The President's Emergency Plan for AIDS Relief: First Annual Report to Congress
Office of the U.S. Global AIDS Coordinator
May 23, 2005

Chapter 8 header -- Akebe Oqubay, the mayor of Addis Ababa, opted to be publicly tested for HIV/AIDS immediately following Ambassador Tobias' challenge to local leadership to be tested and reduce stigma.

Boxed text -- LeadershipA key objective of the President's Emergency Plan for AIDS Relief (PEPFAR/Emergency Plan) is to engender bold leadership and additional resources from other countries, entities and individuals for the fight against global HIV/AIDS. Leadership from every sector is necessary to combat stigma, denial, and discrimination; spur action; and mobilize resources from the public and private sectors. Leadership is also necessary to confront negative cultural patterns, including gender inequity, that contribute to the spread of HIV/AIDS.

The leadership demonstrated by President Bush in launching the Emergency Plan, and the United States' commitment to combating global HIV/AIDS that it represents, has helped strengthen leadership worldwide. Former Secretary of State Colin L. Powell never missed an opportunity to raise HIV/AIDS awareness and advocate for an amplified global response with audiences ranging from leaders of foreign nations to youth groups in severely affected countries. Following his example, U.S. Ambassadors also took up the cause, using their unique access and relationships within host countries to urge greater action. Worldwide, and in the focus countries in particular, government at every level has renewed its focus on HIV/AIDS, while civil society leaders and groups are also taking action against HIV/AIDS in their communities.

Since its inception, OGAC has pursued a variety of strategies to engage diverse audiences throughout the world in the fight against HIV/AIDS, including those in severely affected nations, donor and potential donor nations, and the American people, whose generous compassion has made the Emergency Plan possible. These strategies include outreach to government and community leaders, religious and civil society groups, and people living with HIV/AIDS in severely impacted nations; use of the tools of public diplomacy and communications to reach wider audiences and engage new partners; and active diplomacy to raise more resources for the fight against global AIDS.

Boxed text -- Helping Traditional South African Leaders Combat HIV/AIDS. Photo: Traditional healers in South Africa welcome an American delegation to their rural community in Kwazulu-Natal province.

Promoting Leadership by Government and Community Leaders

Following a visit to a counseling and testing center in Mozambique, Ambassador Tobias answers local reporters questions about the President's Emergency Plan.In nations suffering from the HIV/AIDS pandemic, leadership from the top levels of government is essential for an effective response. Leaders who have scorned stigma in favor of compassion and care for those infected or affected, and who have been bold in addressing the AIDS crisis, have made an impact on the disease in their countries and offered hope of turning the tide. The U.S. Global AIDS Coordinator, Ambassador Randall L. Tobias, and other U.S. Government leaders and staff have met with the heads of state or government of Botswana, C�te d'Ivoire, the Dominican Republic, Ethiopia, Guyana, Kenya, Mozambique, Nigeria, Rwanda, India, and Thailand, and with senior ministers and health officials from many countries receiving U.S. Government bilateral assistance. These relationships helped build country-level support for implementing the Emergency Plan and supported hard-hit nations in mobilizing their own campaigns against HIV/AIDS.

Boxed text -- Supporting National Leadership in Promoting Testing and Defeating Stigma.In hard-hit nations, leadership at the community level is crucial in the fight against HIV/AIDS. Such leadership ensures that messages about HIV/AIDS reach communities at every level, reinforced through forums including churches, mosques, schools, and community associations. The Emergency Plan has made a particular effort to encourage and support community leaders in responding to the pandemic. Ambassador Tobias and in-country U.S. Government staff have engaged community leaders as diverse as religious leaders, traditional healers, people living with HIV/AIDS, popular culture leaders, business executives, and sports icons in leading grassroots efforts against HIV/AIDS.

Ambassador Tobias and U.S. personnel have particularly highlighted the need for community and national leadership in fighting stigma. One of the worst impacts of stig- First Annual Report to Congress ma is its deterrent effect on those in need of HIV testing and counseling. Increasing testing is central to the effectiveness of HIV prevention and treatment efforts, yet those who seek testing are often stigmatized. In this area, leadership can have a tremendous impact. In both private and public forums, Ambassador Tobias has urged leaders to speak out against discriminatory attitudes and in favor of compassion and care for those infected or affected. In keeping with the "lead by example" intent of the Emergency Plan, Ambassador Tobias and U.S. Government in-country staff have publicly sought HIV testing, inviting local media and officials to be present, and, at times, participate. The public attention generated by these events has helped promote testing and defeat stigma.

