Remarks by Ambassador Samantha Power, U.S. Permanent Representative to the United Nations, at the Global Fund Replenishment Conference, December 3, 2013
USUN Press Release #250
It’s the story of neighbors working together to ensure mothers and young children have access to mosquito nets and TB diagnostics in even the most remote communities and among marginalized populations. It’s the story about partnerships between the public and private sectors. And it’s the story about health being embraced as a human right.
It was fifteen years ago this fall that we lost a great man, Jonathan Mann, who more than just about anybody else institutionalized the link between HIV/AIDS and human rights. I knew Dr. Mann only by his towering reputation on the college campus we shared. Most of you know his journey. He was pulled from his AIDS work in Kinshasa in the mid-1980s to run the World Health Organization’s nascent and exceedingly modest AIDS program. In a testament to the state of the field at that time, Dr. Mann worked out of a small cubicle, with a single secretary. In his time on the job, he transformed WHO’s Global Program on AIDS into the largest program in the history of WHO. One colleague said that he had “as profound an effect on the global HIV community as any AIDS drug.”
In 1988, Dr. Mann said at the World AIDS Summit in London, “We live in a world threatened by unlimited destructive force, yet we share a vision of creative potential.”
“A world threatened by unlimited destructive force, yet we share a vision of creative potential.” It is this creative potential–that creative potential—creative potential embodied in the trail-blazing Global Fund—that today has the chance to vanquish one of the most destructive forces that the world has ever known.
Let’s remember from where we’ve come. When Dr. Mann died in 1998, thirty million people were living with HIV/AIDS and most were dying from it. The life expectancy in whole countries was being driven down by a decade or more. People were unwilling even to say the word, “AIDS,” families disowned their children, people died painfully and all alone, all over the world. The heart was carved out of communities as the old and the young had to care for those at the prime of their lives. In many places, the response from opinion leaders was still to deny what caused the disease and to stigmatize the sick, leading to more denial and more death. Worldwide, we were devoting less than $2 billion a year to the fight against AIDS.
Not until 2001 did the international community truly move beyond helping victims to die with dignity, to begin enabling people to live. In that year, UN Secretary General Kofi Annan called for a global fund, a “war chest,” to combat the disease. By 2003, the Global Fund to Fight AIDS, TB and Malaria had begun its work. At the same time, President George W. Bush proposed the creation of PEPFAR. Over the past decade, the United States has invested $48 billion in the battle against the three diseases, including $8.5 billion invested in the Global Fund. These amounts reflect a commitment that transcends partisan politics in this country and that stretches across all sectors of American society.
In 2011, as you know, President Obama announced plans to increase by fifty percent the number of men, women and children receiving treatment through PEPFAR. Yesterday, we learned from him that we have gone well beyond the target–actually increasing the quantity of recipients by two-thirds–from 4 to 6.7 million.
According to the US Center for Disease Control, every time a 1,000 patients are treated for a year, miraculous things happen: 87 people who would have been infected are able to remain AIDS-free; 228 people who would have died, instead, live; and 449 children who would have become orphans do not. I ask you: in the history of finance, has any stock offered an investment with richer returns?
So we must continue to invest. The United States, as you now know, will add to its record contributions to the Global Fund by providing one dollar for every two dollars pledged by other donors over the next three years. And we are going to work tirelessly with you to leverage our money.
Jonathan Mann, Minister Mboi, Connie Mudenda, and many others have dedicated their lives to fighting HIV/AIDS—most of you. Guided by your example, the Global Fund embodies four principles that have brought us this far, and that we have to carry forward.
The first and most obvious–since this is rightly a fund on AIDS, TB, and malaria — is that we need a comprehensive approach. TB is the leading killer of people with AIDS and 80% of deaths from malaria occur in just 14 countries, all of which are among the most vulnerable to HIV. Research shows that malaria infections are more frequent and more severe with HIV-positive women. Accordingly, it is smarter, more efficient, and far more effective to treat the three diseases under one roof whenever possible. The Global Fund has made that an axiom—but remember, life before the Global Fund, before that was how everybody understood business needed to be conducted.
Second, as our event this morning reflects, the responsibility to tackle this “destructive force” is so enormous that it must be shared. Progress requires governments–all governments–to step up. It also necessitates the involvement of local leaders, civil society, philanthropists such as the Gates Foundation, churches, pharmaceutical companies and even the occasional rock star. It requires businesses to take responsibility—businesses like those who put their workers on free ARVs; businesses who donate to the Product Red campaign or the new Born Free movement; or businesses who are simplifying treatment to prevent more infections and treat more people.
