USAID: Opening Remarks by Dr. Anne Peterson, Asst Administrator, Global Health 07/24/02

This is an archived USAID document retained on this web site as a matter of public record.

Remarks by Dr. Anne Peterson,
Assistant Administrator, Global Health

Confronting AIDS in 2002: Moving Forward from the XIV International AIDS Conference
July 24, 2002

Good morning. I'm pleased to be here to represent the U.S. government and to discuss our role in the XIV International AIDS Conference in Barcelona.

As some of you may know, the U.S. Agency for International Development is the largest funder of international HIV/AIDS programs in the world. Because of this, the International AIDS conferences that take place every two years are critical to our work. These conferences offer a unique opportunity to meet with partners and to share the latest cutting-edge research on the best ways to prevent HIV and to care for people living with HIV and AIDS.

USAID funded over 200 presentations made during the Barcelona conference. These presentations covered all aspects of our work, from research into vaccines and microbicides, to the best ways to prevent mother-to-child-transmission of HIV, to how to reduce stigma in people living with HIV. USAID contributes significantly to biomedical research, but operations research helps us answer the key questions we have as we move forward in fighting the war on AIDS: What have we done that really works? How do we know? How can we be more effective in the future?

A major focus area in Barcelona was how to scale-up our response to HIV. USAID has been fighting AIDS for 16 years now, and we now have demonstrable successes of what works. The challenge for USAID and for the international community is how to replicate and scale-up these successes. We know that a local-level program doesn't automatically translate into success on a national scale or that a successful program in southeast Asia will easily be replicated in Africa. But there are common themes and lessons learned. The AIDS conference in Barcelona brought all of the successes together. Now, we need to figure out how to absorb, reflect then integrate the wealth of knowledge and information that we learned there. Today is part of synthesizing all of that information into appropriate action.

This morning, I want to briefly share with you four of the topics we focused on during Barcelona.

Demographic Impact of AIDS

USAID, in partnership with the U.S. Census Bureau, released a study in Barcelona that showed that life expectancies in 51 countries will drop due to the global AIDS pandemic.

The study found that seven countries in sub-Saharan Africa have life expectancies of less than 40 years of age. In Botswana, for example, life expectancy is only 39 years, while it would have been 72, if it were not for AIDS. This means that the majority of Botswanans on average will live 30 years less than they would have if not for the AIDS pandemic.

This trend is also seen in Asia and Latin America and the Caribbean although due to lower HIV prevalence levels, the impact is not as great. In Haiti, life expectancy is now 51, while it would have been 59, if it were not for AIDS. In Asia, Thailand, Cambodia and Burma have lost between two and five years of life expectancy.

In 2010, 11 countries in sub-Saharan Africa will see life expectancies fall to near 30 years, levels not seen since the end of the 19th century. In a region that would have estimated life expectancies to reach 70 years of age by 2010, Botswana's life expectancy will be 27 years, Swaziland, 33 years and Namibia and Zambia, 34 years.

The staggering trend of decreasing life expectancies due to AIDS only strengthens our resolve that we must do more to fight the pandemic. As I mentioned a moment ago, we have learned what programs work, and these statistics make us more determined than ever to expand these programs, and reverse these terrible trends.

Children on the Brink

We also released a study on children orphaned due to AIDS. Children on the Brink was jointly published by USAID, UNAIDS and UNICEF, with estimates developed by the U.S. Bureau of the Census. In addition to providing historical, current and projected number of statistics orphaned by AIDS in 88 countries, Children on the Brink identified several trends.

During the press conference at which we released this report, Dr. Peter Piot, head of UNAIDS, called it "one of the most shocking reports released at this conference." Let me briefly share with you some of the shocking facts:

The report finds that today there are 13.4 million orphans due to AIDS in the 88 countries studied, and this number is projected to grow to more than 25 million in 2010.

Due to AIDS, the number of orphans is increasing dramatically. In Africa, 34 million children are orphans, one-third of them due to AIDS. By 2010, 40 million children will be orphaned, half of them due to AIDS. What this means is that almost 6 percent of all children in Africa -will be orphaned due to AIDS.

In the countries with high levels of HIV prevalence, and resulting high orphan populations, there are major impacts on the society at large. As more adults die, more children are orphaned, and with fewer healthy adults to care for the increasing number of children. In 2010, in four African countries, one in five children will be orphans. The implications of this are unprecedented.