Promoting Leadership Through Public Diplomacy and Communications

Increased worldwide and multisectoral commitment is essential to defeating global HIV/AIDS. U.S. Government leaders have reached out directly to a variety of domestic and international audiences through local and international print, radio, and television media; speaking engagements; and conferences.

Boxed text -- Speaking Out for Access for All at the Bangkok International AIDS Conference.Emergency Plan World AIDS Day activities exemplify this approach. For World AIDS Day 2003, Ambassador Tobias accompanied former Secretary of Health and Human Services Tommy Thompson to six countries in Africa as part of a 100-member delegation that included governmental and nongovernmental representatives. Former Secretary of State Colin Powell taped World AIDS Day messages that appeared in several African countries and at World AIDS Day events including benefit concerts in Moscow and Kiev. U.S. Ambassadors penned opinion pieces that appeared in at least 39 countries and more than 60 print and Web-based publications. For World AIDS Day 2004, OGAC developed and coordinated the placement of domestic World AIDS Day opinion pieces by former Secretary Powell and Secretary of Labor Elaine Chao and a piece jointly authored by Ambassador Tobias and UNAIDS Executive Director Peter Piot. With heavy media coverage, Ambassador Tobias participated in World AIDS Day forums at the National Press Club and the Woodrow Wilson Center in Washington with Dr. Piot of UNAIDS and other leaders. In addition, Ambassador Tobias participated in digital video conferences with media from Russia, France, and Australia; met with Washington-based reporters from Japan and Latin America; and provided interviews to BBC outlets to reach international audiences.

OGAC has looked for every opportunity to raise the AIDS issue on the agendas of international opinion leaders. For example, in collaboration with Under Secretary for Global Affairs Paula Dobriansky, Ambassador Tobias addressed a group of women ambassadors to the United States, focusing on issues affecting women and girls. U.S. Government leadership has engaged religious leaders worldwide, including senior leadership at the Holy See. At the Council of the Americas, Ambassador Tobias encouraged heightened commitment and increased openness from Western Hemisphere leaders in dealing with the pandemic.

Boxed text -- Bringing Global HIV/AIDS Awareness to Wall Street. Photo: Drawing the attention of the business community to global HIV/AIDS, Ambassador Tobias rings the bell of the New York Stock Exchange with leaders of companies that have made fighting HIV/AIDS a priority.By participating in multilateral events, including UNAIDS, UNICEF, and World Bank conferences and the XIV International AIDS Conference in Thailand, Ambassador Tobias has strengthened the call for international action and collaboration, advocating for an unprecedented global response. Through these efforts, international audiences heard clear messages about the need for the world to come together in fighting the HIV/AIDS pandemic and the need for every nation to play its part.

Encouraging the commitment of private sector leaders, globally as well as domestically, has also been a key priority of OGAC. In hard-hit nations, businesses have a unique capability to assist workers and their families in protecting themselves against HIV/AIDS and accessing appropriate treatment and care. Globally, the private sector must be mobilized to bring both its resources and innovations to the fight against the HIV/AIDS pandemic.

U.S. missions implementing the Emergency Plan haveformed dozens of innovative local partnerships with business and industry associations that bring resources and community leadership to the fight against the epidemic in their countries. U.S. Government leadership has engaged private sector leaders in developing strategies to combat HIV/AIDS at forums such as the Global Business Coalition on HIV/AIDS, composed of activist CEOs addressing HIV/AIDS, and the Initiative for Global Development, a network of business executives devoted to mobilizing private sector leaders for economic development in poor nations. With these efforts, participation from the private sector has continued to grow; for example, several large European media firms have joined the Global Business Coalition and are lending their communication expertise to the fight against HIV/AIDS.

The U.S. Department of Labor has been a key implementing partner in promoting private sector HIV/AIDS initiatives under the Emergency Plan, reaching out to ministries of labor, employers, and labor leaders to improve responses to the HIV/AIDS pandemic. In Vietnam, the Emergency Plan supported training and technical assistance to Colgate-Palmolive managers to help the company quickly establish a workplace policy that protected its HIV-positive employees and eliminated mandatory testing. The company will promote anonymous voluntary testing; care and support services for its employees; and ongoing employee education activities. Colgate-Palmolive recently stated that it views its HIV/AIDS program as a model to replicate in its other branches throughout Asia, including those in China, Thailand, India, and Nepal.

