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Randall Tobias
Ambassador Randall Tobias
Former United States Global AIDS Coordinator

December 1, 2005

Ambassador Randall Tobias
I want to thank all of you who read this, and especially those who submitted questions, for taking time to observe World AIDS Day. This morning I was at the White House, where President Bush announced the latest results achieved by his Emergency Plan for AIDS Relief, which after just two years has supported antiretroviral drug treatment for over 400,000 people in 15 severely affected countries in the developing world. Among his guests at the event were a family from South Africa who are in excellent health, thanks in large part to the support the American people are providing for their treatment. Let's turn to your questions.

Charles, from Washington DC writes:
What is the total budget of the Us for the fight against AIDS?

Ambassador Tobias
Charles, I’m going to refer only to the international HIV/AIDS activities of our government, which I oversee as the U.S. Global AIDS Coordinator. In fiscal year 2005, which ended on September 30, we invested approximately $2.8 billion. For the new fiscal year, the President has requested almost $3.2 billion, and we are working with the Congress to ensure full funding. We’re on track to provide $15 billion over five years – the amount President Bush promised.

Ken, from Springfield, VA writes:
How much responsibility for preventing AIDS from spreading is the government's, and how much is the peoples'?

Ambassador Tobias
Ken, thank you for a thoughtful question. I’ve visited many of the countries where the President’s Emergency Plan is supporting efforts to respond, and the point I try to make is this: fighting HIV/AIDS is everyone's responsibility. It starts with citizens doing what they can, at the grassroots level, to combat the stigma that is one of the greatest enemies we face. That means becoming educated about the disease, talking openly about it, and responding to people living with HIV/AIDS with compassion. That fuels a very positive cycle, in which more and more people are willing to be tested and learn their status, which in turn enables them to seek treatment if needed and take appropriate prevention steps. So fighting stigma is fundamental – and it’s something that anyone can do!

In some countries where the government has not yet fully focused on HIV/AIDS, a citizen’s responsibility may also include reaching out to the government and working to increase its commitment. In my observation, governments play a crucial role in effective HIV/AIDS responses, and if they fail to step up to that responsibility, it’s a major handicap. The good news is that a growing number of governments are stepping up. The President’s Emergency Plan is strongly committed to partnership with host governments as well as nongovernmental organizations of citizens, because this task is everyone’s responsibility.

Nicole, from Seattle writes:
How has the world's view of AIDS changed over the past five years, and does it continue to change?

Ambassador Tobias
Thanks, Nicole. When I compare the state of the world’s response to global AIDS today with where we were five years ago, on World AIDS Day 2000, there’s really been a revolution. In the developing world, where most HIV-infected people live, there is clearly growing leadership and commitment to fight this disease. There is so much more that needs to happen, but now there are a growing number of signs of hope.

Dr. Peter Mugyenyi of Uganda’s Joint Clinical Research Center joined the President for the World AIDS Day at the White House today, and over the last two years his organization has expanded from one site to 35, and now supports treatment for 35,000 people. Compared to a few years ago, what a change! It’s the people of these hard-hit nations who are turning things around, and our role is to support them. President Bush’s Emergency Plan has led the world in ramping up that support – in fact, American funding helped fuel that growth from one to 35 clinics. I believe history will look back at the launch of the Emergency Plan in the President’s January 2003 State of the Union Address as a key turning point.

Again, with 8000 people dying from AIDS worldwide each day, we still have a long way to go, but to people in the developing world, the difference between “seemingly no hope” a few years ago and "growing signs of hope" today is a crucial one.

Hayley, from Denver Colorado writes:
How can we as average americans help with this ongoing global AIDS crisis? How can we urge the government to continue supporting and adding more supposrt for this issue?

Ambassador Tobias
Thanks. Simply put, spread the word! The President’s Emergency Plan rests entirely on the support of the American people, which is reflected in Congress. We have been blessed with very strong Congressional support for the President’s initiative, and that support has been bipartisan, I’m glad to say. I think members of Congress are pleased to hear that the people back home appreciate what they’re doing in this regard. At the grassroots level, educate yourself and those in your sphere of influence on what we’re doing. The more people learn about the impact their resources are having overseas, the more I believe we’ll all agree that America should continue to be a leader on global AIDS.

Cliff, from Brimfield, Ohio writes:
Mr. Tobias: What are the AIDS numbers for the United States and the World? Are we gaining or losing ground. How many NEW cases are reported yearly?

Thank You

Ambassador Tobias
Thanks. I’m going to address the situation in the rest of the world, rather than in the U.S, since the international pandemic is what I deal with in my role as the U.S. Global AIDS Coordinator. I’ll use estimates published just last week by UNAIDS, the Joint United Nations Programme on AIDS. (Keep in mind that these are estimates, since there are still major gaps in our knowledge of the pandemic.)

