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The Shared Struggle Against AIDS

July 2000

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

The United States, working with other countries, is helping to design model programs based on prevention and community-based care to stem the rising tide of new AIDS infections in Africa and other regions of the world.

I would like to lay out a vivid picture of the scope of the AIDS pandemic -- particularly as it impacts the stability of families, communities, and nations. I would like to share with you some of my experiences with the faces behind these shocking facts. And I would like to outline for you some key components of the Clinton Administration's enhanced response to this global pandemic.

By any and every measure -- AIDS is a plague of Biblical proportion. And it is claiming more lives in Africa than in all of the wars waging on the continent combined. AIDS is now the leading cause of death among all people of all ages in Africa -- and the progression of this pandemic has outpaced all of our projections. In 1991, the World Health Organization predicted that by 1999 there would be 9 million infected and nearly 5 million deaths in Africa due to AIDS. The resulting numbers are two to three times higher with nearly 24 million infected and 14 million deaths.

And yet this war rages on. Each and every day Africa buries 5,500 men, women, and children as a result of AIDS -- and that count will more than double in the next few years. It is now projected that by 2005 more than 100 million people worldwide will have become HIV infected. And unlike other wars -- it is women and children that are increasingly caught in the crossfire of this relentless pandemic.

In Africa, an entire generation of children is in jeopardy. In several sub-Saharan African countries, between one-fifth and one-third of all children have already been orphaned by AIDS. And the worst is yet to come. Within the next decade, more than 40 million children in Africa will have lost one or both parents to AIDS. Forty million. That is about the same number as all children in the United States living east of the Mississippi River.

In just a few short years, AIDS has wiped out decades of hard work and steady progress in improving the lives and health of families throughout the developing world -- infant mortality is doubling, child mortality is tripling, and life expectancy is plummeting by 20 years or more.

And AIDS is not just a health issue; it is an economic issue, a fundamental development issue, and a security and stability issue.

AIDS is having a dramatic effect on productivity, trade, and investment -- striking down workers in their prime, driving up the cost of doing business, and driving down gross national product (GNP). Many companies are already being forced to hire at least two employees for every one job -- assuming one employee will die of AIDS.

AIDS is also affecting stability in the region. The U.N. Security Council recently held a daylong meeting on HIV/AIDS. This historic event highlighted the growing awareness that AIDS is a security threat that requires a global mobilization. This reality was also addressed in a report recently released by the National Intelligence Council, which documents that the impact of this pandemic is far more serious a threat than we thought.

Yet my message to you is not one of hopelessness and desolation. On the contrary, I hope to share with you a sense of optimism. For amidst all of this tragedy, there is hope. Amidst this terrible crisis, there is opportunity: the opportunity for us -- working together -- to empower women, to protect children, and to support families and communities throughout the world in our shared struggle against AIDS.

It is important to remember that what we are talking about today is not numbers but names, not facts and figures but faces and families. Let me tell you the story of one inspirational grandmother I met in a small village outside of Masaka, Uganda.

Bernadette has lost 10 of her 11 adult children to AIDS. Today, at age 70, she is caring for her 35 grandchildren. With loans from a village banking system, she has begun growing sweet potatoes, beans, and maize, raising goats and pigs, and trading in sugar and cooking oil.

With the money she earns, she is now able to send 15 of her grandchildren to school, provide modest treatment for the 5 who are HIV positive, and begin construction on a house big enough to sleep them all. In her spare time, she participates in an organization called "United Women's Effort to Save Orphans" -- founded by the first lady of Uganda, Mrs. Janet Museveni -- linking in solidarity thousands of women allied in the same great struggle.

And these women are not alone. From the young people doing street theater in Lusaka to educate their peers about HIV to the support groups in Soweto providing home and community-based care for people living with AIDS -- communities are mobilizing and creating ripples of hope.

These are the faces of children and families living in a world with AIDS. And their spirit, their determination, and their resilience lead us on.

The good news is, we know what works. With our partners in Africa we have developed useful knowledge and effective tools. Together, we have designed model programs and proven that they work. And today, we know how to stem the rising tide of new infections, how to provide basic care to those who are sick, and how to mobilize communities to support the growing number of children orphaned by AIDS. Uganda has demonstrated that with strong political commitment and sustained nationwide programs, HIV prevalence can be cut in half. And Senegal has shown that HIV can be stopped in its tracks and prevalence can be kept low. But there is more, much more that needs to be done if we are to continue these successes.