In addition, the increasing number of funding agencies, implementing partners, and other organizations undertaking workplace-related HIV/AIDS activities internationally has Boxed text -- Engendering Leadership in the Private Sectorled to a growing recognition of the need for leadership, information sharing, coordination, and collaboration of private sector efforts. The biannual Roundtable on HIV/AIDS in the International Workplace, jointly sponsored by OGAC, the U.S. Department of Labor's Bureau of International Labor Affairs, and the U.S. Agency for International Development's Bureau for Global Health, encourages the expansion of effective private sector partnerships and related workplace HIV/AIDS initiatives by sharing lessons learned, identifying opportunities for new partnerships, and addressing specific implementation challenges.

The President's historic Emergency Plan reflects -- and depends on -- the compassion and commitment of the American people. Knowing that the fight against the HIV/AIDS pandemic will take years to win, U.S. Government leaders have especially engaged the compassion of Americans to develop domestic constituencies and new partners in support of the U.S. Government's efforts to combat AIDS internationally. At the National Conference of Mayors, Ambassador Tobias urged local leaders to get involved in the global HIV/AIDS fight through mechanisms such as "sister city" relationships with cities in hard-hit nations. U.S. Government leaders have reached out to special affinity groups in the United States, encouraging their leadership in America's efforts against the pandemic. Among the groups addressed were Haitian-Americans, Vietnamese-Americans, the Africa-America Institute, faith-based communities, the International Women's Forum, and the National Association of Women Judges. Through his participation in an Indiana University conference that highlighted the work of the University's treatment program in Kenya, Ambassador Tobias brought media attention to the contributions American institutions can make.

Promoting Leadership for Increased Donor Resources and Commitment

Ambassador Tobias meets with President Joaquim Alberto Chissano of Mozambique to encourage strong indigenous leadership in the fight against HIV/AIDS.Leadership from other donor governments is indispensable for effective action in the fight against the HIV/AIDS pandemic. Beyond the operational challenges, it is imperative that the global community respond with additional resources for fighting global HIV/AIDS. The U.S. Government calls on fellow donor nations, and potential donor nations, to meet this humanitarian crisis with human compassion.

There has been a clear global increase in resources being dedicated to this fight, due in large part to U.S. initiative, but the emergency demands more from the world as a whole. The high-level launch of the Emergency Plan generated heavy media coverage globally. The urgency and scope of the President's historic initiative to turn the tide against global HIV/AIDS created diplomatic momentum that encouraged announcements by other donors, including the United Kingdom, Italy, Canada, Australia, and the Netherlands, of substantial increases during 2004. In some cases, nations doubled or tripled their budgets for international AIDS relief.

At the Special Summit of the Americas, held January 1213, 2004, in Monterrey, Mexico, leaders from the 34 democratic countries of the Western Hemisphere pledged to fight corruption, spur growth, reduce poverty, and improve education and health in the region. To implement this commitment, the leadership agreed to provide antiretroviral treatment for HIV/AIDS to all who need it, with a goal of treating at least 600,000 individuals by the end of 2005. In November 2005, leaders from the Western Hemisphere will once again meet for the Summit of the Americas in Mar el Plata, Argentina, with the theme of "Creating Employment to Confront Poverty and Strengthen Democratic Governance." The U.S. Government is working closely with the Pan American Health Organization and other countries in the hemisphere to encourage an HIV/AIDS initiative aimed at fighting stigma and discrimination through workplace programs.

The United States and European Union (EU) partners have also built on the opening provided by the EU's Dublin Conference, hosted by Ireland as EU President. With U.S. encouragement, the EU has taken initial steps to address the HIV/AIDS technical and resource needs of the EU's new Eastern European member states, which lost access to outside development assistance upon their entry to the EU. The succeeding EU President, the Netherlands, also included a major focus on HIV/AIDS and donor coordination of HIV/AIDS programs at the country level. The United Kingdom will continue to focus on Africa and HIV/AIDS during its Group of Eight presidency in 2005.

Ultimately, the key to reducing the scourge of HIV/AIDS in the developing world, especially in Africa, is assertive leadership on the part of political and social leaders in the countries most affected. This leadership must include a commitment to use indigenous as well as donor resources to educate and empower individuals to prevent transmission of the disease; to provide access to quality antiretroviral treatment and palliative care; and to reduce the stigma associated with HIV/AIDS in order to mitigate its impact on economies, societies, communities, families, and individuals.