The President's Emergency Plan for AIDS Relief: Second Annual Report to Congress
Office of the U.S. Global AIDS Coordinator
February 8, 2006

President George W. Bush, Bono, Laura Bush and Bob Geldof sit talking at a working meeting on Africa at the Gleneagles Summit July 6, 2005

" Our concern about HIV/AIDS does not stop at our borders. Other nations face greater challenges, yet they are moving forward with courage and determination that inspires our respect, and deserves our support. Nations like Uganda and Kenya have demonstrated that leadership amd honesty can overcome stigma and reduce rates of infection. Nations like Botswana and Namibia have shown that antiretroviral treatments can be widely delivered and highly successful. These countries, and many others, are fighting for the lives of their citizens - and America is now their strongest partner in that fight, and we're proud to be so."
--President George W. Bush June 30, 2005

HIV/AIDS is an emergency that is global - yet it is also local, impacting families and communities one by one.

The leadership needed to defeat the disease must come from every nation and from every sector of society within nations. PEPFAR has thus focused on fostering host country leadership on HIV/AIDS in the governmental and non-governmental sectors. Such leadership is especially critical in combating the stigma that continues to inhibit the fight against HIV/AIDS.

Public affairs outreach in the U.S. and public diplomacy abroad contribute importantly to the accountability and leadership goals of the Emergency Plan. At the global level, the U.S. continues to play the leadership role it assumed in the world's fight against HIV/AIDS with President Bush's launch of the Emergency Plan, seeking to mobilize bold leadership and additional resources from other countries, entities and individuals. Through diplomacy with other current and potential international partner governments and multilateral organizations, the Emergency Plan works to deepen other developed nations' commitment to the fight against global AIDS.

Promoting Leadership by Government and Community Leaders
When governments take on leadership responsibilities - including by providing resources to the extent possible - national HIV/AIDS responses are greatly strengthened. At the same time, ordinary people - often organized in community- or faith-based organizations - also have unique strengths that are needed for the fight. Such organizations - including organizations of people living with HIV/AIDS (PLWHA) - can effectively combat stigma, denial, and discrimination, paving the way for successful prevention, treatment, and care efforts. They can also confront negative cultural patterns, including gender inequity, that contribute to the spread of HIV/AIDS.

Emergency Plan personnel - particularly U.S. Government (USG) personnel in the field - work closely
with these organizations, as well as with governments and the private sector, in host nations. Working in a spirit of partnership, these personnel take advantage of their extensive contacts with local leaders to foster leadership on HIV/AIDS.

Senior USG leaders also visit host nations, making it a priority to meet with leaders to discuss ways to deepen and broaden national responses. First Lady Laura Bush, accompanied by Ambassador Randall L. Tobias, the U.S. Global AIDS Coordinator, visited Africa in July 2005. Visiting South Africa, Rwanda, and Tanzania, and touring several Emergency Plan projects, Mrs. Bush sent a powerful message to host nations on the importance of addressing HIV/AIDS, with a particular emphasis on women. Mrs. Bush reiterated this message, as did Ambassador Tobias, in addressing African First Ladies gathered in New York for a meeting of the United Nations General Assembly.

Such efforts to encourage greater leadership are promoted worldwide. Ambassador Tobias joined UNAIDS Executive Director Peter Piot in a visit to China, visiting a range of prevention, treatment, and care facilities, and meeting with governmental and civil society leaders in several cities. For one event, Ambassador Tobias was joined by Pu Cunxin, an extremely popular actor and the nation's goodwill ambassador on HIV/AIDS. Their statements in favor of counseling and testing - and being publicly tested themselves — generated substantial Chinese press coverage, building awareness of the disease at the grassroots level. At a meeting of the China State Council Leading Group on HIV/AIDS, Ambassador Tobias met with leaders from all sectors of Chinese government— from education to transportation—to learn about and discuss ways in which each sector can contribute to the fight against HIV/AIDS. USG personnel in China work to engage diverse community leaders, including religious leaders, PLWHA, popular culture leaders, business executives, and sports icons to raise awareness of HIV/AIDS.

In Swaziland and Lesotho, Ambassador Tobias met with key government leaders, including Ministers of Health, to support and encourage national leaders in their commitment to fight HIV/AIDS. In Swaziland, Ambassador Tobias and the Permanent Secretary of the Ministry of Health were tested together on Swazi TV, the first event of its kind in that nation. News coverage of the event raised HIV awareness and highlighted the importance of testing in one of the most impacted countries in the world.

