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Welcome to "Ask the White House" -- an online interactive forum where you can submit questions to Administration officials and friends of the White House. Visit the "Ask the White House" archives to read other discussions with White House officials.

Ambassador Randall L. Tobias
United States Global AIDS Coordinator
In Focus: Office of National AIDS Policy

December 1, 2004

Ambassador Randall L. Tobias

I want to thank everyone for taking time to observe World AIDS Day. Working together, we can build a future free of the specter of HIV/AIDS. Let's get started.

Perry, from Santa Rosa writes:
What kind of positive things has the President done for AIDS? I hear he is criticized for not giving enough money, but I remember a few years back in his State of the Union that he pledged lots of money to Africa and AIDS funding. Is this still true? Is it going on?

Ambassador Randall L. Tobias
Perry, thanks for your interest. Yes, the President did pledge lots of money to fight global AIDS...and he’s following through on that pledge. His Emergency Plan for AIDS Relief is the largest commitment ever by a nation toward an international health initiative for a single disease--a five-year, $15 billion, multifaceted approach to combating the disease in more than 100 countries around the world.

Under the Emergency Plan, America is working with our partners in-country and supporting national strategies, by providing $2.4 billion this past year (the first year of the plan), and even more this coming year. That money is being used well, to extend lives and reduce the suffering caused by HIV/AIDS worldwide.

Under President Bush, the focus is no longer on the hurdles we face in fighting this disease. We are now urgently employing the best practices available to fight this disease and bring hope. We’re laying the groundwork for a sustained, successful effort.

Beth, from Alameda, CA writes:
How is promoting only abstinence going to stop the spread of AIDS, especially when much of it is spread through trafficking and prostitution?

Ambassador Randall L. Tobias
Beth, I'm so glad you asked this question, because it gives me a chance to clear up a lingering misconception about President Bush's Emergency Plan. A key element of our strategy is the balanced ABC policy, pioneered with tremendous success in Uganda. It does include an emphasis on 'Abstinence'. especially for youth, but also on 'Being faithful,' especially for those in committed relationships, and for those who engage in risky behavior, it includes correct and consistent use of 'Condoms'. Those are the A, B and C of ABC.

And our prevention work doesn.t start and end with ABC. As I mentioned earlier, we are also providing drug therapy and intensive counseling to prevent mother-to-child transmission of HIV. We also support locally designed behavior change strategies that direct tailored messages to appropriate groups, support the roles of parents and others who can help protect girls, and strengthen families. and communities. ability to care for orphans and vulnerable children.

The U.S. is also partnering with communities to find solutions to such issues as sexual coercion and exploitation of women and girls, as well as fighting sex trafficking and prostitution, while still serving victims of these activities.

To ensure that the problems women face are addressed from every angle, the President's Emergency Plan also includes highly successful relationship and anti-violence programs aimed at men and boys to help them develop healthy relationships with women.

So the U.S. policy is not a limited, one-size-fits-all policy. It is a balanced, science-based one that focuses on what works.

Joel, from Salem, Oregon writes:
Amb. Tobias- Can the US simply continue giving these countries that are struggling with AIDS more and more help? It seems that at some point we need to begin teaching them how to deal with AIDS, so that eventually they will be able to better fight AIDS themselves, with minimal US or international help. Thank-you

Ambassador Randall L. Tobias
Joel, thanks, I’m glad for the insightful question! We simply must help the nations that have taken the heaviest blow from HIV/AIDS develop their own capabilities to address the crisis. In places like Africa, the Caribbean, and Southeast Asia, there is a desperate lack of health care workers and infrastructure. For example, Mozambique has only 500 doctors to serve a population of 18 million people! The reality is that all the AIDS drugs in the world won't do any good if they're stuck in warehouses, unable to be delivered to those in need. The way I sometimes put it is that we must provide both fish and fishing poles.

So President Bush’s Emergency Plan is working closely with our partners in the hardest-hit nations in support of their national strategies. For example, we’re helping provide health care infrastructure and supporting training programs. This year, the Emergency Plan is supporting 145 antiretroviral therapy-focused training programs, and an additional 140 programs focusing on palliative care, in the 15 countries where we are placing a special focus. It’s not easy, but we are striving to strike the right balance between meeting the immediate needs of today and helping nations develop the capability to handle the needs of the future.

Alina, from Tacoma writes:
Is it really possible to stop and prevent AIDS?