Progress depends on responsible decisions being made by individuals who are living with — or who are at risk of contracting — AIDS, TB, or Malaria. And it depends on our investment in the concept of local ownership–so that partner countries are able to lead, manage, coordinate and finance the lion’s share of health initiatives within their borders.
Today, we are seeing so many countries stepping up in this fight, showing political leadership and committing their own resources. In South Africa, whose former president questioned the very nature of the disease, AIDS policy has been transformed, thanks to one of the most active civil societies in the history of the world. Authorities there have committed to treating HIV positive mothers and are rapidly scaling up access to HIV treatment, with a 20% increase in the number of people receiving therapy from 2011 to 2012 alone. Governments in Rwanda, Namibia, Botswana, Zambia, and Tanzania are putting domestic resources to work in reducing rates of new HIV infections.
These investments have been met with robust international commitments from the Global Fund and PEPFAR, showing what is possible when local leadership and international action come together. And yesterday at the White House, Nigerian Finance Minister Ngozi Okonjo-Iweala pledged a substantial increase in Nigeria’s own resources to the fight against HIV/AIDS. Indeed, at a time when people are losing faith in the ability of governments to tackle the world’s most pressing challenges, African countries alongside the Global Fund and PEPFAR are demonstrating how it’s done in the 21st century—national authorities in the lead; bilateral and multilateral donors, philanthropists, and corporations working in partnership behind the scenes; activists, scientists, and policymakers collaborating to find the most effective strategies; and a commitment across the board to ensuring that new resources deliver measurable results. This is a new model of cooperation–one with lessons not only for fighting disease, but also for delivering quality education, curbing climate change, promoting honest government, and eradicating extreme poverty.
Third, we must keep our eye on the centrality of human rights. Here, I come back to Dr. Mann and his pioneering work showing human rights abuse fuels the spread of the disease, and showing that those infected saw their rights–and their basic dignity—frequently trampled. Dr. Mann treated the Universal Declaration of Human Rights as most doctors treat the Hippocratic Oath, emphasizing the social exclusion that came with AIDS and developing an entire new discipline to combat it. But it took many around the world a long time to heed this call. In the United States, in my own government, in the very same State Department that has worked to strengthen the global response to HIV/AIDS, HIV positive applicants to the Foreign Service were not admitted until 2008.
It should be clear everywhere that reversing policies, assumptions, and rules that promote stigma is not optional. If we are to beat the disease, ending these practices is imperative. We must broadcast relentlessly the message that there is no sin in being sick, no justification for bigotry, and no license to marginalize anyone based on their HIV status, gender, or sexual orientation. We must eliminate the disadvantages faced by adolescent girls, many of whom are forced into high-risk sexual activity at a very young age.
We must reduce further the number of mother-to-child HIV transmissions. We must continue our efforts to reach, and work together with, key populations such as men who have sex with men, injecting drug users, and sex workers. And we must recognize the economic dimensions of this disease–that the vast majority of people afflicted by AIDS, malaria and TB are poor, that the majority of the poor are women and children, and that no one–no one–should die from preventable disease because he or she cannot afford the price of life.
In these efforts, we are ably led by two remarkable individuals with us today, Michael Sidibé and Mark Dybul, who have taken up Jonathan Mann’s mantle of human rights and global health, championing with rigor and compassion the right of every individual to treatment, care, and dignity.
Fourth, and finally, we must remember what so many of you reminded us even as the disease was exploding around us—we can beat this. Wily as these mosquitoes and viruses are, we are wilier. Since 2000, the mortality rate for all three diseases has dropped by 25% or more.
The rate of new HIV infections is also going down–so far by 1/3 globally and by nearly 40% in Sub-Saharan Africa. More than a dozen countries have reached the tipping point where the number of people receiving treatment is rising faster than the number of new infections. Last year, PEPFAR calculated that its treatments had so far prevented HIV from blighting the birth of more than one million babies. One million babies who would have been born with HIV are instead HIV-free. That is truly a cause for pride.
We have finally reached the time when we can envisage that future that many of you dreamed about long ago where AIDS, TB and malaria no longer claim millions of lives each year. But we, of course, have not climbed that mountain yet. And as we continue our ascent, we must guard against the risk of growing complacent or of sliding backwards.
We must keep our eye on what’s true: good things happen when multilateral organizations and national governments work together with scientists, philanthropists and civil society. Good things happen when we share responsibility and good things happen when never give up. Above all, good things happen when we value every human life and honor the rights and dignity of every human being.
Let us, then, resume our upward climb and not stop until we reach that final destination.
Thank you so much.