Gatherings attended by host nation government leaders also afford key opportunities to encourage action against the pandemic. Highlighting the need for continued leadership and attention to combating HIV/AIDS in Latin America, Ambassador Tobias addressed the Annual Directing Council of the Pan American Health Organization, emphasizing growing Emergency Plan efforts in the Western Hemisphere and noting significant opportunities to leverage important partnerships for a strengthened response.

At the Africa Growth and Opportunity Act Forum, held in Dakar, Senegal, Ambassador Tobias and Honorable Sam Kutesa, Minister of Foreign Affairs for the Government of Uganda, chaired a session highlighting links between health and economic growth and development, demonstrating successful new models of partnership among government, civil society, and the private sector. Distinguished panelists represented each of these sectors, offering examples of contributions to amplified, sustainable responses to HIV/AIDS. Dr. Agnes Binagwaho, Executive Secretary of Rwanda's National Commission to Fight AIDS, stressed the importance of government leadership of coordination efforts. Dr. Peter Mugyenyi, Director of the Joint Clinical Research Center in Uganda, related his experience as a leader in the civil society sector, bringing complicated treatment to resource-poor settings through local innovation, with the support of international partners to enhance the efforts of local groups. Dr. Brian Brink, Senior Vice President of Health at Anglo American in South Africa, illustrated the potential of the private sector to build sustainable partnerships, describing Anglo American's groundbreaking efforts to provide HIV/AIDS prevention, care and treatment services.

To increase PEPFAR's ability to reach host nations and share lessons learned, key leaders were invited to PEPFAR's Second Annual Field Meeting in Addis Ababa, Ethiopia (discussed in the chapter on Implementation and Management). This forum provided an opportunity for Emergency Plan personnel not only to encourage the host nation partners present, but also to exchange lessons learned and best practices against HIV/AIDS.

President Bush listens as Mrs. Bush speaks on World AIDS day remarks to audience on World AIDSs day, then introduces the President A key element of Emergency Plan efforts to encourage host nation leadership is ensuring that USG personnel themselves have the information they need to communicate effectively on HIV/AIDS. To help U.S. Ambassadors, who are critical to public diplomacy efforts abroad, in their efforts against the pandemic, Ambassador Tobias addressed conferences of U.S. Chiefs of Mission for the African and Caribbean regions. He also addressed meetings of Peace Corps and HHS/CDC Global AIDS Program personnel, boosting understanding of PEPFAR and encouraging staff to make use of opportunities to promote leadership in host nations.

Bolstering the Emergency Plan's diplomatic efforts to support leadership, Ambassador Jimmy Kolker was named as Assistant U.S. Global AIDS Coordinator. Ambassador Kolker served most recently as U.S. Ambassador to Uganda, where he led the initial phase of PEPFAR implementation.

Promoting Leadership Through Public Diplomacy and Communications
The USG employs a wide range of communications and outreach strategies to engage domestic and international audiences, building awareness of the global HIV/AIDS emergency and encouraging leadership.

President Bush observed World AIDS Day 2005 with an historic event at the White House. The President provided the nation and the world with a report on the status of the Emergency Plan while recognizing and celebrating the leadership of host nations in working to defeat the disease. He was joined at the address by the Darby family from South Africa, a mother and two young children living with HIV/AIDS who are receiving antiretroviral treatment with PEPFAR support. Also on hand was Dr. Peter Mugyenyi of Uganda's Joint Clinical Research Center, which has expanded from one treatment site to 35 in just two years with USG support, and is now providing treatment to approximately 35,000 people. The President's address drew international attention to the growing basis for hope in the fight against HIV/AIDS. Reflecting the interagency nature of PEPFAR, the Secretaries of State, Defense, Health and Human Services, Labor, and Commerce, the Administrator of USAID, and the Director of the Peace Corps, along with Members of Congress, joined the President to mark World AIDS Day.

Other PEPFAR World AIDS Day events included a briefing to foreign press at the Department of State, digital video conferences for overseas media, editorials placed in numerous newspapers worldwide by U.S. missions, and interviews with foreign and domestic media. Ambassador Tobias also marked International Women's Day 2005 with remarks on Capitol Hill, highlighting the importance of leadership against HIV/AIDS by and on behalf of women.

