On April 7, the Senate Foreign Relations Subcommittee on African Affairs heard testimony on the progress being made in the fight against HIV/AIDS in Africa and implementation of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25).
Stressing that it is important to have realistic expectations in Africa, Chair Lamar Alexander (R-TN) said that the purpose of the hearing is to understand the “benchmarks” used to measure success in the fight against HIV/AIDS and ultimately decide how best to use the provided funds.
U.S. Global AIDS Coordinator Randall Tobias detailed the administration’s efforts to implement the law, stating that last week he announced the first release of funds totaling $350 million. “This money will go to scale up programs that provide anti-retroviral treatment; abstinence-based prevention programs, including those targeted at youth; safe medical practices programs, including safe blood programs; and programs to provide care for orphans and vulnerable children.” He continued, “With just this first round of funds, an additional 50,000 people living with HIV/AIDS in the 14 focus countries will begin to receive anti-retroviral treatment, which will nearly double the number of people who are currently receiving treatment in all of sub-Saharan Africa. In addition, prevention through abstinence messages will reach about 500,000 additional young people in the Plan’s 14 focus countries in Africa and the Caribbean.”
In discussing the five-year plan, Ambassador Tobias called it “comprehensive” and “integrated” and said it was built on four cornerstones: expanding integrated prevention, care, and treatment; identifying new partners; encouraging national leadership around the world; and implementing strategic information systems that will provide feedback on best practices.
“Within this framework, we will strive to coordinate and collaborate our efforts in order to respond to local needs and be consistent with host government strategies and priorities,” he said.
During the question and answer session, Ranking Member Russell Feingold (D-WI) noted that the 2003 law encouraged the empowerment of women and asked what strategies were in place concerning the treatment of women and girls. Noting that women between the ages of 18 and 24 make up 24 percent of HIV/AIDS cases in parts of Africa, Ambassador Tobias responded that one of the critical issues that will need to be “innovatively” addressed is the attitude of men toward women. He pointed out that married women have higher infection rates than single women in this age group because of the cultural practice of older men marrying teenage brides. To address this issue, Ambassador Tobias said that the administration would implement the ABC method and encourage more people to be tested for HIV/AIDS.
Testifying on behalf of the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC), Dr. Jonathan Mermin described his experiences in running the local HHS/CDC Global AIDS Program (HHS/GAP) in Uganda. He contended that Uganda should be seen as a model for other countries fighting the epidemic, noting that it was the first country in the world to show a decrease in HIV prevalence a 50 percent decrease in infection rates since 1992. Dr. Mermin said that the success “was in large part because of early, high-level political leadership in addressing HIV, resulting in a broad response that included many innovative prevention programs such as the promotion of the ABC method, A for abstinence, B for being faithful, and C for condoms, as appropriate.” He said that Uganda would now move to the next stage in the fight against HIV/AIDS delivering treatment to the people who are HIV-positive. Dr. Mermin explained that HHS/GAP has focused on a home-based, family-centered approach to expand HIV testing and counseling, provide a standardized basic treatment to all persons with HIV, and expand access to antiretroviral therapy. “Working with families increases the chance for success because it utilizes the family’s support systems, encourages disclosure of HIV status, and emphasizes the benefits to the whole household of providing effective care for a family member with HIV,” he stated.
Sen. Feingold returned to his previous line of questioning and asked what efforts were in place to assist women and girls in Uganda. Dr. Mermin explained that the Ugandan Ministry of Gender has been very involved in a school-based education effort aimed at HIV prevention known as “Straight Talk.” He said that the family-centered approach would assist women in encouraging the entire family to be tested for HIV and counseled together. He also explained that the counseling would cover such issues as wills and domestic violence.
