The White House
President George W. Bush
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For Immediate Release
Office of the Press Secretary
July 12, 2003

Background Briefing on the HIV/AIDS Issue
Filing Center Abuja, Nigeria

12:15 P.M. (Local)

SENIOR ADMINISTRATION OFFICIAL: Good afternoon, or morning, or whatever time it is by your internal clocks.

Q Which department are you with?


Q Say what part you are.

SENIOR ADMINISTRATION OFFICIAL: I'm with the White House. I direct the Office of AIDS Policy at the White House. I'll be happy to take any questions. Yes, sir.

Q Just a point of clarification. Has the President ever visited an AIDS clinic and met with people with HIV/AIDS, either in the U.S. or abroad?

SENIOR ADMINISTRATION OFFICIAL: Yes, he has. And, in fact, on this trip he's visited two clinics on this trip. But he has visited HIV/AIDS, has had a lot of contact with people living with HIV/AIDS in the United States. It's one of the reasons that he has become so passionate about this issue, is by talking with people living with HIV/AIDS and with providers who are working with patients with HIV and AIDS that he's really come to understand the gravity of the situation.

Q The other night in South Africa, Secretary Powell suggested the White House would work with whatever funding it got, which left open the implication that maybe there wouldn't be a big fight to get the full funding the President requested. As you know, the House has appropriated a little bit less. Yesterday on Air Force One, Dr. Rice said that, no, we're making phone calls, we're going to fight. But then we got sidetracked by other matters. Could you elaborate a little bit about --

SENIOR ADMINISTRATION OFFICIAL: I can tell you that, as being someone, probably the person most intimately involved in these fights at the White House, that we are going all out to get the full amount of money that the President has requested.

Q Can you tell us how? I mean who is getting the calls? Hastert, DeLay? People like that?

SENIOR ADMINISTRATION OFFICIAL: Everyone that you can think of that's involved in this. This is an extremely important issue to the President, an extremely important issue to this White House. We have not wavered one bit in our commitment to get all the resources that we feel that we need and that the President feels that we need to do the job that needs to get done.

Q Lastly, on that point, where is Frist on this? Are you working with him? Is he with you?

SENIOR ADMINISTRATION OFFICIAL: Working very closely with Senator Frist. As you know, he was one of the major supporters of the authorization and is working hard on the appropriations, as well. In fact, I was with Senator Frist the evening that the bill passed the Senate. We were both in the elevator together at 2:30 a.m. to -- when we finally got this through the Senate. And I think it's a great tribute to the leadership in the House of Representatives and the Senate, on both sides, Democrats and Republicans, that people worked so hard to make sure that this piece of legislation was passed.

Q Can you talk a little bit about the AIDS rate in Nigeria? I understand it's only about 5 percent, much smaller than in the other countries the President visited.

SENIOR ADMINISTRATION OFFICIAL: The AIDS -- I won't get into the technicalities of it. The AIDS rate is probably between 5 and 6 percent right now. But you have to understand that in this country, given the size of the population, that adds up to about 6 million people, 4 to 6 million people, which is about one-tenth the number of all the HIV cases in the world, so it's a very significant problem here.

Q But, proportionately, is Nigeria doing something more effective than these other countries?

SENIOR ADMINISTRATION OFFICIAL: I think there's a number of things that are being done effectively in Nigeria. Most importantly is the leadership coming from the President and the government here, as well as the tremendous work that nongovernmental organizations are doing in Nigeria. USAID, for example, is working with 110 nongovernmental organizations in this country specifically on the issue of HIV and AIDS.

Q Why is it that the administration continues to push the issue that it's a heart issue, instead of dealing with the meat, where maybe more people would think it's would come together with you on it in dealing with the issue as a national security issue that Secretary Powell has said before and many others have said? Because some of the word is you can't bring up the military if the age expectancy in Africa is 46 years. And also the fact that there is a concern in America that some of these people may come from here and bring it there. So that's more so the issue than just being a heart issue. Why not bring those points to bear?

SENIOR ADMINISTRATION OFFICIAL: I'm not sure I fully understand your question. But I want to be clear that we view -- -- if I didn't answer your question, you can come back and ask me again. What I'm saying is that I think we view this issue obviously as an issue of compassion. But it is also an issue of national security for us. It's an issue of human dignity for us. It's an issue of -- it cuts across the whole gamut of human interaction. So I don't think it's helpful to just categorize it in one way or the other.

Q But, a follow-up -- but what I'm saying is, it seems more to be more of a compassionate issue than bringing up the issues of national security. And some people are saying, like the issue of SARS, you're trying to break it -- you're trying to keep it contained. And is that a way that the United States is trying to do, fix the problem here so it won't come to our shores, as much as it's -- well, so we can keep it from coming to our shores like it is here?

SENIOR ADMINISTRATION OFFICIAL: We're trying to fix the problem here because it's a problem of tremendous need in this country affecting -- in this part of the world affecting millions and millions of people. As you know, we have a significant HIV/AIDS problem in the United States, as well, that we're also working very, very hard on. But our interest here is in helping people living with HIV/AIDS around the world.

