Plotting The American Role In Fighting The AIDS Epidemic

Among the topics discussed at the U.S.-Africa Leaders Summit this week was the ongoing AIDS epidemic. Melissa Block talks with Ambassador Deborah Birx, the U.S. global AIDS coordinator. Birx oversees the program known as PEPFAR — the President's Emergency Plan for AIDS Relief. Birx talks about combating complacency, as well as the human rights issues that are making it harder for groups to reach some of the most vulnerable populations.

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MELISSA BLOCK, HOST:

Among the topics discussed at the Africa Leaders Summit this week HIV-AIDS. Leading the discussion from the U.S. side is ambassador Deborah Birx. She's the new U.S. global AIDS coordinator and she oversees the nearly $5 billion U.S. government program known as PEPFAR - the President's Emergency Plan for AIDS Relief. Ambassador Birx joins me now. Thanks for being with us.

DEBORAH BIRX: Thank you.

BLOCK: Let's start by talking about money because you have taken over responsibility for PEPFAR at a time when budgets are flatlining, even declining and now the U.S. is talking a lot more about shifting the costs to the countries that are most affected by the AIDS epidemic especially in Africa. So when you talked with the African delegations at the summit what did they say? Are they worried about U.S. commitment dropping off?

BIRX: Well, they've known the U.S. has been beside them from the beginning of this pandemic. They understand that they both have to increase the amount of funding that they're committing to HIV-AIDS but they also understand that we can look at ways to be more effective and efficient just to make sure that every dollar is spent in the most effective way that will change the course of this pandemic.

BLOCK: Would there be countries that would come to you and say, look we understand that ideally we would pick up more of this burden but we just can't. We are stretched in so many different ways we cannot reach the goal that you're setting for us?

BIRX: That's a discussion that occurs in every single country between the U.S. ambassadors in country and the PEPFAR team and the leadership in country. There are countries right now that are coming out of conflict, that are coming out of fragile states, that have still depressed economies. And those countries, we understand that we're in both a financial partnership as well as a technical partnership but it's still a partnership. And as they can do more I know they're committed to do more.

BLOCK: You've said before that you're clearly troubled by human rights issues in some of these African countries at the heart of the epidemic. You do have to deal with countries such as Uganda and Nigeria that have anti-LGBT laws in place. How can PEPFAR successfully work in countries like that, where these anti-gay policies have taken effect?

BIRX: I think we have to look at how the United States has responded with compassion from the beginning in countries as need. We have to ensure that we are still there for the Ugandans at the same time we make it clear to the leadership that this is not only a violation of human rights but also will eventually expand their pandemic which is the one thing no one can afford on the continent.

BLOCK: And how big a concern is that for you?

BIRX: It's a deep concern for me personally because I came out of the Department of Defense and the U.S. military. So I have been with this pandemic from the beginning. Early in the '80s it was very difficult within the U.S. military. There was a lot of stigma, a lot of discrimination and to see that now translated into Africa is deeply heart breaking to me.

BLOCK: But Dr. Birx, in a country like Uganda or Nigeria we're going well beyond stigma, right? I mean, if I'm a gay man in one of those countries I know that I can be persecuted, jailed, beaten, just for being who I am much less seeking treatment for HIV-AIDS or going to a clinic. So what do you do about that?

BIRX: Well, I think importantly within Uganda and within Nigeria are really strong people that I have so much respect for, who have put their own lives at risk to raise this issue every day. And they have been working within the justice systems within both of those countries to bring up both the unconstitutionality of these laws as well as the issues on how these laws were passed. I take every opportunity when I'm meeting with the leadership of Uganda and Nigeria to make it clear that this is not acceptable.

BLOCK: There is so much talk in your community now about reaching an AIDS-free generation but the epidemic is of course ongoing around the world. Is that message, do you think, getting lost because of the success? The good news around HIV-AIDS that we hear about especially in this country these days?

BIRX: Well, I'm glad you raised that because that of course is one of our deepest concerns. If people become complacent, if they lose focus, this could all unravel. We have the example of Uganda - one of the few countries in sub-Saharan Africa where actually the number of new cases is actually increasing - this is deeply concerning to all of us and is really a wake-up call that in order to control this pandemic we need to remain focused and we need to have the leadership to really emphasize the roles of the heads of state, the roles of the first ladies in providing that leadership because you're right. This week while we were gathered here 4,600 children became infected and 36,000 adults of those 7,000 were young women. And during this same week 3,600 children died and 25,000 adults died. So although we can celebrate our success and realize that we have decreased the new infections by nearly half in sub-Saharan Africa since their peak it's still thousands and thousands of individuals who are becoming infected and are dying week after week. And so we are not finished, we cannot declare victory until we're actually done.

BLOCK: Ambassador Deborah Birx is the U.S. global AIDS coordinator. Dr. Birx, thanks so much.

BIRX: Thank you so much.

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