RENEE MONTAGNE, host:
Tomorrow is World AIDS Day, and this year some good news.
Dr. MARK DYBUL (U.S. Global AIDS Coordinator): There's a sense of optimism that wasn't there four World AIDS Days ago. All we did was commemorate people dying. Now we're celebrating all the millions of people who are alive, whose children are not orphaned because of this infection, who are going to be prevented from having this infection. But we're just beginning this.
MONTAGNE: Mark Dybul runs the President's Emergency Plan for AIDS Relief. It's a five year, $15 billion U.S. effort to prevent HIV and bring AIDS medications to developing countries, mostly in Africa.
Earlier this week, the big news from the United Nations was that its numbers of those infected with HIV worldwide are much lower than had been thought. The U.N. says 33 million people have HIV, not the 39 million that those fighting the epidemic have been using as their measure.
Dr. Dybul joined us to discuss the president's plan.
Dr. DYBUL: Most of the revised estimate is actually because we're doing a better job of measuring the epidemic. But buried beneath there is actually some very important data from a number of countries showing significant declines in the amount of people who are infected. And that's correlated with changes in behavior, particularly sexual behavior - reducing partners, delaying when you become sexually active, using condoms more consistently. So we actually are seeing some trends that are very, very promising.
MONTAGNE: Well, how much can the last four years of very intense U.S. aid be credited with the improvement in behavior?
Dr. DYBUL: Well, I think really what we're trying to do is support the countries in their efforts, and the resources and the programmatic support has had a significant impact on what's going on in the countries. But the United States actually had AIDS efforts before the emergency plan. This is just a quantum leap in the resources, and therefore a quantum leap in the change.
MONTAGNE: One criticism that has been leveled at this program - the President's program - came from the Institute of Medicine for how you all have budgeted for prevention; one-third of that money has to go to abstinence or these programs that are called Be Faithful programs.
Dr. DYBUL: Mm-hmm.
MONTAGNE: Is prevention, abstinence - rather Be Faithful programs - are they so key that this program is going to stick with it?
Dr. DYBUL: Well, there's no question they're key. And the Institute of Medicine actually - they actually didn't question whether or not you ought to spend that amount. They just didn't think there ought to be congressional directive for that amount, but rather let the field determine what's appropriate.
But you know, if you look at the data from UNAIDS and you look at the data from a couple of countries with significant reductions and prevalence, like Kenya or Zimbabwe, what we're seeing is what's called the ABCs - Abstain, Be Faithful and Correct and Consistent Condom Use - is occurring and is correlated with these declines in prevalence. And the United States, since the emergency plan began, has supplied 1.8 billion condoms, so it's not as if condoms aren't an important part this. And I think one of the things people miss, though, is beneath these programs, ABC is a nice catch-phrase, but what we're fundamentally doing is changing how people look at themselves, beginning with very young children, five to 10 years old, and teaching them to respect themselves and respect others.
And one of the consequences of that is, for example, young boys don't abuse young girls, and that you delay when you become sexually active and you're more personally responsible in your behavior. So we're definitely seeing these behavior changes that are correlated with prevalence. And I think anyone reasonably would say that makes sense.
MONTAGNE: One concern about the program would be its link to, let's say, other goals of the United States.
Dr. DYBUL: Mm-hmm. Mm-hmm.
MONTAGNE: An example would be Vietnam, with a rather low incidence of HIV infection, added to this program, and the question is, would that have been for diplomatic or political reasons? The U.S. wants to have a stronger connection to Vietnam.
Dr. DYBUL: No. It actually wasn't, but it would be an interesting link for someone to make. The reason Vietnam was selected is because it was on the verge of an explosive epidemic. There were predictions of a million new infections. And so we thought if we could get in early and prevent that, we would actually show a different type of model. Also, we didn't have any programs that had significant intravenous drug use. And we thought looking to the future, we need to be engaged in a country that did, and so we're working with Vietnam to support methadone programs. And so we had a hole, and Vietnam was a good country to fill it.
MONTAGNE: You know, from our discussion right now, it sounds like you're so positive.
Dr. DYBUL: Optimistic?
Ms. MONTAGNE: That's not a bad thing. Or optimistic. What has been the greatest failure?
Dr. DYBUL: You know, if I had hours I couldn't go through all the things we could do better. I think we can do better at everything we're doing, but we're only four years into this, and so it's going to take a long-term effort. To talk about failures, we need to do a better job at expanding prevention. We need to do a better job by getting services throughout the country to rural areas. We're seeing it in some countries, but not all. We need to change policies that allow for better healthcare workers. We need to focus on where the new infections are and tackle those rather than using old techniques. We're still using prevention techniques that were developed 20 years ago. So we have a lot to do.
MONTAGNE: Mark Dybul runs the President's Emergency Plan for AIDS Relief. Thanks very much for joining us.
Dr. DYBUL: Thank you very much.