This is an archived USAID document retained on this web site as a matter of public record.
Administrator J. Brian Atwood
AIDSCAP Conference: Lessons Learned
Washington, D.C., October 7, 1997
U.S. Agency for International Development
Thank you. It is a pleasure to be here today. I'd like to
thank Congresswoman Pelosi for her remarks and for taking the
time to be with us today.
Recently I returned from a trip to India. My time in India
only further impressed upon me how devastating the HIV/AIDS
pandemic continues to be throughout the developing world. India,
with its nearly 900 million people, already has more HIV
infections than any other country: between 2 and 5 million. In
India, as in other locations, we have seen the epidemic move
beyond being a problem for only high risk groups, with infection
rates escalating among the general population. When you look at
India, and when you think of the crippling costs of dealing with
this social crisis, it only highlights how important your work is to
developing and developed nations alike.
Globally, an estimated 22.6 million people are currently
living with HIV/AIDS and the number of new infections is rising
at a rate of 8,500 a day. At current rates, the number of people
living with AIDS could rise to 40 million by the year 2000.
Close to 95 percent of those infected with the HIV virus live
in developing countries. The epidemic continues to grow at
alarming rates in sub-Saharan Africa, and is now growing at
alarming rates in Asia and parts of the former Soviet Union. It is
mind boggling to read in the American press the attitudes of some
parts of the public who feel the worst of the crisis has passed.
It is true, however, the pandemic is changing course. Over
half of the new cases of HIV/AIDS are now found among women
and young people. Nearly 60 percent of all new HIV infections
throughout the world are occurring in the 15 to 24 year old age
group.
Across the developing world, we are seeing the pandemic
erode both economic development and the important progress we
have made in public health. For many years we were seeing
improvements in key health indicators such as infant mortality as
an optimistic sign of public health progress. However, we are
now seeing tragic increases in infant deaths due to AIDS. In
Zambia and Zimbabwe, for example, infant deaths are 25
percent higher than they would have been without AIDS.
Similarly, life expectancy was increasing throughout the
developing world. AIDS is reversing this trend. Demographers
predict, for example, that by the year 2010 life expectancy in
Africa will fall from 66 to 33 years in Zambia, from 70 to 40
years in Zimbabwe, from 68 to 40 years in Kenya and from 59 to
31 years in Uganda.
Since HIV/AIDS strikes at the most economically productive
age groups, and it cuts across all income levels, the epidemic has
particularly severe economic and social repercussions. We have
seen a breakdown in family structures as parents die leaving
behind orphaned children. We have seen rising medical and other
costs of care borne by people living with HIV/AIDS, their
families and the community. We are seeing lower national
revenues and GNP in every country where HIV/AIDS in
endemic.
For all of these reasons, the agency is continuing to lead
international efforts to address the HIV/AIDS pandemic. During
the past ten years USAID has been a global leader in developing
and implementing nearly 600 HIV/AIDS prevention programs in
over 45 developing countries. The cornerstone of USAID's
HIV/AIDS program has been a focus on prevention efforts
designed to decrease sexual HIV transmission, increase condom
availability and control other sexually transmitted infections.
USAID's prevention efforts are supported by other
interventions that stress policy dialog for host country decision-makers, social and behavioral research to better understand ways
to reduce high risk sexual behavior, evaluation to provide
programs with information about strengths and weaknesses and
capacity building and the collaborative process to build in-country
sustainability and ownership of these programs.
The total expenditure for prevention and mitigation of the
HIV/AIDS pandemic in the developing world was estimated to be
$400 million in 1996. USAID alone provides approximately 25
percent of this worldwide total. USAID has been the major donor
for the global response to the pandemic, with annual contributions
ranging from $88.2 in 1991 to $117.5 million in FY 97. This
year USAID provided 25 percent of the UNAIDS Secretariat
budget and an additional $1 million for the coordinated appeal of
UNAIDS Cosponsors that include UNICEF, UNDP,
WHO,UNFPA and UNESCO. For next year we anticipate that
these funding levels will be maintained.
But more important than numbers and dollar amounts, these
programs are showing vital results. Studies in Tanzania and
Malawi have demonstrated that a 42 percent drop in the number
of new HIV infections can be achieved by proper management of
other sexually transmitted infections.
In Thailand, increasing the use of condoms in commercial
sex establishments contributed to a decrease of HIV prevalence
from 3.6 percent in 1993 to 2.5 percent in 1995. USAID support
for Thailand's family planning program helped make Thailand's
vigorous national HIV/STI program possible. In Uganda, young
women aged 15-24 are delaying the onset of sexual activity and
following safer sex practices due to a decade of community
mobilization and behavior change programs, and the prevalence
of HIV in this group has fallen by 35 percent.
USAID has also provided strong HIV/AIDS global
leadership among other multilateral and bilateral international
donors. Since its inception, USAID was a major source of
financial support for the WHO Global Program on AIDS and,
when that program ended, took the lead in establishing the
UNAIDS program which is designed to increase the effectiveness
of six U.N. agencies in taking a multi-sectoral approach to
combatting the pandemic.
We have worked collaboratively with the Government of
Japan to put HIV/AIDS on the Common Agenda, a bilateral
partnership of our two governments with the goal of addressing
critical global issues. Since 1993, the U.S and Japan have
collaborated on HIV/AIDS assessments and projects in over ten
countries.
Through consultation and collaboration with stakeholders
worldwide, USAID has developed a new HIV/AIDS strategy
which will expand our previous efforts, and focus on the
reduction of HIV transmission and the mitigation of the impact of
the HIV/AIDS pandemic.
In 1996, USAID undertook a re-examination and
participatory redesign of its HIV/AIDS strategic objective to
respond more effectively to the growing and changing
pandemic.The new strategy for our expanded response will
continue to support HIV/AIDS interventions that we've found to
be successful, but will add other elements such as support for
home based HIV care and human rights protection for HIV-infected individuals.
Our expanded response also will continue to rely heavily on
indigenous nongovernmental organizations to mobilize community
support and to reach vulnerable populations, and will encourage
greater program involvement of people living with HIV/AIDS.
The Agency also will explore mechanisms to promote
collaborations between U.S. HIV/AIDS PVOs and host country
indigenous NGOs for sharing skills and lessons learned. The new
strategy also will focus on developing roles for the private
commercial sector in making high quality tools and services more
readily available.
This HIV/AIDS lessons learned conference is timely and
will contribute significantly to shaping and improving our new
strategy. Over these past several years USAID has undergone a
major transformation and reengineering. We are a development
organization but at the same time we are a learning organization.
We are willing to take risks -- that is the nature of development.
While we hope that all our efforts are successful, we know that is
not possible. But time has shown that we can replicate our
successes and avoid past mistakes. We are more intent than ever
on sharing and building on experiences we have had so far.
What AIDSCAP has learned over these past six years will
be enormously useful to us, as well as to you, as we begin the
launch of our new USAID HIV/AIDS strategy. I wish every
success with the conference and thank you for working along with
us in addressing the challenge of combatting the HIV/AIDS
pandemic in the developing world. Thank you.
This is an archived USAID document retained on this web site as a matter of public record.
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Last Updated on: July 18, 2001
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