Gauging U.S. Efforts to Fight AIDS in Africa

In 2003, the White House pledged $15 billion over five years to combat AIDS in Africa. How has that money been spent, and has it made a difference? Dr. Mark Dybul, deputy U.S. Global AIDS coordinator and chief medical officer for the program, talks about the program.

Copyright © 2006 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

TONY COX, host:

From NPR News, this is NEWS AND NOTES. I'm Tony Cox in for Ed Gordon.

The U.S. State Department says there is good news about President Bush's $15 billion global AIDS plan, particularly when it comes to Africa. Highlights from a report were submitted to Congress earlier this month. It says that since the program began in the year 2003, there are more than five times as many people in Sub-Saharan Africa receiving HIV drugs.

The Bush plan continues to draw heat though, mostly for its so called ABC strategy. Dr. Mark Dybul has been countering some of the criticism. He serves as deputy U.S. global AIDS coordinator and chief medical officer for the program. He joins us now by a phone from the nation's Capitol. Dr. Dybul, nice to have you own.

Dr. MARK DYBUL (Deputy U.S. Global AIDS and Chief Medical Officer): Thank you for having us today.

COX: We're told that the Bush administration's plan has spent $5.2 billion so far. Put it in perspective for us, please.

Dr. DYBUL: Well, the perspective is when President Bush first announced his emergency plan for AIDS relief, only about 50,000 people in all of Sub-Saharan Africa were receiving anti-retroviral therapy and not in a very systematic way. President Bush's emergency plan was and is the largest international health initiative in history dedicated to a single disease.

We know how to fight this disease. We fight it in this country. And where you live shouldn't determine whether you live or die from HIV/AIDS. And so it's really been a transformation particularly around the continent of Africa, and the subcontinent and Sub-Saharan Africa in the response to AIDS bringing hope. And you can see when you go from month to month the transformation, the hope that's been reborn, hospices now turning into places where people come and celebrate their life, rather than coming to die.

But it's not us, the United States, it's the United States supporting the people of Africa and their efforts to fight HIV/AIDS, and that's an extraordinary piece of the emergency plan.

COX: Would you say that the rate of progress with regard to the United States' involvement in helping to eradicate this disease is it going along as fast and comprehensively as can reasonably be expected?

Dr. DYBUL: Absolutely. It's been an extraordinary, extraordinary pace. And to be honest, at the beginning, there are very few people who thought this pace could be maintained. And the reason for it is because the president and the American people stood up and said we're going to intervene now. We have not in the past, even though we knew about this problem. Now, is the time for action.

COX: Now, that having been said, you are, of course, aware that there is some criticism of the program, California Representative Barbara Lee being one of those. She co-sponsored legislation that launched the program. And she says that the report shows that while there are some advances, the rate of progress, in her view, is inadequate to meet either the needs for treatment and prevention or the commitment that was initially set out.

What about that? Is there in validity to that criticism?

Dr. DYBUL: Oh, there's no doubt there's still a great need. The issue is how much can you do and at what pace. Unfortunately, the conditions in the sub-continent of Africa are not at a point where you can just say, okay, we're going to take care of this problem and take care of it. Things we take for granted here in the United States in terms of the health system, just simple things like electricity, waste disposal, communication systems, supply chain management system, sufficient numbers of doctors, nurses, health aids, pharmacists, technicians, these are not in place.

Mozambique has 500 doctors for a population of 19 million people. There's a limitation in terms of what you can do in capacity to move rapidly. And, in fact, given those capacity limitations, it's extraordinary what has been achieved in such a short period of time, and that's because of the dedication, commitment and effort of the Africans themselves and their response to AIDS.

What the American people have done is said, we're going to stand by your side. And that's been catalytic, it's encouraged people, and it's led to hope. But the pace is as fast as it could possibly be.

COX: One of the other issues seems to be, sir, the concern over the approach. Which approach is most effective? In the introduction, I made reference to the ABC strategy. Let's define that for the audience and talk about how effective and perhaps controversial it is.

Dr. DYBUL: Well, ABC stands for an approach to prevention, which is abstain, be faithful to an HIV uninfected partner, and correct and consistent condom use; and you need all three components. And here it's a good thing we are concentrating on Africa, because the data, the evidence from Africa are crystal clear. There are only three countries in Africa, Sub-Saharan African, that have had demonstrated reductions in prevalence or the percent of people in the population who have HIV, Kenya, Zimbabwe, and Uganda. The data from each of those countries are almost identical and crystal clear.

The reason for the reduction in prevalence is ABC and all three components. Young men and young women are delaying that time in which they engage in sexual activity. They're reducing the number of their partners. People who were sexually active are becoming abstinent. And there's a slight but important increase in correct and consistent use of condoms. You need all three components.

COX: You made reference to Zimbabwe. As I understand it, that is not one of the 15 so called focus countries that are the main beneficiaries of the president's AIDS relief plan. If that's true, how does that factor into what you have just described.

Dr. DYBUL: You know, we wouldn't take credit for what's happened in Kenya or Uganda either. These were the Ugandans and Kenyans, and this process began before the president announced his emergency plan. It's because of the efforts to instill the behavior change ABC. I would point out, I was just in Zimbabwe, and in fact, the United States is contributing significantly to their struggle with over $20 million a year, not at level of the focus countries where, for example, in South Africa, we're at $220 million a year, but pretty significant amount nonetheless.

But again, Ed, we're not taking credit for the change. All I'm saying is that the data is crystal clear that it's ABC together in what's called a generalized epidemic that will be effective.

COX: Dr. Mark Dybul, chief medical officer and the office of the U.S. global AIDS coordinator. Dr. Dybul, thank you very much for joining us.

Dr. DYBUL: Thank you.

Copyright © 2006 NPR. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to NPR. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.

Comments

 

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.