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U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy Ambassador Deborah Birx
December 1, 2017

Special Briefing

Deborah L. Birx, M.D., U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy Ambassador

Washington, DC
November 30, 2017

MS NAUERT: Hi, everyone. Good afternoon. Hope you’re all having a good day. Many of you may have received a notice from us earlier today about World AIDS Day, and tomorrow is World AIDS Day, so to start with today I’d like to introduce our Ambassador Deborah Birx. Ambassador Birx is going to talk to us a little bit about U.S. global AIDS coordination and also a program called PEPFAR that I know many of you are familiar with. She’s agreed to join me to say a few words about the annual results that were released today and show that the program has received – reached, pardon me – historic highs in HIV prevention and also treatment.

At the United Nations General Assembly in September, Secretary Tillerson was proud to launch PEPFAR’s strategy for accelerating HIV/AIDS epidemic control. It is a landmark strategy set as a bold course for accelerating progress toward epidemic control and reaffirmed the U.S. Government’s leadership and commitment through PEPFAR to support HIV/AIDS efforts in more than 50 countries. PEPFAR has not only saved and improved millions of lives, but it’s also transformed the global HIV/AIDS response.

With that, I’ll turn it over to Ambassador Birx. She’ll take a few of your questions and then I’ll follow up with the remainder of the briefing. I know you have a lot of questions today. Ambassador, thank you.

AMBASSADOR BIRX: Great. Thank you, Heather. It’s great to be here. Good afternoon. Just quickly, just to let you know, we are at an unprecedented moment in the HIV/AIDS pandemic. For the first time in modern history, we have the opportunity to actually control the global pandemic without a vaccine or a cure, and this is a very exciting time for us. The United States remains the key leader of the HIV/AIDS response, and under this administration leadership of President Donald Trump, we are continuing to lead in the response around the globe. Today we announced the President’s Emergency Plan for AIDS Relief, or PEPFAR, historic highs, as just noted by Heather. We’re actually preventing more HIV infections and saving more lives than ever before, and we’re doing this driven by transparency, accountability, and cost-effective investments.

One big reason for our great success in this last 12 months is we’ve really refined our approach and expanded our impact based on using the latest science around the globe that’s available to us and the best available data, including data down to the actual sites of where they’re delivering services to our clients. That results in enormous efficiency and cost-effectiveness across the program. We’re also ensuring that we have the greatest impact with our every dollar that’s entrusted to us from the American public, both the – demonstrating the generosity and the compassion of the American people through their taxpayer dollars.

When PEPFAR began in 2003, less than 50,000 people were on treatment in Sub-Saharan Africa. Entire communities were decimated. Children were living without mothers and fathers, schools went without teachers, hospitals went without nurses and doctors. And today, in these same areas, we have nearly 13 million people on treatment because of PEPFAR.

In addition, we’ve been focused over the last year heavily in prevention, in preventing new infections in men and boys. We’re using new biomedical intervention, voluntary medical male circumcision, that’s reached a historic high of 15 million; 3.4 million circumcisions just done in the last 12 months. And I think the most important announcement we have today, for the first time in the history of HIV/AIDS, we’re announcing a dramatic decline in infections in women, in young women and girls, due to our DREAMS program. It stands for Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe Young Women. We have – we were in – 90 – in 63 districts, but 14 of them had more than a 40 percent decline in the infection rate in young women. Another 27 had declines of 25 to 40 percent in the rate of new infections, and nearly all the districts saw some improvement in the rate of infections in young women and girls. And this is the first time we’ve been able to have that kind of dramatic impact. It’s this public-private partnership. It brings the strength of the private sector with the U.S. taxpayer dollars to have and augment our response, and we’re very excited about that result.

Finally, within orphans and vulnerable children, we’re reaching over 6 million orphans and vulnerable children. We’ve prevented 2.2 million babies from being born with HIV because of care for their mothers and making sure that they receive lifesaving treatment that both saves their lives so that they can be a mother to their children, but also prevents infection in their babies.

