4 March 2002
U.S. Leads Effort to Battle Disease
administrator of the U.S. Agency for International Development, spoke last week
with The Washington Times State Department Bureau Chief Ben Barber
on the Bush administration's support in the international fight
Question: The United Nations and
other health advocates called last year on donor nations, including
the United States, to contribute $10 billion a year to a new global fund to fight AIDS, malaria and tuberculosis. But less than $2 billion
was pledged so far. What is your response?
Answer: Because very few donors
have funds specifically targeted to HIV/AIDS, the assumption was
that all would go through this trust fund. The United States, although smaller than the amount the U.N. sought, has the largest
bilateral HIV/AIDS fund in the world. The United States will spend in 2003 almost $1.2 billion on AIDS care, prevention and
treatment between NIH [the National Institutes of Health], AID
[Agency for International Development] and CDC [the Centers for Disease Control and Prevention].
The bulk of those funds goes through USAID, and all of the money is for the Third World; none of it is for
The original [Global Fund] request was
for $7 billion to $10 billion. We are contributing a lot, including technical
people in the field. Since 1999, we've had a 500 percent increase
in spending on AIDS in the Third
World, a geometric increase. Spending
doubled every year in the last three years in the Caribbean.
You don't just spend that much
money. We are gearing up.
But you don't do it all through
the trust fund. Don't put all your eggs in one basket, because
it could fail. We will judge that as it goes along.
Meanwhile, Congress gave us more
money for our bilateral programs, and we will spend it in an aggressive
Q: Aside from the U.S.
contribution, were you disappointed by those of other countries?
A: Other countries don't target
specific diseases. I'm not saying it's the wrong or the right
way. Europeans tend to take a health care systems approach as
opposed to a disease approach. Europeans contribute in a way that
may not be rightly reflected as affecting the disease.
We donate to programs for HIV/AIDS,
sexually transmitted diseases, women's health — to pull out the
disease is more a budget exercise than how we administer funds
in the field.
Q: Secretary of State Colin L.
Powell was criticized by conservatives for saying recently that
condoms are vital for preventing AIDS in sexually active people.
Yet you made even stronger comments on Capitol Hill that same
week, pledging increased U.S.
aid to spread the use of condoms. How did you avoid criticism?
A: Part of our strategy has been
condoms. It has been abstinence, faithfulness and condoms, especially
in one family where one partner is HIV-positive.
Q:What is the administration doing
to overcome political obstacles to fighting AIDS, such as foreign
leaders refusing to tell their people that sex spreads the disease
and that they need to change their behavior?
A: We are having conversations
with medical and other leaders. In some cases, leaders are doing
things [to fight AIDS], and in some places not. It depends on
the views of heads of state.
When heads of state do take an
aggressive and sustained level of leadership, it does affect our
ability to prevent the spread of diseases. ...
Many of the leaders are way ahead
of us. In other countries, they are not. There is only so much
we can do as a government in convincing other leaders to do what
we want them to do. We can't force them.
What has happened is some heads
of state in Africa talk to other heads of state. That's why some heads of state are taking
Q: Is the AIDS pandemic tapering
A: Infections are dropping in Uganda.
There are programs that are successful. We know rates can drop
if there is an aggressive prevention effort.
Those programs are scaling up in
other countries. AIDS can be controlled, but it takes a multi-pronged
The places of most concern now
are Russia and India, where growth rates [of HIV/AIDS] are very high. And we are concerned
about rates in Burma.
We have no AID mission there. It is isolated, and the disease
could be out of control.