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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 Mark R. Dybul
United States Global AIDS Coordinator

President's HIV/AIDS Initiatives

December 1, 2006

Mark R. Dybul
Thank you very much for joining me on 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 (PEPFAR), which has supported antiretroviral drug treatment for over 822,000 people in 15 severely affected countries in the developing world. We've also made exciting progress in the areas of prevention and care. All these results are made possible through the promise of partnerships - supporting nations in developing the capacity that will allow communities to sustain their efforts long after the initial five years of the Emergency Plan. Visit our website for more information on what was announced today.

Daniel, from Lakeville, CT writes:
How much does the U.S. government spend on AIDS every year? Thanks.

Mark R. Dybul
Thanks for your question, Daniel. 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. PEPFAR is the largest commitment ever by a single nation toward an international health initiative. President Bush committed $15 billion over five years, and our nation is on track to exceed this commitment.

The United States committed approximately $2.4 billion to the Emergency Plan in fiscal year 2004, $2.8 billion in FY05, and $3.2 billion in FY06. To give you a sense of how things have changed, for 2007 alone, the President has requested more than $4 billion - well more than four times what we provided in 2001. The $4 billion includes support for the Global Fund to Fight AIDS, Tuberculosis and Malaria, of which the United States is the largest supporter.

With this massive increase in funding, the United States accounts for roughly half of all resources going into the global fight against AIDS. We provide about as much on global HIV/AIDS as the rest of the developed world's governments combined. America has kept its promise, and continues to lead the world in its level of support for effective partnerships against HIV/AIDS. This is a commitment from which the U.S. will not turn away.

Adam, from Nebraska writes:
Hello Mr. Dybul. What is actually being done to fight AIDS? Especially AIDS in Africa.

Mark R. Dybul
Thanks, Adam. PEPFAR is the most comprehensive prevention, treatment, and care strategy in the world. America's partnerships around the world are having dramatic, life-saving results in the fight against AIDS. The statistics tell the story.

Since I've focused on prevention in some previous answers, let me focus on treatment here. Only 50,000 people were receiving treatment in Sub-Saharan Africa when the President announced PEPFAR in 2003. As I mentioned, President Bush announced this morning that the Emergency Plan supported life-saving antiretroviral treatment for approximately 822,000 men, women and children through bilateral programs in the program's 15 focus countries in sub-Saharan Africa, Asia and the Caribbean as of September 30, 2006. Of PEPFAR's 15 focus countries, 12 are in Africa.

The impact of these efforts can be seen in our partner nations. On a recent visit to South Africa, I visited a former hospice where people with AIDS once came to die. It has been converted into a treatment clinic, where people come for medicines that allow them to live. For a growing number, HIV is no longer a death sentence. They call it "the Lazarus effect."

You can find more Stories of Hope about the profound results made possible through partnerships between the American people and the people of the world on our website at

Cliff, from Brimfield, Ohio writes:
Ambassador Dybul: One does not hear much about AIDS anymore. The newspapers seldom have an article on it, nor does the TV have anything on it anymore. Have we made that much progress, that its not a problem anymore or has it become a back burner for the Iraq War? Thank You

Mark R. Dybul
That is a great question, Cliff. The problem of global HIV/AIDS is far from being solved - there are almost 39 million people worldwide living with HIV. It's such a critical issue, and all of us need to be creative in talking about it and reminding the people we know about it.

In terms of what your government is doing to keep it on the front burner, today President Bush held an event at the White House, welcoming people from organizations - both here and abroad - that are leaders in the fight against global HIV/AIDS. We're proud to partner with these people. The international theme for World AIDS Day today is "Stop AIDS: Keep the Promise," and the United States is doing just that. America followed through on the President's $15 billion commitment and now leads the world in its level of support for the fight against HIV/AIDS thanks to our partnerships around the world.

America's partnerships around the world are having dramatic, life-saving results in the fight against AIDS. The statistics announced by the President this morning tell the story. In addition to the treatment results that I noted previously, the Emergency Plan has supported through September 30, 2006:

- Prevention of mother-to-child HIV transmission services for women during more than 6 million pregnancies; - Antiretroviral prophylaxis for women during 533,300 pregnancies; - Prevention of an estimated 101,500 infant infections; - Care for nearly 4.5 million, including care for more than 2 million orphans and vulnerable children; and - 18.7 million counseling and testing sessions for men, women and children.

These results could not have been achieved without our friends and partners in host nations, while they may be measured in numbers - what these numbers represent are children, women, and men who are alive today because of the promise of partnerships between the United States and our host nations.

Gregory, from Torrance, CA writes:
Dear Ambassador Dybul: there are many who believe condoms are the best way to combat aids and many, like the Vatican, that believe condoms send the wrong signal--how does the administration deal with such conflicting views? Especially in the case of Africa? Thank you.

Mark R. Dybul
Gregory, thank you. Today, the U.S. supports the most diverse portfolio of HIV/AIDS prevention strategies of any international partner: the ABC strategy to prevent sexual transmission, the expansion of programs that focus on mother-to-child transmission, on blood safety and safe medical injections, on intravenous drug users, on HIV-discordant couples, on women, on men, and on alcohol abuse, among other key issues. 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.

John, from Savannah, GA writes:
Ambassador Dybul, Will you please take a few moments to put the Global AIDS epidemic in proper persepctive? Even today there seems to be a strong sentiment that this disease affects mainly drug users, low income persons, and third (fourth) world countries. Is it possible for you to provide a statistical break down of whom this disease affects and its costs to society as a whole on an per annum basis or at least provide a website reference

Best regards

Mark R. Dybul
Thanks. Last week UNAIDS, the Joint United Nations Programme on AIDS, released updated estimates on the HIV/AIDS epidemic, which you can view online at More than 39 million people are estimated to be living with HIV worldwide. Of those 39 million people, almost 25 million live in sub-Saharan Africa, over 13 million are women, and over 2 million are children.

