"The American people need to know that everybody in this country and, indeed, throughout the world, is now vulnerable to this disease."
President Clinton, December 5, 1996
The White House Conference on
HIV and AIDS
AIDS is a global epidemic. The World Health Organization (WHO) estimates that 94 percent of new infections occur in developing countries. In the United States it is estimated that between 650,000 and 900,000 people are currently infected with HIV. The WHO and UNAIDS estimate that 27.9 million adults and over 1.6 million children are currently infected worldwide and there will be 10 to 15 million orphans worldwide attributable to HIV by the year 2000. Two to three million new HIV infections are expected annually, so by the year 2000, 30 to 40 million people are likely to have been infected around the globe.
The epidemic jeopardizes decades of economic and social advances in many developing nations. In some of the nations of Africa and Asia, economic advances are threatened, and in some cases, may be reversed due to HIV and AIDS. Socio-economic studies have shown a decrease in overall domestic savings and investment levels, negative effects on foreign investments, reductions in the volumes of imports and exports, and a reduction in receipts from tourism. In many countries governments will be forced to cope with increasing numbers of cases, weakened health care systems, a deleterious economic impact on the most productive segments of society, and the reduction in the number of healthy men and women able to serve in the government and the military.
Since it began, HIV and AIDS has been a global concern. The U.S. has worked closely with developed and developing nations to design an international response that is both vigorous and coordinated. Sentinel achievements include:
The United States is the largest contributor to international efforts to combat the pandemic of HIV and AIDS. Several Federal Agencies are working to slow the AIDS epidemic internationally. (See Appendix E.) The Department of State works with other agencies and non-governmental organizations within a framework to guide U.S. foreign policy in the global efforts against HIV and AIDS. The major areas of U.S. leadership in the global HIV arena are: mobilizing and unifying national and international efforts; preventing new infections; biomedical research; and, reducing the personal and social impact of the epidemic.
The U.S. Agency for International Development (USAID) plays a leadership role in the global HIV response through development assistance, research, and policy formulation. USAID focuses its efforts on developing prevention programs based on proven interventions. The agency addresses social, cultural, regulatory, and economic issues related to HIV/AIDS and other sexually transmitted infections and develops and tests new interventions and methods to prevent transmission and mitigate the impact of the epidemic. The Peace Corps trains a portion of its volunteers to directly address HIV-related concerns in their countries of placement. The U.S. Information Agency (USIA) supports programs that promote dissemination of U.S. policies and information related to HIV and AIDS.
In addition, several Agencies support research overseas, including the National Institutes of Health, the Centers for Disease Control and Prevention, and the Department of Defense. The DOD is conducting clinical trials of candidate HIV vaccines in Thailand and NIH, (working in collaboration with USAID), supports a range of scientific studies in developing countries. The results of the studies ultimately will be used to develop interventions to reduce behaviors that place individuals at risk for contracting HIV infection.
To accomplish the goal of providing strong continuing support for international efforts to address the HIV epidemic, the following steps will be taken:
The United States has established a global leadership role in combatting the epidemic. This leadership will continue. The U.S. strongly supports the newly established Joint United Nations Programme on HIV/AIDS (UNAIDS). The U.S. is a member of the governing body of UNAIDS, signed the 1994 Paris Declaration, and also supports the Greater Involvement of People Living with HIV and AIDS Initiative (GIPA).
The U.S. also supports efforts to access available resources more effectively as well as encourage non-traditional donor countries to provide much-needed contributions. Supporting UNAIDS member organizations such as UNICEF, WHO, UNDP (United Nations Development Program), the U.S.-Japan Common Agenda and its innovative programmatic efforts, and UNAIDS' goal of working to increase the availability of therapeutics (and vaccines when developed) to the residents of developing countries is not only morally correct, but also furthers U.S. interests by promoting economic and social stability worldwide.
In addition to maintaining multilateral partnerships, the U.S. must continue to place high priority on its bilateral programs for HIV activities in developing countries where more than 90 percent of the world's AIDS cases are found.
It is essential that the U.S. continue to involve networks of domestic and indigenous non-governmental organizations (NGOs) and persons living with HIV and AIDS in decisions affecting them and their work at the country level. It is only through this kind of public-private partnership that we will make the most progress in combatting the global epidemic.
Technology and Bringing Lessons Home
Utilizing the expertise of both domestic and international AIDS groups is an important element of global AIDS efforts. Domestic groups have shared valuable insights and experiences with organizations abroad. Similarly, through USAID's "Lessons Without Borders Project," the U.S. has gained valuable insights from experiences in participating countries and is applying them to communities here at home. The initiative brings lessons learned abroad back to inner-city and rural areas with problems similar to those experienced overseas. These efforts will be continued and expanded for HIV and AIDS.
One of the most challenging aspects of the U.S. effort is effective coordination among a host of agencies with varied missions and activities. In order to ensure that efforts are productive, the U.S. agencies supporting international activities must develop a mechanism for coordinating programs in a systematic and efficient manner.
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