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Halting the Spread of Hiv/Aids: Future Efforts in the U.S

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Halting the Spread of Hiv/Aids: Future Efforts in the U.S S. HRG. 107–330 HALTING THE SPREAD OF HIV/AIDS: FUTURE EFFORTS IN THE U.S. BILATERAL AND MULTI- LATERAL RESPONSE HEARINGS BEFORE THE COMMITTEE ON FOREIGN RELATIONS UNITED STATES SENATE ONE HUNDRED SEVENTH CONGRESS SECOND SESSION FEBRUARY 13 AND 14, 2002 Printed for the use of the Committee on Foreign Relations ( Available via the World Wide Web: http://www.access.gpo.gov/congress/senate U.S. GOVERNMENT PRINTING OFFICE 77–846 PDF WASHINGTON : 2002 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001 VerDate 11-MAY-2000 09:04 May 09, 2002 Jkt 000000 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 77846.001 SFRELA2 PsN: SFRELA2 COMMITTEE ON FOREIGN RELATIONS JOSEPH R. BIDEN, JR., Delaware, Chairman PAUL S. SARBANES, Maryland JESSE HELMS, North Carolina CHRISTOPHER J. DODD, Connecticut RICHARD G. LUGAR, Indiana JOHN F. KERRY, Massachusetts CHUCK HAGEL, Nebraska RUSSELL D. FEINGOLD, Wisconsin GORDON H. SMITH, Oregon PAUL D. WELLSTONE, Minnesota BILL FRIST, Tennessee BARBARA BOXER, California LINCOLN D. CHAFEE, Rhode Island ROBERT G. TORRICELLI, New Jersey GEORGE ALLEN, Virginia BILL NELSON, Florida SAM BROWNBACK, Kansas JOHN D. ROCKEFELLER IV, West Virginia MICHAEL B. ENZI, Wyoming EDWIN K. HALL, Staff Director PATRICIA A. MCNERNEY, Republican Staff Director (II) VerDate 11-MAY-2000 09:04 May 09, 2002 Jkt 000000 PO 00000 Frm 00002 Fmt 5904 Sfmt 5904 77846.001 SFRELA2 PsN: SFRELA2 CONTENTS HALTING THE SPREAD OF HIV/AIDS: FUTURE EFFORTS IN THE U.S. BILATERAL AND MULTILATERAL RESPONSE FEBRUARY 13, 2002 Page Dobriansky, Hon. Paula, Under Secretary for Global Affairs, Department of State, Washington, DC .................................................................................... 29 Responses to Additional Questions Submitted for the Record by the Committee to Under Secretary of State Paula Dobriansky ...................... 48 Lyman, Hon. Princeton, working group co-chair, Center for Strategic and International Studies Task Force on HIV/AIDS; executive director, Global Interdependence Initiative, Aspen Institute, Washington, DC ........................ 78 Prepared statement ...................................................................................... 82 Natsios, Hon. Andrew, Administrator, U.S. Agency for International Develop- ment, Washington, DC ......................................................................................... 20 Prepared statement ...................................................................................... 24 Okaalet, Peter, M.D., Africa director, Medical Assistance Program Inter- national, Nairobi, Kenya ..................................................................................... 98 Prepared statement ...................................................................................... 102 Piot, Dr. Peter, executive director, UNAIDS, Geneva, Switzerland .................... 53 Prepared statement ...................................................................................... 56 Ray, Dr. Sunanda, director, Southern Africa AIDS Information Dissemination Service, Harare, Zimbabwe ................................................................................. 88 Prepared statement ...................................................................................... 92 Thompson, Hon. Tommy G., Secretary, Department of Health and Human Services, Washington, DC; Accompanied by Claude Allen, Deputy Sec- retary ..................................................................................................................... 11 Prepared statement ...................................................................................... 14 RESPONDING TO AFRICA’S HIV/AIDS CRISIS: ROLES OF PREVENTION AND TREATMENT FEBRUARY 14, 2002 Kim, Dr. Jim Yong, director, Program in Infectious Disease and Social Change, Harvard Medical School, Boston, MA .................................................. 158 Prepared statement ...................................................................................... 161 McCray, Dr. Eugene, director, Global AIDS Program, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA ........................................................................................................... 119 Prepared statement ...................................................................................... 123 Peterson, Dr. E. Anne, Assistant Administrator, Bureau of Global Health, U.S. Agency for International Development [USAID], Washington, DC ......... 130 Prepared statement ...................................................................................... 