A key point that captured attention in Barcelona was that even if we could stop the spread of AIDS starting today, the number of orphans would continue to increase for the next decade. For example, in Uganda, where HIV prevalence began declining in the early 1990s, the number of orphans continued to grow for 10 years and is only now beginning to decline.

In Asia, the total number of orphans is larger than in Africa, because the population is so much larger. However, the number of children orphaned due to AIDS is smaller. Due to large populations, even a very small increase in HIV prevalence could cause a massive leap in new orphans due to AIDS.

As alarming as these trends are, they still do not include the millions of children whose lives are dramatically altered by AIDS. Countless children are living with and caring for parents who are sick and dying.

Current efforts to address this problem are significant. USAID currently has 75 projects in 22 countries working with children affected by AIDS, and we have successful models for reaching children. However, the efforts of everyone working on this problem around the world reach only a small proportion of children affected by AIDS. We hope that this report spurs the global community to respond to this unprecedented problem in an unprecedented way.

Preventing AIDS among youth in Zambia

Another topic we highlighted in Barcelona was a success story in preventing AIDS among youth in Zambia. Zambia is a country that has been one of the hardest hit by the AIDS pandemic, where over 20% of the adult population is HIV infected.

One out of every 6th urban youth aged 15-19 is HIV positive. By the age of 15, 37% of boys and 27% of girls have had sex. Among 15-19 year olds, 62% of boys and 59% of girls have had sex.

Because of this, USAID worked with the Government of Zambia and Johns Hopkins University to launch a series of campaigns directed at youth- one of these is the HEART - Helping Each Other Act Responsibly Together - program.

In the past 5 years, HIV infections in 15 to 19 year old urban girls have dropped nearly 50%--from 28 to 15%. This is a remarkable accomplishment and may echo Uganda´s success story.

How did this happen? What changes in behavior led to this decline? Reducing infections in youth involves three basic strategies that we call the ABCs. A is for Abstinence, B is for Be Faithful, C is for condoms. This is not a new concept but we do have a growing body of evidence that each component of A,B and C contributes to successful programming against AIDS. We are also gaining a better understanding of the delicate balance between these three strategies. In some communities, the delay of sexual debut is key to reversing the epidemic. In other communities, particularly when young people marry early, faithfulness is critical. Prevention success is about changed behavior. Each component of the A,B and C requires behavior change. There was a great deal of debate in the past, especially about youth, and whether they could or would change their behaviors for abstinence and faithfulness. We now have evidence that they can and will change their behaviors in delaying onset of sexual activity, reducing partners or staying in a faithful relationship as well as increasing condom use. Zambia is new and strong example of this.

The HEART program demonstrates how a program designed by youth for youth using mass media can dramatically reduce premarital sex among single women from 41% in the early 1990s to 14% in the late 1990s.

Condoms also play a contributing but smaller role in Zambia. Certain HEART participants who were sexually active used condoms during their last sexual act nearly twice as often as those youth who were not part of the program. These persons tended to be older and were more likely to be female.

We are excited about the HEART program and hope it will serve as a model to scale up in Zambia, and to replicate in other countries.

Introduction of Antiretroviral Drugs in three countries

Finally, we held a press conference to announce that USAID is working with the governments of Ghana, Kenya and Rwanda to provide antiretroviral treatment to people living with HIV and AIDS. At our press conference in Barcelona, we were pleased to have senior representatives from Ghana and Rwanda to discuss these new programs.

These are the first U.S. government-funded programs in these countries to provide comprehensive ARV treatment for people living with HIV and AIDS. This announcement marks an expansion of the U.S. government's care and treatment programs, to now include life-saving anti-retroviral drug therapies in developing countries. Until recently, the provision of these drugs was both complex and too expensive for many developing countries. The price of these drugs has declined significantly such that USAID has been able to work with its partners to integrate ARV treatment and management into relevant prevention and care programs.

Finally, while this is billed as a technical conference, there is a significant side-show of press conferences, political meetings, partnership meetings that also contribute to advancing the war on AIDS. We all know political will is a key factor to successful national programs. There were over 20 Ministers of Health at Barcelona, and representatives of the U.S. government had the chance to meet with many of them. An initiative of the International AIDS Trust brought African first ladies to Barcelona, and I met with the First Lady of Malawi and Rwanda and the Princess of Cambodia.

Given all that happened in Barcelona, I promise this is just a really brief summary of USAID's contribution in Barcelona. For those of you who are interested, USAID will be hosting a full-day wrap-up on Barcelona next Wednesday, July 31, at the National Press Club.