Ambassador Randall L. Tobias
Alina, thanks for your question, I’m glad to see such interest from the Pacific Northwest!

HIV/AIDS is a paradox. It’s a vicious virus that has thwarted our best efforts to prevent its spread. Yet it is one of the few diseases that is actually 100% preventable, with knowledge we have today. The challenge, then, is doing the things we already know will work.

Because many factors lead to the spread of HIV, the U.S. is pursuing a range of prevention approaches that address those different factors. When we offer our various prevention strategies, what we’re really offering people is hope. In many of the countries where we work, death from AIDS is an oppressive, everyday reality. We’re working to show people that there is hope for them, that HIV infection is avoidable, and we’re showing them what they can do to be safe. It’s certainly not easy, but yes, it is possible to stop and prevent AIDS.

Beth, from Denver CO writes:
Do you visit Africa a lot because they have the most amoung of people with AIDs? I bet it is very interesting. Are the people looking for help at all? Or is it difficult to help them?

Ambassador Randall L. Tobias
Beth, thanks for your question. HIV/AIDS really is a global emergency, so I do want to emphasize that the problem is not limited to Africa. You’re correct, though, that more people are currently suffering from HIV/AIDS in Africa than in any other region: approximately 25 million of the 39 million people in the world living w/HIV are in sub-Saharan Africa alone.

The U.S. is thus placing a special emphasis on some of the hardest-hit nations in Africa, so yes, my work does take me to Africa quite a bit. And yes, it is very interesting! I do find that people in Africa are eager for help in dealing with this pandemic, simply because the crisis is far beyond Africa’s resources to deal with it without help from the world. Our approach is to work shoulder-to-shoulder with partners in these countries in support of national strategies. We have thousands of programs up and running in Africa and around the world. 61% of our current partners in the 15 countries where we’re placing a special focus are indigenous organizations.

Let me mention a story from Mozambique. I visited a woman in her terribly impoverished home – 12 feet by 12 feet, dirt floor, mud brick walls, straw roof. Tragically, she was days if not hours from passing away from AIDS. Sitting on the edge of the woman’s mattress was her daughter, perhaps 5 years old. I asked the home-care volunteer who was present during my visit who would be taking care of that little girl when her mother was gone. She told me no one had an answer. Her father had also passed away from AIDS, and she had no other family. It was not clear that anyone would be able to help. This was a child destined for the street.

It is easy for the terrible statistics to become just numbers. But it’s important to remember that each one is an individual, with a name, a family, a story. When I think of the people we’re trying to help, in Africa and everywhere, I think of that mother and daughter.

Peter, from Ann Arbor Michigan writes:
Ambassador Tobias, do you travel frequently with your job? What has been your most significant moment in your current position helping others?

Ambassador Randall L. Tobias
Peter, yes, travel is a big part of the job. In fact, tomorrow I’m traveling to Tanzania, Kenya, and South Africa, to learn more about their HIV/AIDS situations and our U.S. programs there. I’ve been in this job just over a year, and if I count correctly, my work has brought me to 18 different countries, some more than once! Many of them are in Africa, but I’ve also been to places like Vietnam and Guyana, as I oversee the President’s Emergency Plan. I also travel to places like Switzerland and Germany representing our nation as we seek to increase worldwide cooperation in this fight. In all my meetings with national and community leaders, I try to impress upon them the crucial role of leadership in combating HIV/AIDS. In these places I try to meet with leaders among people living with HIV/AIDS, by the way, to demonstrate the importance of including them in the response.

And I also make it home to Indiana on the weekends when I can!

I get to see some very heartbreaking things, but also some very heartwarming ones, in this work. It’s hard to single one moment out of all the touching things I’ve been able to see. Some of the happiest conversations I have had in my job are with women living with HIV, who have been given the gift of a healthy baby and the joy of dreaming about that child’s future. Those conversations define hope. The U.S. has dramatically ramped up our efforts to provide drug therapy and intensive counseling to prevent mother-to-child transmission of HIV. In the first 18 months of intensive effort, we quickly trained 14,700 health workers and built capacity at over 900 different health care sites to prevent mother-to-child transmission. That snapshot was taken 8 months ago—the numbers are far higher now. Anyway, that’s one example of the encouraging moments I have.

Trevor, from Salt Lake City UT writes:
Ambassador Tobias,Thank you for taking questions today. I have two:

1. What is the origin of World AIDS Day? Who started it? 2. Why is the word "Ambassador" in your title and not something like Director or something like that?

thank you.

