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World AIDS Day

December 1, 2003 at 12:00 AM EST
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SUSAN DENTZER: In China on this World AIDS Day, viewers of government-run television saw an unprecedented sight. Premier Wen Jiabao was shaking hands and chatting with three AIDS patients at a Beijing hospital. China has at least 840,000 people infected with HIV, the virus that causes AIDS. The World Health Organization predicts the number could be 10 million by 2010. Until recently, the Chinese government had for the most part denied the scope of its AIDS problem.

Meanwhile, in South Africa, the government has also undergone a major policy shift. It announced earlier this year that it would begin to pay for antiretroviral drug treatments for many of its 5 million citizens infected with HIV. These and other actions have come as the global AIDS pandemic grows worse. Last week the United Nation’s umbrella AIDS organization, UNAIDS, estimated that roughly 40 million people around the world are infected with HIV.

Today the World Health Organization announced details of a major new initiative; it would provide antiretroviral drugs to at least 3 million people by 2005. That’s just over half the number of people whom the WHO estimates need the drugs. The WHO says the goal is achievable now that the annual cost of the drugs has fallen to as low as $300 per person per year. It says the total cost of the initiative, dubbed “Three by Five,” will be about $5.5 billion.

The WHO says most of the money will come from funds already pledged to combat HIV and AIDS. That includes the U.N.’s global fund on HIV, AIDS and malaria, and the $15 billion five-year global HIV initiative proposed by President Bush and approved by Congress earlier this year. The heightened resolve to combat AIDS can’t come too soon, experts said today. They estimate that 3 million around the world will die from AIDS in 2003, the highest annual AIDS death toll ever.

GWEN IFILL: And joining me now to discuss the World Health Organization plan and other efforts to fight HIV/AIDS are Debrework Zewdie; she’s the director of the global HIV/AIDS program at the World Bank. Josh Ruxin, a professor of public health at Columbia University, and a coordinator for the U.N. Millennial Task Force focused on HIV/AIDS. And Stephen Lewis, the U.N. Secretary-General’s Special Envoy for HIV/AIDS in Africa.

Welcome to you all.

Stephen Lewis, we just heard Susan Dentzer report that 3 million people will have died of AIDS just this year, at least that’s probably a conservative estimate. Yet this plan, this WHO plan hopes to reach 3 million people, put them on these drugs by 2005. Is it an achievable objective?

STEPHEN LEWIS: Well, there are tremendous numbers of skeptics, necessarily, because it’s a huge task. But on balance, I have never seen a U.N. agency so determined and so committed, and they have broken through the inertia which afflicts a large part of the world, and I think if we give the WHO the support it deserves, then they may indeed achieve almost all of it or at least a significant enough part of it to drive the momentum.

GWEN IFILL: We’ll talk more about the kind of support you think it deserves. First I want to ask the same question to Debrework Zewdie. Do you think the WHO plan is achievable, is realistic?

DEBREWORK ZEWDIE: It is an ambitious plan, but it is a plan that the world has needed for a very long time, and as Stephen Lewis said, if all of us put our efforts together, there’s no reason why we shouldn’t achieve it, and the people who are infected by this disease expect this from us.

GWEN IFILL: Josh Ruxin, what is your sense of this, that this is something that can be achieved, this ambitious plan?

JOSH RUXIN: I’m hopeful that it can be achieved and I share Ambassador Lewis’ optimism that it is, in fact, achievable. I think what’s most important is that we really stay focused on what needs to be done out in the field and how to keep countries accountable for their actions, as well as the U.N. agencies themselves. And in particular, I think we have to focus on the equity issue, we need to make sure that the poorest and most vulnerable people are the ones who are receiving this much needed treatment.

GWEN IFILL: Now that’s a lot that you just laid out there. You’re talking about accountability on the part of these countries; you’re talking about make sure the poorest people receive the treatment. How does this or any other plan, I’ll start with you since you raised it, Mr. Ruxin, how do you begin to achieve that, what are the first steps? Is it money; it is prevention programs; is it treatment programs?

JOSH RUXIN: Well, I think you really have to begin at the country level and make sure that the political accountability is there. Leaders in many of these countries have recommitted themselves just in the past couple weeks, we’ve seen it in India and in China and South Africa, and I think this is promising news. But up to date, I think the past year suggests that it’s been a year of enormous setbacks as well as great progress, when it comes to that type of political accountability. And many countries are still far behind.

GWEN IFILL: Stephen Lewis, I want to direct that to you. What is the first thing that this plan has to address? Is it the accountability on the part of countries as Josh Ruxin says, or is it something else?

STEPHEN LEWIS: You know, I don’t think there can be a first, second and third. I think in this instance everything has to work simultaneously. The countries have to come on board, you have to repair the fractured infrastructures in so many of these countries, so that the health systems can deliver the antiretroviral treatment.

You have to train and refurbish human capacity, which has been so deeply wrenched and decimated in the course of the pandemic, and you have to find the resources, the World Health Organization talks about $5.5 billion, they don’t talk about it with facile and gratuitous ease, but they know that we don’t have that money. We need billions of additional dollars in order to drive this through, so everything must work simultaneously in order for those people to be reached, to achieve Josh’s equity goal.

GWEN IFILL: You know, it’s difficult to get things to work simultaneously, even in a developed nation like the United States, and its own health care plan. Let me ask you to follow up on how that would, how you would do that, Mr. Lewis, how would you get everything to work simultaneously in something so complicated?