Over 40 million people around the world are living with HIV today. Of those 40 million people, almost 26 million live in sub-Saharan Africa, over 17 million are women, and over 2 million are children.

Over 3 million people are estimated to have died from AIDS in the past year worldwide, while almost 5 million became infected. Since the number becoming newly infected is greater than the number who died, that tells you that the overall number of people living with HIV is growing – and this has been the case for many years. So from that perspective, we – the world – are losing ground. We simply must prevent HIV infection more effectively than we now do if we’re going to win this fight.

On the other hand, I do believe we are gaining ground in certain aspects of the prevention fight. UNAIDS’ new report (which you can read at highlights areas of success, including certain countries where infection rates are going down. In at least some of these countries, people appear to be changing their sexual behavior in ways that help to keep them safe. It’s essential that the world understands and builds upon lessons learned in the area of prevention, and the President’s Emergency Plan is definitely doing so.

Dave, from Falls Church, VA writes:
Could you weigh the pros and cons of bilateral AIDS initiatives (such as the President's Emergency Plan) vs. multilateral AIDS programs (such as the Global Fund). What more can be done to convince our European friends to step up their contributions to the Global Fund, and why do you think they've resisted doing so thus far?

Ambassador Tobias
Great questions, Dave – ones that come up often. The U.S. has been operating bilateral HIV/AIDS (and tuberculosis and malaria) programs around the world for many, many years. Given that, you might wonder, why was there a need to create the new Global Fund mechanism a few years ago. The answer is that most developed nations do not have the extensive bilateral programs the U.S. has. Since the U.S. cannot be the only major international partner in this fight, we believed that creating the Global Fund vehicle would be very helpful in getting other nations involved. To help ensure its success, the U.S. has even been its leading donor, contributing up to one-third of its contributions (the maximum permitted under U.S. law).

As you point out, however, some other developed countries have been reluctant to boost their global HIV/AIDS funding in the dramatic way the U.S. has, with the result that we are still providing half of all international funding for global HIV/AIDS. We are thus working with other donor nations to encourage them to get involved. We are also providing much-needed technical assistance to Global Fund grantees on the ground, so donor nations can be assured that they will get results for their investment in the Fund.

Kevin, from Marlton, NJ writes:
Are there any plans for the United States to expand their funding for AIDS relief to Caribbean nations?

Ambassador Tobias
Kevin, I’m glad you asked. Over 3 million people in the Western Hemisphere are believed to be living with HIV/AIDS, and approximately 440,000 of those people live here in the Caribbean. There were approximately 340,000 new infections in the Americas last year, including over 50,000 in the Caribbean. In fact, after Africa, the Caribbean has the second highest level of HIV prevalence in the world. And it is estimated that only 5 to 10 percent of those who need care and treatment for HIV in this region are currently receiving it.

For these reasons, we have already greatly expanded funding for the Caribbean under the President’s Emergency Plan. In the region, the Emergency Plan works through a variety of bilateral, regional, and multilateral HIV/AIDS initiatives. Haiti and Guyana are two nations that receive special focus under the Emergency Plan, but we work throughout the region. The U.S. investment in the Caribbean has risen from less than $35 million before the Emergency Plan to over $75 million in fiscal year 2005 – an increase of 115% percent in just two years. That is a clear statement of the importance the U.S. Government places on fighting the pandemic in this region.

In addition to our bilateral and regional efforts, the Emergency Plan also works in partnership with other nations through the Global Fund to Fight AIDS, Tuberculosis, and Malaria, to which the U.S. is the largest donor nation. The Global Fund is particularly central to our strategy for the Caribbean. Given that the United States provides about one-third of the money for the Global Fund, between $45 and $75 million of the Global Fund’s investment in the region comes from the American people.

Lois, from Illinois writes:
When does the United States plan to honor its commitment to fund AIDS treatment?

Ambassador Tobias
Lois, thank you. We’ve been honoring it ever since the President’s announcement of the Emergency Plan. He promised $15 billion over five years, ramping up as the program grew. Funding for the first two years of the plan (2004 and 2005) was $2.4 billion and $2.8 billion, respectively. For 2006, President Bush has requested almost $3.2 billion from Congress, and we’re awaiting final action on that request. So funding has grown steadily to date, and we are fully committed to providing the entire $15 billion over five years.

With respect to antiretroviral treatment in particular, let me refer again to the President’s announcement today that the U.S. has supported treatment for over 400,000 people in 15 hard-hit countries in the first two years of the program.

The American people can be proud that the United States has honored, is honoring, and will continue to honor its commitment.

Ambassador Tobias
Many thanks to everyone for your interest in global AIDS. Working together, we can win this fight.