In addition to communicating with the general public on the Emergency Plan, efforts were made to engage particular subgroups with interest in the issue of global AIDS. At the annual meeting of the National Association of People with AIDS, Ambassador Tobias spoke to the group about the leadership PLWHA are bringing to PEPFAR implementation in the field, and was awarded the organization's "Positive Ally Award."

Reaching out to the scientific community, Ambassador Tobias addressed the Institute for Human Virology, discussing the mechanisms through which scientific input influences Emergency Plan programming. Dr. Mark Dybul, Deputy U.S. Global AIDS Coordinator and Chief Medical Officer, made a presentation to the international development community in Washington, explaining issues around attribution of results to HIV/AIDS programs. To build linkages to organizations working to deliver the food aid which is so vital to PLWHA in the developing world, Ambassador Tobias addressed USAID's Export Food Aid conference in Kansas City, introducing many in this key audience to PEPFAR and opening doors to intensified cooperation.

In America as in other nations, the engagement of faith communities in the fight against global AIDS is important for the Emergency Plan to succeed. Ambassador Tobias has addressed a number of faith-based audiences, including Esperanza USA, a network of Latino churches and ministries, and a pastors' conference at Saddleback Church organized by Rick Warren, author of The Purpose-Driven Life, highlighting opportunities for partnership in the fight.

PEPFAR continues to work for intensified leadership from the U.S. business community, as it does with the private sector in host nations. Secretary of State Condoleezza Rice addressed the Global Business Coalition on HIV/AIDS to discuss opportunities for joint efforts, and the Emergency Plan will increase its focus on public-private partnerships in 2006. Other outreach events in communities around the U.S. have helped to increase the sense of investment in the Emergency Plan among those on whose generosity it ultimately depends on the American people.

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Best Practices
C�te d'Ivoire: The U.S. Embassy and a mosque - partners against HIV/AIDS
Beneath the minaret walls of Yamoussoukro's Grand Mosque, the faithful flowed from the evening's last prayer into a temporary outdoor theatre which had been erected in the mosque's courtyard. They took their places for the first-ever formal discussion on HIV/AIDS at the largest mosque in C�te d'Ivoire's capital.

Imam of the grand mosque in Yamousoukro was joined by over 400 faithful for the first-ever presentation or discussion on AIDS at the mosqueWith the endorsement of the nation's top Muslim leadership and the mosque's Imam, the U.S. Embassy's HIV/AIDS Video Road Show was welcomed for a presentation and discussion on a topic shrouded in misunderstanding and stigma. Over 400 people - old and young, male and female — gathered for an event that opened the doors of Ivoirian mosques to discussions about HIV/AIDS and risky traditional practices, such as polygamy. The initiative was warmly received by those who attended, though some questioned whether such a topic should be raised inside a mosque. In his opening remarks the Imam addressed this issue directly. He said that HIV/AIDS is a serious problem for Ivoirian Muslims, and must be addressed openly and directly, adding that nothing in the Quran or in Islam forbids discussing the issue. He said he had brought the show to the mosque as a resource for its members and encouraged his congregants to listen, learn, and ask questions.

The event brought open discussion of an increasingly dangerous disease for Muslims into the heart of their community. On his departure, the Imam profusely thanked the U.S. personnel and expressed interest in further events — reflecting the growing relationship between the Embassy and the Islamic community in C�te d'Ivoire. The Imam showed leadership and courage in breaking a barrier that has prevented Muslims from understanding the risks of HIV/AIDS and the prevention, treatment, and care resources available to their community - and thanks to the initiative of the Embassy staff, the Emergency Plan was there to support that leadership.

Promoting Leadership for Increased International Partner Resources and Commitment
At this point in the global response to HIV/AIDS, it remains imperative that the global community provide additional resources. Currently, the USG provides more than one-half of all resources from international partner governments for global HIV/AIDS - a situation which is neither appropriate nor sustainable. The USG renews its call for other donor nations to meet this humanitarian crisis with human compassion.