The United States has been engaged in the fight against AIDS here at home since the early 1980s. But increasingly we have come to realize that when it comes to AIDS -- both the crisis and the opportunity have no borders. We have much to learn from the experiences of other countries, and the suffering of citizens in our global village touches us all.

We have done much, but there remains much more that the United States and other developed nations can and must do.

During the past year and a half I have made four trips to eight African countries. Together with members and staff from both parties and chambers of Congress we went to witness firsthand both the tragedies and triumphs of AIDS in Africa. In response to the findings of these trips, the administration requested and Congress appropriated an additional $100 million in fiscal year 2000 to enhance our global AIDS efforts.

This initiative provides for a series of steps to increase U.S. leadership through support for some of the extraordinary community-based programs currently being funded through the U.S. Agency for International Development (USAID) and to provide much needed technical assistance to developing nations struggling to respond to the needs of their people infected and affected by AIDS. This effort more than doubles our funding for programs of prevention and care in Africa, and challenges our G8 (group of seven major industrial countries plus Russia) and other partners to increase their efforts as well.

The initiative focuses on four key areas:

  • Prevention
    Particularly stigma reduction strategies, especially for women and young people, including HIV education, voluntary counseling and testing, and interventions to reduce mother-to-child transmission.

  • Home and community-based care
    This will help to create and enhance counseling and support systems, and provide some basic medical care, including treatment for related illnesses like sexually transmitted diseases (STDs) and tuberculosis (TB).

  • Care of children orphaned by AIDS
    This will be done through nutritional assistance, education, training, health, and counseling support, in coordination with micro-enterprise programs.

  • Infrastructure
    These funds will help to increase the capacity for the effective delivery of essential services through governments, NGOs, and the private sector.

Some of the other key components of this initiative include an increase in our efforts to make the AIDS epidemic a part of our foreign policy dialogue, to promote the use of resources freed up by debt relief for HIV prevention, and to engage all sectors including business, labor, foundations, the religious community, and other non-governmental organizations in a broad-based mobilization.

While this new initiative greatly strengthens the foundation of a comprehensive response to the pandemic, UNAIDS has estimated that it will take $1,000 million to establish an effective HIV prevention program in sub-Saharan Africa. Currently, all donors combined are contributing less than $350 million to that end. In addition, UNAIDS estimates that it will take a minimum of $1,000 million to begin to deliver basic care and treatment to people with AIDS in the region. We have not even begun to scratch the surface when it comes to delivering even this most basic treatment.

In the face of such tremendous need, the administration has requested, in the president's 2001 budget submission, an additional $100 million increase to enhance and expand our efforts to combat AIDS in Africa and around the world.

These funds will enable us to bolster our efforts already underway at USAID and the Centers for Disease Control (CDC), and to expand our approach to include the Departments of Labor and Defense for efforts to address HIV/AIDS transmission in the workplace and in the military.

Let me repeat, however, that the United States cannot and should not do this alone. This crisis will require the active engagement of all segments of all societies working together. Every bilateral donor, every multilateral lending agency, the corporate community, the foundation community, the religious community, and every African government must do its part to provide the leadership and resources necessary to turn this tide. It can and it must be done.

The bottom line is this: we have no vaccine or cure in sight, and we are at the beginning of a global pandemic, not the end. What we see in Africa today, frankly, is just the tip of the iceberg. As goes Africa, so will go India and the Newly Independent States of the former Soviet Union. There must be a sense of urgency to work together with our partners in Africa and around the world, to learn from both our failures and our successes, and to share this experience with those countries that now stand on the brink of disaster. Millions of lives -- perhaps hundreds of millions of lives -- hang in the balance. AIDS is a devastating human tragedy that cries out to all of us for help.

We are one world, and in many ways, Africa's destiny is our destiny. There is hope on the horizon, but that hope will only be realized if we take constructive action together. Today, let us commit to seize this opportunity. As South Africa's Archbishop Desmond Tutu said: "If we wage this holy war together -- we will win."

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

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This article was provided by U.S. Department of State.
See Also
More Background on HIV Policy and Funding for the Developing World