Ambassador Randall L. Tobias
Trevor, thanks for your questions – we’ve received a number of questions about World AIDS Day, so let me address yours. The first World AIDS Day was conceived and adopted unanimously by the World Summit of Ministers of Health on AIDS in January 1988, which was attended by 140 countries, including the United States. The first World AIDS Day was December 1, 1988, making this the 17th observance of the day.

As to my title, I suppose I really have two titles. The one that describes my job is “United States Global AIDS Coordinator.” When the President proposed, and Congress agreed, to create such a position, they also decided to give that person the rank of “Ambassador” to reflect the high priority our nation places on the global AIDS emergency. That’s an important message, both for the general public and for the other governments with whom we work, as I often meet with Presidents, Prime Ministers, and officials at the highest levels of many governments.

Toby, from LA writes:
When did this type of position begin? Has your position been around a long time? What is the overall goal of your position?

Ambassador Randall L. Tobias
Toby, thanks. My position is actually quite new. President Bush proposed the creation of this role when he proposed his Emergency Plan for AIDS Relief in January of last year. After Congress passed the legislation establishing the Emergency Plan in May 2003, the President nominated me for this position in July, and after Senate confirmation, I was sworn in last October as the first U.S. Global AIDS Coordinator.

My goal is to lead and coordinate all the activities of the U.S. government to fight global HIV/AIDS. America has a tremendous number of AIDS programs around the world, operated through many U.S. agencies. My job is to lead them all in following a common strategy – the one President Bush established. The President believed that the U.S. could not approach this crisis in a “business as usual” way, and believe me, we aren’t.

Julia, from Reno, NV writes:
do you ever visit hospitals for AIDS patients? I'm sure they are very scary, yet very surreal to visit. What are some of your experiences?

Ambassador Randall L. Tobias
Julia, it’s certainly true that I’ve seen some very sad things at facilities in the developing world that care for people afflicted with HIV/AIDS. One of the saddest I saw was in Hanoi, Vietnam. I visited a hospital there that has to put two dying patients in each bed, simply because there are not enough hospital beds in the city to care for the rapidly increasing number of people suffering from HIV/AIDS. That image may help you understand why we’re focusing our U.S. assistance on helping countries increase their capacity to deal with their own situations.

I must say, however, that it is also quite inspiring to visit such facilities, because there I get to meet the people who are serving the suffering. I try keep these people, as well as those afflicted with HIV/AIDS, in my mind. I’m inspired by the love they show to suffering people, and I consider it a privilege that our U.S. government is able to support them. They are among the true heroes of this fight.

Alexander, from Seattle, WA writes:
As American, born and raised in Ethiopia, I am still concerned about the highst number of Ethiopians Dyning with aids. The American government has allocated in billions to fight the aids and Ethiopia is one of the recipiant countries. Is the us following up with the ehiopian government on how much of that mony is spent in fighting aids? and how?

Ambassador Randall L. Tobias
Thanks, Alexander. Ethiopia is, as you note, among the nations most severely affected by HIV/AIDS. With a population of over 80 million people, it’s crucial that we turn the tide there, and that’s why it is one of 15 nations receiving special focus under President Bush’s Emergency Plan.

Making sure that we spend our money wisely is critically important, in Ethiopia and everywhere else we are working. Most of our U.S. funding is not actually going directly to governments, but to nongovernmental organizations – including many community-based ones – to provide prevention, care, and treatment services. For example, we’re partnering with the Ethiopian Orthodox Church, which has 40 million members and a unique ability to reach them with effective prevention messages.

In our partnerships with these organizations, we are requiring extensive reporting on results and holding them to very strict accountability standards. We believe we owe that to the American taxpayers, as well as to the people suffering in Ethiopia and elsewhere.

Chris, from Rancho Palos Verdes, CA writes:
Do you think we will see a cure for AIDS in our lifetime?

Ambassador Randall L. Tobias
Chris, I wish I could give you an answer – and even more, that the answer would be “very soon.” But I simply do not know. What I do know is that America is making a tremendous investment in doing the scientific research that might lead to both a vaccine and a cure. The other thing I know is that while we wait for a vaccine and a cure, we must use all the tools currently available to us to defeat HIV/AIDS. That means using effective prevention programs to keep people safe in the first place. It means making lifesaving antiretroviral drugs available to people in the developing world. It means caring for the orphans and the others affected by HIV/AIDS. These activities are the focus of President Bush’s Emergency Plan, even as our nation’s vaccine and cure research activities continue.