134 Sachs, Dr. Jeffrey, director, Center for International Development, Harvard University, Cambridge, MA ................................................................................. 146 Prepared statement ...................................................................................... 149 Vorster, Martin J., Mahyeno Tributary Mamelodi, Pretoria, South Africa ........ 174 Prepared statement ...................................................................................... 177 (III) VerDate 11-MAY-2000 09:04 May 09, 2002 Jkt 000000 PO 00000 Frm 00003 Fmt 5904 Sfmt 5904 77846.001 SFRELA2 PsN: SFRELA2 VerDate 11-MAY-2000 09:04 May 09, 2002 Jkt 000000 PO 00000 Frm 00004 Fmt 5904 Sfmt 5904 77846.001 SFRELA2 PsN: SFRELA2 HALTING THE SPREAD OF HIV/AIDS: FUTURE EFFORTS IN THE U.S. BILATERAL AND MUL- TILATERAL RESPONSE Wednesday, February 13, 2002 UNITED STATES SENATE, COMMITTEE ON FOREIGN RELATIONS, Washington, DC. The committee met at 11:12 a.m., in room SD–419, Dirksen Sen- ate Office Building, Hon. Joseph R. Biden, Jr. (chairman of the committee), presiding. Present: Senators Biden, Feingold, Smith, and Frist. The CHAIRMAN. The hearing will come to order. Mr. Secretary, who is not here, Madam Secretary, Mr. Natsios, thank you for coming this morning to speak to the committee about what has become one of the most, if not the most, pressing global health concerns of our time, and that is the spread of HIV/AIDS. As you know, this is the first in a series of hearings that this committee will hold on HIV/AIDS. Senator Feingold will chair a hearing on HIV/AIDS in Africa tomorrow afternoon, and others on this committee will chair hearings on the same issue after the re- cess as it relates to the problem in other parts of the world. I do not have to tell any one of you how devastating this epi- demic is. The disease has killed more people than the bubonic plague of the Middle Ages. And it is spreading. Five million people were infected with HIV/AIDS in the past year alone. It has ravaged the continent of Africa and is spreading like wildfire. There are countries in the region that have infection rates of over 30 percent. Africa is not alone. The number of people affected in India could soon be greater than that of any African country. China has recently acknowledged its problem, and the countries of the Caribbean have infection rates second only to those in Africa. And lest we in the north begin to think that we are insulated from this problem, all we have to do is look at the increase in the infection rate in Russia—up 1,300 percent in the last 5 years—to know that nowhere on the planet are we invulnerable to this dis- ease. Ladies and gentlemen, we are facing a disaster of epidemic pro- portions in my view. This disease could wipe out a generation. It has already created millions of orphans in Africa. Who is going to care for those children when the parents and relatives are dead? Who will educate them when their teachers are dying of AIDS fast- er than universities can train them? Where will they go for medical (1) VerDate 11-MAY-2000 09:04 May 09, 2002 Jkt 000000 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 77846.001 SFRELA2 PsN: SFRELA2 2 attention in countries where the health care system is under- funded, overburdened, and understaffed due to HIV/AIDS? I do not think that the security, social, and economic implications of the spread of AIDS have been fully appreciated by most. I sub- mit that we must begin taking them much more seriously. The con- sequences of this disease running unchecked throughout the world are everything from 3 decades of development gains lost to ramp- ant instability and state failure in parts of the world. The potential for political instability due to the deaths of political and military leaders is a cause for concern in newly emerging democracies, ac- cording to reports. Gross domestic products are set to decline any- where from 8 to 20 percent depending on how many years out one calculates the loss. This cannot be allowed to happen. We must attack this disease on all fronts, using every technique feasible from prevention to care to treatment—or we will fail. It is imperative that the United States engage in a considered co- ordinated strategy in its bilateral assistance programs. We cannot afford to waste a single dollar with duplicative, overlapping efforts among various U.S. Government agencies. The problem is big enough for more than one of our agencies to constructively con- tribute something, but it is far too big for every agency to focus its efforts on doing the same thing. One important tool to contain the spread of infectious disease and to spot biological terrorism efforts is effective disease surveil- lance. Senator Helms and I plan to introduce
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