The U.S. leads the G-8 industrialized nations in meeting the financing needs for HIV/AIDS. At the July 2005 G-8 Summit in Gleneagles, Scotland, President Bush and other heads of state endorsed language that promotes leadership from every nation affected by HIV/AIDS. The G-8 committed to:

"Investing in improved health systems in partnership with African governments, by helping Africa train and retain doctors, nurses and community health workers. We will ensure our actions strengthen health systems at national and local level and across all sectors since this is vital for long-term improvements in overall health, and we will encourage donors to help build health capacity.

"With the aim of an AIDS-free generation in Africa, significantly reducing HIV infections and working with WHO, UNAIDS and other international bodies to develop and implement a package for
HIV prevention, treatment and care, with the aim of as close as possible to universal access to treatment for all those who need it by 2010. Limited health systems capacity is a major constraint to achieving this and we will work with our partners in Africa to address this, including supporting the establishment of reliable and accountable supply chain manage ment and reporting systems. We will also work with them to ensure that all children left orphaned or vulnerable by AIDS or other pandemics are given proper support. We will work to meet the financing needs for HIV/AIDS, including through the replenishment this year of the Global Fund to fight AIDS, TB and Malaria; and actively working with local stakeholders to implement the '3 Ones' principles in all countries."

The U.S. leads the G-8 in contributing to the expansion of prevention, treatment, and care access. The G-8 commitment on HIV/AIDS embodies the commitment of the U.S. and other governments, working with multilateral organizations such as World Health Organization (WHO) and UNAIDS, to further increase access.

PEPFAR has emphasized setting achievable goals and insisting on results. It is only through accountability for real successes that sustainable progress in the fight against HIV/AIDS will be achieved.

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Best Practices

Vietnam: A business makes its workplace more welcoming to people living with HIV/AIDS
Vietnam's workforce is threatened by HIV/AIDS. The country's epidemic is growing rapidly, particularly among younger people. As in every country, businesses must be a part of a true multisectoral response. Colgate-Palmolive has a history of awardwinning wellness programs for employees, and had established HIV/AIDS policies in its sub-Saharan Africa offices, but had done little in its significant Asian holdings. As was noted in an annual report, "With over 5.5 million reported AIDS cases in India, China, Thailand and Vietnam, it is clear that the Company's efforts must expand into Asia as well."

The Emergency Plan-supported SMARTWork (Strategically Managing AIDS Responses Together in the Workplace) project has supported the company in meeting the challenge in Vietnam. SMARTWork worked with Colgate-Palmolive to quickly establish a workplace policy on HIV/AIDS that protected HIVpositive employees and eliminated mandatory testing while making anonymous voluntary testing available. Care and support services for employees, as well as ongoing education activities, were also added. The company worked with SMARTWork to train more than 2,300 factory, field sales and management personnel.

Colgate-Palmolive operates in other nations such as China, Thailand, India, and Nepal, and an official noted that after its success in Vietnam, "We will take the lead in Asia and introduce SMARTWork to our other country affiliates in Asia."

As discussed in the chapter on Strengthening Multilateral Action, the USG continues to strengthen its relationships with multilateral institutions and international organizations to amplify global action against HIV/AIDS, encouraging coordination, filling gaps in current activities and ensuring the efficient and effective use of funds under the Three Ones principles for coordination among international partners at the country level.

Vietnamese medical practitioner and Buddhist monk pose for camera.  Doctors provide training and education to the monks, who work with young people in VietnamThe Gleneagles communique also reiterated the G-8 commitment to the Global HIV/AIDS Vaccine Enterprise endorsed by the group in 2004. The U.S. is increasing direct investment and promoting market incentives as a complement to basic research and pursuing mechanisms such as public-private partnerships.

The USG also continues to use its leadership roles (discussed in the chapter on Strengthening Multilateral Action) on the Board of the Global Fund (where Ambassador Tobias serves as Chair of the Policy and Strategy Committee) and the UNAIDS Programme Coordinating Board to advocate for increased international commitment of resources to global HIV/AIDS.

Bold leadership from political and social leaders in each country severely affected by HIV/AIDS remains an indispensable element of a truly successful response. This leadership must include a commitment to use indigenous as well as international resources to educate and empower individuals to prevent transmission of HIV/AIDS; to provide access to quality antiretroviral treatment and care for those infected and affected; and to reduce the stigma associated with HIV/AIDS in order to mitigate its impact on economies, societies, communities, families, and individuals.