Posted on April 12, 2005
Good afternoon. We're here today for an update on America's 5-year, $15 billion commitment to fight against HIV/AIDS. We're looking specifically at the African portion of this commitment: 12 of the 15 focus countries are in Africa. I believe this is Ambassador Tobias' first appearance before a Senate committee since Congress funded the initiative in January. So this is an important opportunity for a progress report. Our objective today is three-fold: 1. What are our goals? What should they be? The President has outlined three major goals: to treat 2 million, provide care for 10 million, and prevent 7 million new infections. But what are the smaller goals we're setting to get us on the path to meeting these three big ones? 2. Are we meeting those goals? Do we have benchmarks to measure progress as we move forward in meeting those goals? It's important that we have a way to tell if we're on the right path or not, so the next time we hold a hearing on this topic, we'll be able to say. 3. Are we spending taxpayers' money wisely to reach those goals? Senator Frist recently reminded us that this is the largest public health initiative we've ever undertaken abroad. $15 billion is a lot of money. We need to ensure that money is spent on the most effective means to reaching our goals. We often hear the statistics of how terrible the AIDS pandemic is in Africa: over 40 million people infected with HIV around the world, three-fourths - 30 million - in the 48 African countries south of the Sahara desert. The figures are staggering - but they get bandied about so much we sometimes forget what they mean. So I've been trying to think about a way to explain this in more personal terms that will remind us how serious this crisis is. Let's take the example of Botswana. Botswana has a lot of things going for it right now: it has a stable government, per capita incomes are higher than its neighbors, it has a good National Park System, and most of its citizens have access to medical care. It stands out - not only in Africa, but it would stand out virtually anywhere in the world. Yet one thing is threatening to destroy their country: HIV/AIDS. Nearly 40 percent of Botswanans are infected. Think what that would mean to a family of five: you could expect two of those five family members to be infected - in effect, to have received a death sentence. They may already be sick. Now multiply that by an entire country - 1.7 million people - and you have some sense of the devastation this disease is causing. And that's just one country. America is stepping up to the plate to combat this disease. Here's what's happened so far: A year ago in January, in his State of the Union Address, President Bush led us in confronting AIDS by proposing an Emergency Plan for AIDS Relief. Congress passed legislation authorizing the President's Emergency Plan for AIDS Relief five months later in May. Ambassador Randall Tobias, whose office of Global AIDS Coordinator was created by that legislation, was confirmed last October, And the first year's money for the President's Plan was just appropriated in January of this year. Since that appropriation only three months ago, Ambassador Tobias and his team have been busy, and I look forward to his update of what he's accomplished so far. Today we need to make an honest assessment of what things we can do to move us quickly towards reaching our goals - things such as reducing unsafe medical practices since they account for 5 percent of transmission, or ramping up efforts to prevent mother-to-child transmission of HIV since this requires the admission of a single drug just before and after birth. We also need to have an honest discussion about the things that will take longer - like building capacity to deliver care and treatment, and choosing the right drugs. A person on anti-retroviral (ARV) therapy must take multiple drugs one or two times every day for the rest of their lives. Each individual's response to those drugs must be monitored to ensure resistance does not develop - and when it does develop, that the drug combination is altered. These simple facts make treatment of AIDS both complicated and expensive. When one considers the challenges of attracting patients - 90 percent of HIV-positive individuals don't know their status, and many who are living with AIDS are too ashamed to seek help - it becomes even more complicated. Take the example of Mozambique, which has only 400 doctors for a population of 17.6 million. We need to build a lot of new capacity there. That's why I think it's important for us to be realistic in setting expectations for progress in the battle against this terrible disease. I believe we can reach the goals set by the President, but I don't expect us to make steady progress towards them in each of the five years - especially in the area of treatment. While our initial ramp-up of already active programs will provide a quick boost to our numbers, I expect much of the first few years to be dedicated to building the capacity to deliver treatment, and more of the last few years dedicated toward utilizing that capacity to provide treatment. Said another way, we should expect a quick rise in the number of people on treatment, followed by a period of slow growth, followed by a second surge toward the end of the five years - a surge that will hopefully reach or exceed the President's goal of 2 million on treatment. If any of the witnesses disagree with that assessment, I hope they will correct me, but based on what I saw in Africa last August, that is my sense of how things should go. Today's hearing provides a unique opportunity to assess our progress to date and consider how to reach or exceed the goals the President has set. We have a distinguished group to help us do that. First, Ambassador Randall Tobias, who coordinates America's response to the global AIDS crisis, will testify. Following Ambassador Tobias, we'll hear from three individuals who have run or are running successful AIDS treatment programs in Africa. Dr. Jonathan Mermin of the CDC will go first to talk about CDC's home-based treatment program in rural Southeastern Uganda. He is followed by Dr. Ernest Darkoh - operations manager for the treatment program in Botswana, funded in part by the Gates and Merck Foundations, and Dr. Lulu Oguda, who served as a Field Doctor at two Doctors Without Borders treatment programs in Malawi and Zambia. It's not often we get advice from people really doing the work in Africa, and I look forward to their testimony. But before we begin, let me turn to my colleague Senator Feingold, the Ranking Member of this committee who is a leader here in the Senate both generally on Africa and specifically on HIV/AIDS.