Deputy Secretary of State
U.S. Global AIDS Coordinator & U.S. Special Representative for Global Health Diplomacy
MODERATOR: Alright, I think that’ll do it. So thank you all for coming out today to the Zola Community Healthcare Center in Soweto. It is our honor to be here to welcome our U.S. Deputy Secretary of State, John J. Sullivan, and our U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy, Deborah L. Birx. We’re happy to have them here to talk about HIV/AIDS response and the U.S. President’s Emergency Plan for AIDS Relief. So with that, I will turn it over to Ambassador Birx for some opening comments.
AMBASSADOR BIRX: Great. Such a pleasure to be here this morning, now afternoon, in the brilliant South African sun and here in Soweto. I think you know the United States has been a partner in the HIV response in South Africa for the last 16 years, investing over $6 billion in this response, in South Africa, to really generate a different outcome and future for all South Africans.
We know what needs to be done. We have every piece of evidence that we need to combat this epidemic. The issue is, are we implementing to serve the public in the best way possible? The young women behind me represent one of those prevention programs, to ensure that every young woman has the information that she needs to be successful in her life, and so that she is aware and understands how HIV is transmitted and she can protect herself. It’s about empowering young women, protecting them, also ensuring young men are protected through our voluntary male circumcision program, and then of course our treatment programs, and that is fundamentally with the government, but with the community, serving others and translating the U.S. taxpayer dollars to a different outcome and impact for the future of South Africa.
So I thank you, and it’s my pleasure to introduce my boss, the Deputy Secretary from the U.S. State Department, who is here visiting. He wasn’t specifically here for this, but now is here for all of us and is visiting southern Africa and it’s really such a pleasure, because he has been supportive of the PEPFAR program from the minute he came to the State Department and has met the DREAMS Ambassadors 18 months ago, at World AIDS Day. A woman from KwaZulu-Natal came to visit us, and the Deputy Secretary was there for World AIDS Day, so it was a really important moment for us. Thank you, Deputy Secretary, for supporting us and making sure that PEPFAR is successful.
DEPUTY SECRETARY SULLIVAN: Well, thank you, Ambassador Birx. It’s a great honor and privilege for me to be here in Soweto and at this magnificent Zola clinic. We’ve gotten a tour of the facility, much of which is supported financially by PEPFAR, and of course we’ve met these young ladies behind us, who are part of the DREAMS program. As the Ambassador said, we had an event in Washington some time ago—almost a year and a half ago—where I met some of the young women from this area, and it’s a great example of the positive effect of U.S. investment in South Africa.
I was serving in government, as was Ambassador Birx, when President George W. Bush established the PEPFAR program in 2004. We’ve invested $6 billion here in South Africa in young people like the young women behind us, and it’s a magnificent use of U.S. taxpayer funds, working with the local community and with the provincial and national governments on such a noble end, on treating and preventing HIV/AIDS, but also educating young women and young men and producing the great ambassadors that you see behind us. So again, on this beautiful day it’s great to be here and I’m very grateful for that.
MODERATOR: Thank you, Deputy Secretary Sullivan, Ambassador Birx. Thank you very much. We’re pleased to have our colleagues from Jozi FM here, broadcasting live. They’ve been here all day and they’re here now. I think they had a couple of questions to start off with.
QUESTION: I’m here!
MODERATOR: Alright, please go ahead.
QUESTION: Good afternoon, everyone. How are you? Sanibonani, dumelang. Good afternoon. Alright, my question here is—oh, my name is Prince Tshabalala from Jozi FM—what is PEPFAR and your role in reducing HIV and AIDS in our communities? I’ve got more questions, just one more. I’ve got another one that says, “Why did you choose Soweto?” And maybe you can give me an answer to that one. And, “In what ways are you guys involved in supporting all the community projects that are around?”
DEPUTY SECRETARY SULLIVAN: Sure. Well, I will take a stab at an answer and then turn it over to Ambassador Birx. PEPFAR is a program that was established by the U.S. president, President Bush, back in 2004, to address the epidemic of HIV/AIDS, with a particular focus on Africa. Over the 15 years since that program was established, the United States has invested billions in PEPFAR, has changed the lives—saved the lives—of millions of people as a result. We’ve invested here in South Africa $6 billion, and the reason I’m here in Soweto today is to come to this Zola clinic to see the program firsthand, on the ground, in the heart of South Africa, in Soweto. To meet the young people who are benefitting from it and to learn from them about the positive impact that the PEPFAR program has had. Ambassador?
AMBASSADOR BIRX: Great. So I think let’s go back to the beginning and how severe the epidemic was in South Africa, and continues to be in South Africa. And that’s why we are still here in partnership with your community and with the government. South Africa is approaching eight million people infected with HIV. Eight million people. We’re beginning to see a complacency. At a time when one in 15 adults may already be positive, one in 10 in many communities, one in five in many communities, around Durban, around Johannesburg, we believe that there’s not enough awareness about how significant this issue was.