Q Do you have a dollar figure for Nigeria for the President's AIDS initiative or USAID funds --

SENIOR ADMINISTRATION OFFICIAL: Between 1999 and 2003, we have spent $65 million on AIDS in Nigeria. Our '04 budget, we expect to spend about $35 million. When the new money kicks in for '05, we will -- we don't have those numbers yet, we're working those out.

Q Yesterday in Uganda, the President talked about supporting abstinence programs for young people.


Q He did not talk about federal dollars being used for condom purchases, distribution, where as Africa -- people say is desperately needed in Africa. Can the federal money be used for that? Is the United States going to be urging programs?

SENIOR ADMINISTRATION OFFICIAL: Absolutely. And I don't recall everything that the President said yesterday, but every time I've heard him speak on this issue, he has talked about abstinence, but has also talked about the use of condoms, as well. We've been very clear and very supportive of an approach similar to the one that has been successful in Uganda, which is abstinence, faithfulness, and use of condoms. The specific answer to your question, yes, these dollars will be spend on condoms.

Q Can you clarify something about the money issue? You've talked about full funding, but no one has yet defined what full funding is. Is it the $2 billion that the President originally requested for next year? Is it the $3 billion that was in the authorization bill? Or is it something else?

SENIOR ADMINISTRATION OFFICIAL: Full funding and what we are going after is $15 billion over five years. Our request for this year, 2004, as you know, is $1.9 billion if you exclude the tuberculosis and malaria money.

And I want to make a very clear point on this, because it's something where there's been continuing confusion. We have requested and will request $15 billion over five years. Now, in order to be effective with those dollars, we would be foolish to spend -- think we would spend the same amount every year. In order to do the -- particularly to do the treatment that is the cornerstone of this initiative -- and I can say this because I'm a practicing physician myself, I still HIV/AIDS patients, this is a very tough thing to do -- in order to do that, we need to build a lot of infrastructure, we need to do a lot of training, particularly of health care workers. So in the first year, it's going to take less money to get the job done than it will in the out-years.

So we've always been clear, we've always tried to be clear that we've always intended to ramp these dollars up over five years for a total of $15 billion over five.

Q So the bottom line is

SENIOR ADMINISTRATION OFFICIAL: Full funding from our perspective is what we've requested in the President's budget and it's what we're going after.

Q You're happy with the House Appropriations Subcommittee numbers?

SENIOR ADMINISTRATION OFFICIAL: We're looking for the $1.9 billion that we requested.

Q Is that what they gave you?

SENIOR ADMINISTRATION OFFICIAL: We're still in there are some issues that we're still working out in terms of restrictions on those dollars. But we're still going after the $1.9 billion that we've requested.

Q Sorry, two questions. One, what you just said seems counter-intuitive, that you would ask for less money to begin with and ramp up later. It sounds to me like you would want to build something more with more money to begin with, and then as it settles in, you'd have an infrastructure to make it more effective and more streamlined.

SENIOR ADMINISTRATION OFFICIAL: It's not counter-intuitive to a practicing physician, nor from a medical perspective, which is that, in order to do this job correctly and, remember, we're expecting 55 to 60 percent of these dollars to be spent on treatment. That's what people in Africa are looking for. I believe that's the cornerstone of effective prevention. It's the heart of this initiative. In order to do treatment, if we don't do it correctly and, by "correctly" I mean medically, technically correctly -- that we will be harming people rather than doing it successfully. And it's very difficult to do and it requires quite a lot of training, intensive training of nurses, doctors. That is what we're that's going to be a major focus in the first part of the year.

The bigger expenses are going to come later, once we start really doing the treatment, paying for the medications, and more intensively. But we want to make sure that we've got people trained, that we've got the right infrastructure built, that we've got the right delivery systems in place.

You know, it's very critical that once you start somebody on anti-retroviral treatment, you can't stop. So one of the things that we're very, very concerned about is to make sure, for example, that we have got the right supply lines in place. So if we've got somebody that we start on treatment out in say, outside of a big city here, that we can be sure that once we start them on medication, that those medicines will be available continually. That work is the kind of groundwork that we need to be going on now.

In our judgment when we looked at this issue, when we looked at the countries that we wanted to work in -- and believe me, we spent a lot of time on the analysis here to figure out what was the smartest way to spend the money -- we believe that our budget request is the right amount for this year.

Q The second question is different -- a slightly different topic. The first question asked was the President's meeting with AIDS patients in the United States, as well as here. Prior to the two meetings, or however many meetings he's had here in Africa, can you point to a time in the United States an event -- maybe it's my faulty memory -- where he has met with patients in the States somewhere?

SENIOR ADMINISTRATION OFFICIAL: There have been people that -- I don't -- I'll be honest, I don't know of a public meeting. I've only been in this office for a year. But I can tell you that he has in private settings has interactions with people with HIV and AIDS and he's very, very well aware of these problems.