STEPHEN LEWIS: Oh, yeah, and I agree. And I don’t want to be silly about it. It’s tough and it’s going to take a lot of time. I think that the World Health Organization idea of training 100,000 people at country level to deliver the goods, I think the idea of having monitors and community health workers to make sure that those who receive the drugs comply and adhere to the regimen, I think that the money that has been promised but never delivered to the global fund, others of us in the U.N. system have to make sure that money is rounded up. What we haven’t had, let me put it this way, in the midst of this desperate unprecedented calamity is the resolve at the political level to drive it through. And if there isn’t the resolve, then the World Health Organization will not succeed.

GWEN IFILL: Ms. Zewdie, you’re at the World Bank. Let’s talk about money: $5-and-a-half billion optimistically in this plan, $10 billion people say is the minimum to really break through. How does that gap get closed?

DEBREWORK ZEWDIE: The gap gets closed in a number of ways. As Stephen said, the resources that have been pledged have to be realized. And the world has to realize that the cost is going to be much more if we don’t act now. As far as the World Bank is concerned, currently we have the largest resources and their implementation on the ground. These are resources which could immediately be mobilized. But the most important thing is not only leaving it to the countries. We the donor agencies and other countries have to get our acts together so that we don’t throw these countries in ten different directions, we need to get our acts together so that the countries will be mobilized to achieve this goal.

GWEN IFILL: What about the part that Mr. Ruxin was talking about earlier, about the countries themselves getting their acts together and being able to contribute to the cause, is that something that you can see happening?

DEBREWORK ZEWDIE: It will happen and it has happened, in many of the African countries now we see a lot of political mobilization. Some of the countries have a long way to go, but even we have seen what happened in China, for example. Along with that, the northern governments and donor agencies need to come together. What is a big problem now, with limited capacity is that we try to draw this countries in different directions as we go with our own plans and with our own rules and regulations. So we need one strategic plan, one national mobilizing body, and one monetary and evaluation system so that the countries would be mobilized, and we reach this goal. Otherwise it will be very difficult.

GWEN IFILL: Mr. Ruxin, let’s talk about priorities, which transcend the money question, I suppose, which is where the money should go. Should it go to AIDS prevention or AIDS treatment? It seems that AIDS treatment is what much of this WHO plan is talking about, getting the antiretroviral drugs to people. How about stopping the infection in the first place?

JOSH RUXIN: Well, I think the focus of their plan is certainly on treatment, but all of us today recognize that treatment goes hand in hand with prevention and with care. You simply cannot initiate a program to deliver antiretroviral drugs without doing a number of other activities which meet other preventive needs such as conducting voluntary counseling and testing, providing rapid test kits, for example, for people who desire them and certainly getting condoms to populations that otherwise don’t have access to them.

GWEN IFILL: And who are the people who are going to be empowered, I guess, to bring that information to people? Are there enough trained individuals to deliver the drugs, to pass out the prevention pamphlets, to actually be on the ground?

JOSH RUXIN: There are growing teams that are on the ground in all the countries that we’re discussing who are learning how to give out the drugs, and no longer do we have to talk about simply medical doctors giving out drugs, but we can start to talk about other health workers and nurses, and even community health workers who are involved in the distribution of those essential antiretroviral drugs. And luckily the global fund to fight AIDS, tuberculosis and malaria, which received half a billion dollars this year from the U.S. and hopefully if the Bush administration lives up to its promises will receive a billion dollars from this administration next year, is financing those types of training initiatives on the ground.

GWEN IFILL: Is the U.S. living up to its promises right now?

JOSH RUXIN: So far, the U.S. has certainly expanded its promises, and a lot of us are still waiting to see the money. And we’re hopeful that in the coming year, the Bush administration will expand its appropriations to the global fund and it will also start to see some of this $10 billion in incremental financing that was promised by the administration during the state of the union address.

GWEN IFILL: Certainly, Mr. Lewis.

STEPHEN LEWIS: May I just say that the global fund is really central to all of this. The global fund is the best multilateral financial instrument we’ve had in years, and it is extremely disappointing that the rich countries of the world have failed to fund it adequately, and indeed that the United States has not lived up to the expectations. That has dashed a lot of hope.

GWEN IFILL: Mr. Lewis, you’re laying on a fairly steep mountain to climb here, there is not enough money, the people who promised the money apparently around delivering it, at least not immediately, this goal of 3 million people getting drugs by 2005 seems difficult to achieve. Give me an idea of how or what optimism you find in all of these numbers.

STEPHEN LEWIS: I find a glimpse of optimism in this miasma of despair by the mere fact that we’re talking about millions of people in treatment, we’re talking about getting additional resources, we’re talking about strengthening the delivery of these drugs. I don’t know how to balance these things. We are losing 3 million lives unnecessarily every single year. And what other motivation do you need to galvanize this world?

GWEN IFILL: Debrework Zewdie, do you see any optimism in all of this?

DEBREWORK ZEWDIE: I do, because we have to look at the initiative of the WHO, which was announced today as if we are starting from scratch. We have excellent examples in Haiti, in Uganda, in Senegal where treatment has been delivered in resource poor settings. The capacity issue is something which comes up over and over again. We haven’t done enough in tapping existing capacity. If we do that, as we build long term capacity, there is enough on the ground to start on this, provided we come up with the resources and we have global solidarity to respond to this global epidemic.

GWEN IFILL: Ms. Zewdie, Mr. Lewis and Mr. Ruxin, thank you very much.