USAID: Testimony of USAID Administrator Andrew S. Natsios, 06/07/01

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

Administrator's Testimony on HIV/AIDS

Submitted to the House International Relations Committee
June 7 11:00 a.m.

Since 1986, USAID has provided $1.6 billion in HIV/AIDS assistance; we are the largest donor in the world. USAID has been working with host country partners, citizen groups, and other donors to understand and address this global concern.

Equally important, we play a critical leadership role in assuring that developing countries benefit from gains in knowledge about HIV/AIDS. We help support groundbreaking research in the United States in critical areas such as the development of vaccines and microbicides. We carry out operations and social science research in host countries to track the epidemic and to see that scientific breakthroughs are translated into effective interventions for use in developing countries. We do this through a four step process: 1) identifying relevant findings, 2) testing their utility in the resource-scarce environment of developing countries, 3) adapting the approaches to host country conditions, and 4) developing the systems, protocols and training necessary to use these approaches on a large scale. Once this is done, we help countries scale up to reach significant populations. Important milestones in this process include the following:

In 1988 rapid, inexpensive kits were developed which made it possible to detect HIV in a prospective donor's blood. The use of this technology and these tests has changed blood collection and storage in developing countries. By screening prior to blood collection, hospitals are able to ensure safe blood supply without elaborate blood storage and testing. This approach is being used throughout the world. It has significantly reduced HIV transmission through blood transfusions.

In 1995, a study in Tanzania showed the treatment of other sexually transmitted infections (STIs), such as chancroid and syphilis, reduced HIV transmission by nearly one half. As early as 1990, USAID had incorporated STI management in its strategic approach to HIV/AIDS. After the publication of the Tanzania study, STI treatment became one of the cornerstones of our HIV/AIDS prevention programs. In 1999/2000, periodic presumptive treatment, a new approach to the treatment of STIs among high-risk groups, was developed. This approach has been shown to reduce significantly the transmission of STIs among high-risk populations. It is an important element of programs such as our Cross-Border Program in Southern Africa, which targets high-risk populations including truck drivers, migrant workers, and prostitutes.

In 1996-7, a USAID-sponsored study in Uganda found that those who used voluntary testing and counseling services (VCT) and knew their HIV/AIDS status changed their behavior to avoid risk. This was true of both those who were HIV positive and HIV negative. In addition, those who know their status, in many cases, became powerful educators in their community, advocates for improved care, and the creators of innovative non-governmental organizations. In Uganda, women living with AIDS helped found a NGO which helps other widows and widowers with HIV/AIDS leave a legacy through memory books for their children, many of whom will soon be orphaned. Voluntary testing and counseling is now increasingly an essential part of national HIV/AIDS programs. USAID has introduced VCT in six country programs. In Uganda, more than 500,000 people have used VCT services.

In 1997, a Thai national policy that mandated 100% condom use in brothels resulted in a dramatic decrease in HIV and STI transmission. Thailand is one of the few developing countries in the world to succeed in keeping HIV/AIDS prevalence low. The lessons learned from Thailand are being applied in Cambodia and the Dominican Republic.

The first treatments to reduce mother to child transmission (MTCT) were developed in the U.S. in 1994 but were too expensive and difficult to use in a developing world setting. In 1998, pilot studies showed that a simpler, less costly, four-week treatment could be successfully used to prevent MTCT. Subsequently, USAID began to pilot test MTCT in countries where there were many HIV positive women. In 1999, U.S. financed studies found that the drug nevirapine offered an even cheaper and even simpler approach to preventing MTCT. Nevirapine only requires a single dose each for the mother and the newborn child at a cost of approximately one-dollar for the drug. This is a considerable improvement over the previous four-week treatment with other drugs. Currently, Nevirapine's manufacturer, Boerhinger Inglem, is making the drug available at no cost to developing countries. USAID is supporting pilot MTCT prevention programs in Kenya and Zambia with additional activities planned for Uganda, Malawi, Rwanda and South Africa.

In 1998, studies in Uganda showed that delaying sexual debut by two years could have a profound impact on HIV prevalence. The prevalence rate in urban settings was cut in half. This has led to an increased emphasis on youth and education programs like Uganda's straight talk clubs.

In 1987 two ground breaking African care programs for people living with HIV/AIDS were established: The Chikankata AIDS program in rural Zambia and The AIDS Service Organization (TASO) in Kampala Uganda, an urban setting. Both programs demonstrated that community supported, home-based care programs were feasible at relatively low cost. USAID is expanding its support for home and community based care programs.
Plans are underway to expand our programs to include training for health care workers and to improve health infrastructure to meet the growing demand for AIDS care services. The highest priority will be to expand access to treatment for tuberculosis (TB) and other opportunistic infections to reduce suffering and prevent and delay deaths. TB is the most common opportunistic infection in the world and the leading cause of death for persons living with HIV/AIDS.