So together today we’re excited about these new announcements, but we’re also using this time to commemorate all of the people that we have lost to HIV/AIDS, really renewing our effort to have even a bigger and better and greater response over the next 12 months and have the impact that we believe can end up with controlling this pandemic over the next three years. Thank you.


AMBASSADOR BIRX: I can take questions.

MS NAUERT: Ambassador – certainly. We can – have time to take a few questions and then I’ll get started. I know you’re all a curious bunch. Said, why don’t you go right ahead?

QUESTION: Yes, I have a very quick question: How do you collect and maintain data on the rise or decline of HIV in conflict zones like Libya, Yemen, Syria, Iraq?

AMBASSADOR BIRX: So it’s – we are fortunate that over the last 30 years, the U.S. has supported UNAIDS in developing the data systems in conjunction with countries, so our reporting is supported both for UNAIDS with the U.S. co-investing in those and – both around the globe to ensure that data collections are correct. That’s the advantage that the HIV/AIDS pandemic has had from the beginning, is we have the ability to map in great detail the progress that we’re making, not only in the countries that I’m talking about where PEPFAR has a significant investment – those 50 countries – but throughout the world and the countries you just cited.

MS NAUERT: Okay, anything else? Josh, how are you?

QUESTION: Good. There’s been a major rise in HIV prevalence in Iran that the Iranian Government’s clearly trying to work on. We obviously don’t have diplomatic relations, really, with them, but is there anything that we’re doing through multilateral fora to try to help Iran address their epidemic?

AMBASSADOR BIRX: Yeah. Throughout the world, the U.S., remember, invests in the Global Fund, which is a very important fund that takes – translates our dollars two-for-one to make them more impactful with the rest of the donor community. They work throughout the countries where often there isn’t a direct U.S. presence. It’s important to note that it’s not just Iran with a rising number of new infections; the greatest rise in new infections around the globe is in Russia, due to primarily key populations and the lack of responsiveness to addressing the depth and breadth of the epidemic there.

MS NAUERT: Okay. Conor from ABC.

QUESTION: Thank you for doing this, Ambassador. How do you square your desire to prevent more and new cases of HIV/AIDS with the Trump administration’s push for major cuts of over, I think, $800 million to PEPFAR, $225 million to the Global Fund? In particular, the – one organization released a report this week saying that the proposals would lead to – excuse me – lead to 4 million new – 4 million more deaths and 26 million new HIV infections in Sub-Saharan Africa over the next 15 years. Just a response to that.

AMBASSADOR BIRX: Yeah, I think that’s an important question to put in perspective. So since 2010 – this program reached its highest investment in 2010. Since then we’ve had a decrease investment year over year. And that has been our responsibility to translate the dollars that we have into more and more effective programs. And that’s why I really led with the concept of us increasing maximum efficiency and effectiveness, because we went into this year with a flat budget, yet we dramatically increased results.

And I think you have to measure the administration’s commitment to HIV/AIDS by their political will and willing to address and talk about PEPFAR, as the President did at his inaugural address at the UN General Assembly, and the support that we get both from the State Department and the White House over these World AIDS Day. The President wrote out his proclamation today. That inspires the world that we can do more and be more and be better, and I think that’s – for us that manage programs within the U.S. Government, it’s always important to recognize that this money comes from our parents, ourselves, and our children. And translating that money into the most effective programs that we can that reaches the most lives in the most impactful way, that’s our job, and that’s what we are really excited about being able to talk about today.

QUESTION: So do you dispute any of those numbers, that there will be more deaths because of the cuts that the administration’s proposed?

AMBASSADOR BIRX: I haven’t seen the report yet, but I look forward to reading it. I am very data-driven, so I will be looking very carefully about the analysis, because we constantly are looking at data for how we can be better and do more with the resources we have.

MS NAUERT: Okay. Sir, right there, in the back. Go ahead.