Q The President said in Pretoria that he would support a moratorium on having laws that -- production. First of all, the U.S. is blocking the Doha agreement on that right now. So how did that --

SENIOR ADMINISTRATION OFFICIAL: We have been very clear in our negotiations that for countries where there is a severe crisis, such as the countries that we're working in now, that we will allow these dollars to be used for purchase of generic drugs. We've been very clear about that. We understand that we -- and the President has been very clear about that.

Q I don't understand. Why is the U.S. blocking the agreement?

SENIOR ADMINISTRATION OFFICIAL: We don't believe we are. We've put a proposal on the table that would allow in countries where there's a severe need for medications that are needed for severe public health problems, for those drugs to be available. And that's definitely for HIV/AIDS. In the countries that we're working in now, our proposal and our desire is that drugs be available -- quality drugs be made available at the lowest possible cost.

Q I'm sorry, but the hold-up is that the U.S. is asking for a wide array of drugs not to be included. I mean, the States wants a broad agreement on these matters.

SENIOR ADMINISTRATION OFFICIAL: I'll come back. For HIV/AIDS, which we're talking about today, drugs that are necessary to treat people with HIV/AIDS, particularly anti-retroviral drugs, which are the most expensive, in countries and for nations and people that can't afford them, we are, and on record of, supporting these drugs to be made available at the lowest possible cost.

Q Did you accompany the President this morning on the visit to the National Hospital?

SENIOR ADMINISTRATION OFFICIAL: Yes, I did. I did not accompany him to the laboratory, but I was there at the meeting with the --

Q Okay, was he briefed on the PMTCT program?


Q Has any of this money started flowing to Africa? Could you be specific where it's gone to?

SENIOR ADMINISTRATION OFFICIAL: The PMTCT -- let me be clear -- the PMTCT, which is the perinatal transmission money, is targeted for 14 countries, two in the Caribbean and 12 in Africa. All of those countries have received dollars, funds from this initiative. Those are '03 dollars. Obviously, I'd have to get you the exact number. We've accepted and approved -- we've approved, I think, in the neighborhood of $80 million in the first tranche of funds. But let me get that exact number to you.

Q Can you say why this is I mean, I can explain, but why this is an issue of national security, funding -- this AIDS funding?

SENIOR ADMINISTRATION OFFICIAL: I didn't catch the last --

Q Why is this AIDS funding an issue of national security?

SENIOR ADMINISTRATION OFFICIAL: Living in a world with 60 right now 40 million and the projection, as you know, the projection is going up to 60, potentially hundreds of millions of people living with a life-threatening illness, is not a secure world, particularly when there's such great imbalance in terms of where this epidemic exists.

I'm not an expert and don't pretend to be an expert on national security, and those questions may be better directed someplace else. But I can tell you in a world where children are growing up without parents is not a secure world, either for the countries where these people are living or for us living in other places.

Q Is it frustrating to you at all that Iraq has really dominated the picture during the President's trip here?

SENIOR ADMINISTRATION OFFICIAL: I think that this is a complex world that we live in and I am so pleased to see the President, President Bush take on HIV/AIDS in the way that he has.

I want to make a very important point here. We've talked a lot about the money here and it's a huge amount of money. It's an enormous investment that the United States is making. I started seeing HIV/AIDS patients in my practice in the early 1980s in San Francisco. I've been involved with this disease as a practicing physician continually ever since. So I have a great deal of passion for this issue. In addition to the money, which is important, the most fundamental thing in terms of leadership I think that President Bush has done is to place treatment dead center in the global agenda for HIV/AIDS. And I want to point out that that is really new. There has been, I think, in the past a reluctance to really tackle an issue as complicated as treatment. And then, of course, also bringing Africa into the highlight, as well, is very, very important.

But treatment is absolutely critical. And it is -- it's critical, obviously, for the people who are infected to be cared for. But it's also very, very important for treatment to be in place for effective prevention. The key to prevention is to get people tested and find out your sero status, know your status. If you know your status, then you can take the appropriate actions to protect other people.

But if you put yourself in the place of somebody who is living in a community where there may be, say, 35 or a very high percentage of people living with HIV and AIDS, and you don't see any reason to be tested, it's very hard to get people to come in to be tested. But if there's treatment available -- in every place, in every resource-poor setting where treatment has come in, and there have been places, both here in Africa, as well as the Caribbean and in Asia, where treatment has been made available to people, the uptake in voluntary counseling and testing has been dramatic.

So I think I mentioned it earlier that the fundamental importance of treatment cannot be underestimated. And the fact that the President of the United States walked into his State of the Union address and put this dead center as an agenda item for us, for the United States -- not just the money, but the focus on Africa and the Caribbean and the focus on treatment -- is truly a watershed time in this epidemic. And I say that as someone who has been fighting this thing for 20 years.

Q Thanks very much.

END 12:35 P.M. (Local)

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