Approximately 3 million people are estimated to have died from AIDS in the past year worldwide, while over 4 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 if we're going to win this fight.

At the same time, there is growing reason for hope in the fight against the spread of the virus. As I mentioned in the previous answer, new evidence shows that in additional nations in Africa and the Caribbean, people have changed their behavior to avoid HIV, causing infection rates to drop. As I noted previously, the U.S. Government is supporting the most diverse portfolio of HIV/AIDS prevention strategies of any international partner. At the same time, the number of people in the developing world who are receiving life-saving antiretroviral treatment, and care that helps that stay healthy, is also growing very rapidly. Working in partnership with host nations, we are learning new best practices each day that are benefiting the entire world in the battle against this disease. The U.S. will continue to share and use these lessons to guide our work with partner nations in order to address the ongoing emergency while building capacity for sustainability.

Dee, from Oregoncoast community college, LC Oregon writes:
We have an AIDS epidemic here in the United States and it affects those in lower social economic conditions, gays but now others are at risk too. If we can't seem to get a handle on it here, how would you help a place like Africa with limited resources and extreme poverty?

Mark R. Dybul
Thanks for your question, Dee. You are absolutely right to note that the challenges involved in fighting HIV/AIDS in the developing world - in places devastated by poverty, disease, war and many other problems - are daunting. One of the most challenging issues is the severe lack of trained health workers in many countries. But these nations also have tremendous resources - and their people are the most important resources of all. Around the world, partnerships between PEPFAR and host nations are proving that there is hope of winning this fight - even in the most difficult places. The heart of President Bush's Emergency Plan for AIDS Relief is to work shoulder to shoulder with partners in host nations in support of the national strategy in each country. Local people are leading the fight in their own nations and communities, buoyed by the generosity and goodwill of the American people.

A great example of the promise of partnerships is seen in Côte d'Ivoire. Because of its four year old civil war, mail is not delivered in most of the country, but antiretroviral drugs are becoming increasingly available in rural and rebel-controlled areas. A successful program works through local organizations, such as school groups, village associations, and religious organizations, providing prevention, treatment and care services by empowering local partners to utilize their local knowledge to create community-based solutions. To support these efforts, PEPFAR provides resources, training, and support that will not only address the immediate problem at hand, but also invest in long-term capacity building. The program has had remarkable success in overcoming major barriers to provide HIV/AIDS services and is a great example showcasing the power of partnerships.

georgette, from Wilson,louisiana writes:
Why is AIDS such a problem,even after years of research? Is there NOTHING that can be done? Does it seem to you as if AIDS as a whole is better are worse than say 20 years ago?

Mark R. Dybul
Thanks for your question. The challenges facing the developing world in seeking long-term solutions to prevent the transmission of HIV are daunting. The latest UNAIDS report that I mentioned earlier indicates the highest number of infections ever - over 39 million worldwide, including approximately 4 million new infections in 2005. So we are a long, long way from achieving the goal of an AIDS-free generation.

Yet at the same time, it's also true that through the promise of partnerships between the American people and the people of the world, hope has begun to be reborn. Around the world, partnerships are proving that there is hope of winning this fight - even in the most difficult places.

President Bush's announcement of PEPFAR in 2003, it is now clear, marked a turning point in the worldwide response to HIV/AIDS. The Emergency Plan represents historic leadership in terms of financial resources: no nation has ever undertaken a larger international health initiative directed at a single disease.

Yet money alone can not defeat HIV/AIDS, or bring about the societal transformation needed in nations devastated by the pandemic. The Emergency Plan thus invests in partnerships with host nations to build locally led HIV prevention, treatment and care strategies. As President Bush put it, "This effort is succeeding because America is providing resources and Africans are providing leadership. Local health officials set the strategy and we're supporting them."

Mark R. Dybul
Before I close, let me mention an element of the pandemic I haven't had a chance to discuss until now. One of the most tragic aspects of the pandemic is the large number of children being left behind. Over 15 million children have lost one or both parents to HIV/AIDS. These numbers will almost double over the next 10 years. I recently went to Zambia and Botswana, where partnerships with the American people are helping to address the impact of the pandemic on children. You can view the photo gallery from my trip to Zambia and Botswana on

For too many children, education has been a casualty of the HIV/AIDS pandemic. To address this problem, PEPFAR supports programs to assist children to attend school, while also linking with other programs to address difficulties in the educational sector due to HIV/AIDS.

For example, in Zambia, I visited Bwafano community-based program in Lusaka. Bwafano, which means "helping one another," has integrated programs for orphans and vulnerable children into the home-based care program.

Partnerships between American people and the people of the world, like the partnership with Bwafono, are providing care to millions, including orphans and vulnerable children. As I noted previously, the Emergency Plan had supported care for nearly 4.5 million, including more than 2 million orphans and vulnerable children, through September 30, 2006.

PEPFAR also supports HIV prevention education for youth both in-school and out-of-school. On the same trip, I visited Botswana, one of the world's most severely affected nations. There, I visited Mater Spei, a high school run by the Catholic Vicariate of Francistown. Mater Spei was one of the pilot schools for the new PEPFAR-supported Life Skills Materials Curriculum that was developed to support HIV/AIDS education in schools. The materials help teachers discuss life issues important to young Batswana (that's what people in Botswana are called). I visited a class where the students were discussing the "Self-Understanding" chapter of the materials. The spreads life-saving messages about HIV prevention will help the students to protect themselves.

Many thanks to everyone for your interest in global HIV/AIDS, and for your observance of World AIDS Day.

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