When President Bush announced this program, he announced the program because he believed that the very fabric and communities of sub-Saharan Africa were at risk, because we were losing 20-30% of all the adults on the continent. We thought this was a critical emergency for the world, and that’s why the U.S. government has now invested $75 billion over the last 16 years, just in sub-Saharan Africa, where the problem is. But with South Africa and Mozambique, its neighbor: 10 million people that are HIV-positive. This is a crisis; we need to treat it as a crisis, we need to treat it as an emergency. We need to make sure every young woman knows that it’s an emergency and has the skills and the ability to thrive without HIV, and we want to make sure that every single person, including every male that is out there on your radio station understands that he is at risk.
Most of them will not have symptoms; by the time you have symptoms, by the time you have TB, we can’t restore you to full health. If we can find you early—this is why many of these young women have already been tested, because they know that if they’re found early and put on treatment early, they can live to be as old as their grannies and their grandpas and be in their eighties. But if you don’t find it soon, you not only transmit the virus but it threatens your own health. The problem with HIV isit’s asymptomatic. You don’t know you have it; you can’t tell who has it. The only way to tell is to come into a clinic like this clinic and get tested. And people are ready to receive you and move you to the right prevention information or the right treatment information.
South Africans need to rise up and get tested. Everyone out there in your listening area knows that they’re at risk. If they’re having sex, and unprotected sex, they’re at risk and they need to be tested, because we have a solution. 20 years ago we didn’t have a solution; we have a solution. And that’s why we’re here. We’re here to raise awareness that South Africa, at the community level and at the government level, need to understand the crisis that HIV and TB is.
QUESTION: Thank you very much.
MODERATOR: Okay. Thank you both very much. We also have Katharine Child from the Sunday Times, who had a question for you.
QUESTION: Thanks. Welcome, ambassador. My question for you was if you read the country letter to South Africa, it says here, “We celebrate successes but we know it’s a fundamental problem in PEPFAR’s program in South Africa.” It carries on. “There’s a significant infusion of resources by the U.S. government over the last three years; progress has been grossly sub-optimal and insufficient to reach epidemic control.” And then it speaks about poor performance. This letter is scathing; what are you specifically unhappy with, with the government, in order to write such a strongly-worded letter?
AMBASSADOR BIRX: Well, South Africa wasn’t the only one who got a strongly-worded letter, because this is an issue for all of us. We are serious, and we use data to guide us, because it’s impartial. It sees through our perceptions of how we think we’re doing, to the reality of how we are truly doing. And the reality of how we’re truly doing, despite our current investment in South Africa, where we increased our funding by $250 million.
So $750 million is on the ground here in South Africa right now for these 12 months, and we see incredibly poor retention rates. Retention rates that illustrate that although people have come into the clinics, and worked hard to stand in line and get their drugs and get on medication, the barriers that they have to return to the clinic, and to be successful with treatment have not been addressed; barriers in waiting lines, barriers in times that the clinics are open, barriers in respecting and treating young people with respect.
And so we’ve worked very closely with the community—we start with the community. We understand what the community needs, and then we work with government to ensure that the facilities, the public facilities, the outreach facilities, are embracing the clients to meet them where they need to be. So it’s a client-centered approach, it’s listening to others, it’s trusting our clients, but critically, it’s ensuring that we’ve created environments without barriers, so that 17-year-olds and 77-year-olds can be received and have the treatment and respect that they deserve in order to get treatment.
MODERATOR: Okay, I think the schedule will allow for one last question, and I think Jozi FM has a follow-up.
QUESTION: Okay, so alright. I understand that you work in many different developing countries now. Are our challenges similar or probably different?
AMBASSADOR BIRX: Challenges are similar; it’s interesting, because sometimes the countries that have the least find the most creative solutions, because they’ve had to. So our countries that sometimes have the weakest health system—the least number of doctors, the least number of nurses—figure out how to make it work for the communities that they serve. And sometimes when you have more, or you believe you have more, you’re more complacent about the structures and the outreach and what you really need to make a successful program. And so we see all different kinds.
And it’s a privilege, I have to say. I’ve been able to work on this continent since the 90’s, long before Global Fund and PEPFAR, where many of you—I see a few faces in the audience—James Mcintyre, who understands what it was like before we had treatment. And to say that today we have treatment for everyone, and we’re not serving them like everyone, there’s a problem. And it doesn’t matter where you are on the continent; that’s a problem. That’s why seven countries got these letters. We put out about 60; there were seven with a problem, because in the end, our taxpayers—people like your parents—are giving us their trusted funds to use outside of the United States. And when the United States had its serious recession, almost for a decade long, we did not falter in our commitment to addressing HIV/AIDS around the globe.
So independent of what’s happening economically in every country, there should be that same commitment to address the epidemic the best they can with every resource and with every human capacity: every nurse, every doctor, every receptionist, every pharmacist. This should be their priority, and that’s what we’re here to say and give voice to.
MODERATOR: Thank you both very much. If you can indulge us in one more selfie photo before you leave, we’d welcome that. Thank you all for coming out, and thank you to our DREAMS Ambassadors for being here as well.