In 1997 USAID published Children on the Brink which for the first time enumerated the large numbers of children orphaned by HIV/AIDS especially in sub Saharan Africa. This was followed up by Children on the Brink 2000. At the end of 1999, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that 13.2 million children under age 15 world-wide had lost their mother or both parents as a result of AIDS; 90 percent of these children live in sub-Saharan Africa. USAID estimates that 44 million children in 34 countries hardest hit by HIV/AIDS will have lost one or both parents from all causes, but primarily from AIDS, by 2010. USAID has initiated 40 programs in 18 countries to care for children affected by the HIV/AIDS pandemic. These programs are focused on providing communities with the assistance they need to keep orphans and vulnerable children in the community, and to ensure they are provided with an education and food.

USAID is currently supporting applied research in 21 countries. This includes research to develop and improve our approaches to: reaching youth with effective services and messages; integrating HIV testing services into existing health care settings; improving programs to prevent mother to child transmission of HIV; providing home and community based care for persons with HIV/AIDS; assisting children affected by HIV/AIDS; and reducing the stigma of HIV/AIDS so that persons affected can freely use the services that are available.

In addition, USAID supports efforts to develop an AIDS vaccine, preventive microbicides, STI diagnostic tools, and new methods of measuring the extent and impact of the epidemic.

We are having a powerful impact on the global pandemic with the tools available now. However, there is no single intervention that slows transmission, comforts the sick, or cares for those affected. In each country, we must determine the state of the epidemic in both biomedical and behavioral terms. Once we know who is infected, who is at greatest risk, the dominant forms of HIV transmission, and the numbers and needs of those infected and affected, we can apply the right mix of interventions.

USAID's strategy has two important elements: a geographic focus and a programmatic focus. Although we work in 50 countries, we concentrate resources in 20 countries. These countries have been selected on the basis of the severity of the epidemic, risk of rapid increase of infection and national willingness to act.

USAID is now aggressively pursuing six strategies for fighting the HIV/AIDS pandemic worldwide.

Prevention remains the cornerstone of USAID's program. Special attention is given to scaling up proven approaches, ultimately to a national scale. We can and must reach youth early with prevention messages. Almost half of all of new infections in developing countries are to 15 to 24 olds. We target high-risk populations to change behavior through abstinence, faithfulness and the use of condoms to slow the spread of the virus to the general population. High priority is given to diagnosis and treatment of sexually transmitted infections in these groups. We support the gradual introduction and expansion of programs to prevent mother-to-child transmission through the provision of limited medications for mother and newborn. Finally, promotion of voluntary counseling and testing has proven to be a highly effective way of achieving behavior change, eventually slowing transmission.

Care and support: We focus care interventions to reach the most vulnerable populations, and those with the greatest potential to prevent transmission where possible, and improve the quality of life of infected individuals. Our support to people living with AIDS is focused on the prevention and treatment of AIDS-related illnesses like tuberculosis and other opportunistic infections. These conditions can be treated with low cost, more readily available medicines. This can reduce suffering and prevent premature death.

Orphans and vulnerable children: Our help to orphans and other vulnerable children is focused on the areas worst hit and draws upon community resources to develop programs and solutions. In Zambia, for instance, the USAID mission provides small grants to community organizations which determine what is needed to help them care for the children in their midst. These range from providing seed, fertilizer, and help with plowing (the elders caring for their many grandchildren are not strong enough to plow) to community schools which use transmitted instruction and community volunteers to educate the children. In Zambia, more teachers are dying each year than graduate from Zambia's teaching colleges.

Increasing surveillance capacity to track the epidemic: USAID supports programs to monitor the status of the epidemic, measure the impact of prevention and care programs, coordinate donor and other partner activities, and use resources most effectively.

Encouraging greater financial commitments of other donor governments and multi-lateral institutions in the fight to combat the disease: USAID recognizes the need to generate additional financial and human resources through multi-national initiatives such as the Global HIV and Health Fund.

Engaging National Leaders and other Sectors in the Fight: We must enlist the active, sustained and visible support of national political leaders in mobilizing their own governments to change people's behavior and to address the pandemic. Mitigating the consequences of the HIV/AIDS pandemic requires a broad, multi-sectoral approach. I have recently sent a cable to our missions telling the Agency that HIV/AIDS is not just a health issue and every USAID officer in every sector must consider AIDS programming.

And finally, USAID is committed to a sustained and significant effort. We know from Uganda, from Senegal and from Zambia that it takes a sustained commitment to realize gains and that until infections are substantially reduced globally, we can not diminish our efforts.

I am determined, as the Administrator of USAID, that with your support we will meet this challenge. When we look back 10 years from now at our legacy, we will be able to say that the generosity and know-how of the American people made a difference and saved many.

Last Updated on: January 02, 2009