Cliff, from Brimfield, Ohio writes:
Ambassador Tobias: Not long ago you could not pick up a newspaper or watch the news without hearing something about HIVAIDS. Has this issue been placed on the back burner with the war and all going on? You don't even hear of it anymore, it's as if a cure all has been found. I know of course thats not so. So just where are we in fighting HIVAIDS? Are we gaining ground or like the drug war, losing ground. With the issue out of sight it kind of gets out of mind also. So just what are the most resent facts and figures? Thank You

Ambassador Randall L. Tobias
Cliff, complacency is a deadly enemy in this fight, and I share your concern. The facts are these: no cure for HIV/AIDS has yet been found. In the world last year, 3 million people died of AIDS – that’s 8000 people a day. And in that same year, 5 million people became newly infected. So if you do the math, it is apparent that it would be madness to put the fight against HIV/AIDS on the “back burner.”

At the level of the U.S. government, I’m pleased to report that there is absolutely no complacency in responding to this killer. President Bush sees HIV/AIDS as the global menace it is, and the whole premise of his Emergency Plan for AIDS Relief is that this is an unprecedented emergency requiring an unprecedented response. But it is crucial that all of us as individual citizens continue to take HIV/AIDS seriously. Without 8000 people dying each day, time is not on our side.

A good resource for facts and figures is the UNAIDS website:

Mea, from St. Augustine, FL writes:
Why do you think AIDS funding is imporant to the people of the United States?

Ambassador Randall L. Tobias
Mea, thank you for your interest and for asking such a fundamentally important question. Not long ago, I accompanied President Bush on a trip aboard Air Force One. On the plane, and later on the drive from the airport – as he has on other occasions with me – he spoke at some length about the global HIV/AIDS pandemic as a humanitarian crisis that we simply have to address. But he also talked about its relationship to the other international challenges we face as a nation. He made the point that in the wake of 9/11, America’s near-term homeland security challenge is clear. We must locate and defeat the terrorists who seek to destroy American and its people. But with equal fervor, he talked about how our long-term strategy for protecting our nation against the threat of terrorism must rest on the foundation of promoting peace, freedom, and hope around the world. The pursuit of those goals must take on different forms in different places. And the President has made clear that in many of those places, bringing hope simply must include aggressively confronting HIV/AIDS. So we must confront global AIDS because it is the right thing to do – and because it is the wise thing to do.

Greg, from Athens, Georgia writes:
Its seems as if your background is well rounded for the business world. However, a ceartain amount of compassion and sincere interest is needed to understand the affects of AIDS at a single human level. Where did you recieve an understanding of the effects of terrible effects of AIDS on one person, families, and nations? Thank you for your time. Greg

Ambassador Randall L. Tobias
Greg, thank you for your interest. In terms of compassion as a general matter, I suspect that my parents were an early influence in that regard. Both were very active in the broader community, and I have always felt the need and desire to also be focused on life beyond my own job.

As for the impact of HIV/AIDS in particular, as you can imagine, the exposure I have had to people impacted by HIV/AIDS in my 14 months in this position dwarfs my previous exposure in my capacity as a business leader. It’s impossible not to be humbled by the responsibility I have to those people. I now see my previous roles as preparation for this one.

Abby, from Washington, DC writes:
In what ways is the Bush Administration coordinating its HIVAIDS treatment policy with its economic development programs in Africa? Do the Administration's strategies take into account the connection between raising the standard of living in rural communities, especially in regards to minority or marginalized populations, and HIVAIDS prevention?

Ambassador Randall L. Tobias
Abby, thanks. You make an important point, because HIV/AIDS vulnerability is connected to economic circumstances. The U.S. Agency for International Development (USAID) leads America’s economic development efforts in Africa and the developing world, and they also implement many of our HIV/AIDS prevention programs. The other day, USAID Administrator Andrew Natsios and I, along with other key U.S. officials, spoke to media at the State Department’s Foreign Press Center, and Administrator Natsios discussed USAID’s integration of economic development efforts and our HIV/AIDS prevention, treatment, and care efforts. He also noted that having a coordinated, government-wide HIV/AIDS effort, as we now do, is helping to make this integration more possible. I share your view that this is important.

Ambassador Randall L. Tobias
Friends, thanks so much for all the tremendous questions, and for doing your part to fight global HIV/AIDS.

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