QUESTION: The World AIDS Day is – we all know every year is on December 1st. But today the President has issued and declared that it’s – December 1 as the World AIDS Day. Reading through the whole thing from the White House, there’s no mention about any additional grant or money or anything. How do you see until the next December 1st your funds being – with all the cuts in the State Department budget, and the cuts, overall federal cuts – how do you see this declaration adding any value to —

AMBASSADOR BIRX: First, it demonstrates amazing political will, and not every government and administration’s willing to talk about HIV/AIDS, willing to talk about the people who are affected by HIV/AIDS. This administration is not only willing to talk about it, but willing to actually commemorate the day and ensure that we continue in the next 12 months to march forward in a very productive way to meet our goals. And I think that’s a great question for you to ask me a year from now, because we believe that we’re going to continue to accelerate our program, as we did in the last 12 months, despite a very flat or decreasing budget.

MS NAUERT: And sir, from Al Jazeera – I’m sorry, I don’t know your name.

QUESTION: Thank you. Abderrahim Foukara from Al Jazeera. Can you talk a little bit about the challenges that you face in dealing with HIV/AIDS in a time of great migration movements such as what we’re seeing from Africa and the Middle East into Europe? That’s number one. Number two: Can you talk a little bit about – in terms of your progress, about the overlap between what you do to achieve that progress, or have done, and what governments in the regions concerned have done?

AMBASSADOR BIRX: Great. Thank you for that question, because if I didn’t make it feel like this is a partnership between communities, host government, and our multilateral colleagues and bilateral donors, I was mistaken. So let me really emphasize that our progress today is only possible – and you can see where we make the most progress in each country. It is when the governments have the political will to have the policies and the comprehensive approach that we know are critical for both preventing new infections and treating those who are HIV-positive.

As you know, if you’ve followed this pandemic, there have been decades of stigma and discrimination against individuals who are HIV-positive or at risk for HIV. And I think what PEPFAR has done, what the Global Fund is doing, and what host countries that are successful are doing is supporting everybody that could potentially become infected to make sure that they have prevention access to services but also to ensure that people that are at risk and could be positive have access to the health centers without discrimination and without stigma.

And I think you’ll see in the countries where – we put everything up online, so if you go to pepfar.gov you’ll see all of our data down to the district level, so you can see the impact that we’re having. And we track dollars very down to the client to ensure just what you talked about. What clients aren’t we reaching? What age groups aren’t we reaching? Who have we left behind? And I think that evolves as the epidemic evolves, and that’s why we’ve been very much focused on the data and understanding how the epidemic is moving.

And I tell you our biggest gap right now, since you’re a lovely man, is men. Men don’t interact with the healthcare delivery system in almost every place where we work and don’t believe they’re at risk for HIV/AIDS. So we are really putting on a push with host country governments to really raise the alert so that men know that they are at risk and men will come to the health center. The health centers often are for women and children, and they don’t see themselves there. But I think if we’re successful over the next 12 months, men will see themselves in a wellness campaign to really understand and get tested for HIV/AIDS.

So thank you for raising the question.

QUESTION: And again, on migration?

AMBASSADOR BIRX: Migration, yes. So in areas of conflict where we’ve had strong programs like in South Sudan, as South Sudanese have moved into northern Uganda we have supported programs. Our dollars move with the risk of the individuals that have moved, so we’re very careful to follow those migratory patterns. Certainly, the European groups and the groups that we work with in Europe also have a very strong HIV/AIDS response. But whether it’s South Sudan or Burundi and the issues in the borders, we both supply services in the country itself and in the areas of transition.

MS NAUERT: Ambassador, thank you so much. She has to go. She’s hosting an event over in —

AMBASSADOR BIRX: So we hope you come there too at 3:45 to see our event and the kiosk. You can explain that.

MS NAUERT: They have an interactive program which you can see, and it sort of overlays some of the areas where the programs have been particularly successful. So if anyone has any follow-up questions for the ambassador, I’d be happy to get those to her and put you in touch.