, in some cases, we need new paradigms.

One new paradigm is how we organize to attack this issue. I’ve asked all of the departments and agencies to leave their uniforms at the door, to come together into a single United States Government team, under the direction of the U.S. Ambassador.

Our activities in this area will now be U.S. Government programs, drawing on the strengths and capabilities of individuals and organizations in whatever ways make the most sense. I am pleased to tell you that we already have funding mechanisms in place that we hope will allow for the rapid expansion of effective, accountable, prevention, care, and treatment programs already underway by NGOs who have already produced results from their work in single or multiple countries. Proposals are being accepted between now and the first of the year from organizations able to rapidly expand their existing activities in five target areas:

1. HIV/AIDS prevention, through abstinence and behavior change for youth, intended to expand and strengthen primary prevention efforts;

2. Rapid expansion of antiretroviral therapy programs for HIV-infected persons; including the provision of technical assistance to develop indigenous capacity to continue antiretroviral therapy programs;

3. The provision of expert guidance and technical assistance to ministries of health and national blood transfusion services for the rapid development and strengthening of safe blood programs;

4. Support to orphans and vulnerable children affected by HIV/AIDS;

5. Programs to reduce transmission by unsafe medical practices, including in particular the promotion of safe medical injection practices.

There is no doubt that HIV/AIDS represents one of the greatest challenge of our time, and will require constant and concerted commitment from all of us to defeat. Without intervention, researchers predict that over 75 million people will be infected worldwide by 2010, with a loss of human life to AIDS totaling 100 million by 2020.

In partnership, we can maximize our efforts and make real gains in the fight against HIV/AIDS, a fight in which every battle won is measured in lives saved, families held intact, nations moving forward with development, the future secured. The U.S. Government cannot achieve the goals of the President’s Plan -- 7 million infections prevented, 2 million on treatment, 10 million receiving care -- on its own, nor should the plan represent the limits of what is possible. Working together, these goals should be mere stepping stones to a world in which AIDS and the devastation it wreaks are eradicated for all time.

President Bush has said that "The advance of freedom and hope is challenged by the spread of AIDS." All who join in the worldwide campaign against AIDS serve on the frontlines of freedom and hope. We look forward to serving with you. Thank you very much.