In his State of the Union Address of Jan. 28, President Bush announced that he would ask Congress to approve a five-year, $15 billion emergency initiative designed to combat the rapidly worsening global HIV/AIDS pandemic.

"To meet a severe and urgent crisis abroad, tonight I propose the Emergency Plan for AIDS Relief - a work of mercy beyond all current international efforts to help the people of Africa...I ask the Congress to commit $15 billion over the next five years, including nearly $10 billion in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean," said President Bush.

On Jan. 29, the White House released the following details on the emergency AIDS initiative. Specifically, the initiative is intended to:

• Prevent 7 million new infections-This would prevent 60 percent of the projected 12 million new infections in the target countries; 
  
  
• Provide antiretroviral drugs for 2 million HIV-infected people-Only 50,000 are receiving antiretroviral drugs in Africa today; and 
  
  
• Care for 10 million HIV-infected individuals and AIDS orphans

Implementation of this initiative will be based on a model currently being employed in countries such as Uganda. This model involves a layered network of central medical centers that support satellite centers and mobile units, with varying levels of medical expertise as treatment moves from urban to rural communities.

The $15 billion in funding for this initiative virtually triples the current U.S. commitment to international AIDS assistance. Funding will begin with $2 billion in FY04, and ramp up thereafter. The $15 billion includes $1 billion for the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria, conditioned on the Fund showing results.

In order to ensure accountability for results, the President will propose to establish at the Department of State a new Special Coordinator for International HIV/AIDS Assistance. The Special Coordinator will have the rank of ambassador and will be responsible for coordinating all U.S. participation in international HIV/AIDS programs.

The Continuing Spread of the Pandemic 
The HIV/AIDS pandemic has killed at least 20 million of the more than 60 million people it has infected thus far, leaving 14 million orphans worldwide. Today, on the continent of Africa, nearly 30 million people have the AIDS virus-including three million children under the age of 15. There are whole countries in Africa where more than one-third of the adult population carries the infection.

Recent developments have now made widespread therapy for HIV possible. The price of advanced antiretroviral (ARV) drugs, which can effectively suppress the AIDS virus in infected people, has fallen from more than $12,000 to under $300 per year with generic formulations. In addition, ARV treatment regimens have been greatly simplified by decreased dosing and monitoring requirements and decreased toxicity.

Despite these advances in therapy, the number of people actually receiving ARV treatment remains remarkably low. In Africa, for example, it is estimated that over 29.4 million people are infected with HIV, more than 4 million of whom have a sufficiently advanced stage of the disease to warrant ARV treatment-but only about 50,000 are receiving it.

The President's Emergency Plan for AIDS Relief 
The President believes the global community can-and must-do more to halt the advance of the HIV/AIDS pandemic, and that the United States should lead the world by example. Thus, the President's Emergency Plan for AIDS Relief will provide $15 billion over five years to turn the tide in the war on HIV/AIDS in the hardest hit countries in Africa and the Caribbean: Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zambia. These 14 countries, which are also the focus of the President's previously announced Mother-and-Child HIV Prevention Initiative, have among the highest prevalences of HIV infection and account for nearly 20 million HIV-infected men, women and children-almost 70 percent of the total in all of Africa and the Caribbean.

The Emergency Plan for AIDS Relief is intended to: 
Prevent 7 million new infections (60 percent of the projected new infections in the target countries): The initiative will involve large-scale prevention efforts, including voluntary testing and counseling. The availability of treatment is expected to enhance prevention efforts by providing an incentive for individuals to be tested.

Treat 2 million HIV-infected people: Capitalizing on recent advances in ARV treatment, the President's Emergency Plan for AIDS Relief will be the first global effort to provide advanced antiretroviral treatment on a large scale in the poorest, most afflicted countries.

Care for 10 million HIV-infected individuals and AIDS orphans: The initiative will provide a range of care, including support for AIDS orphans.

Implementation of the President's Emergency Plan for AIDS Relief 
Implementation of the President's Emergency Plan for AIDS Relief will be based on a "network model" being employed in countries such as Uganda. This model involves a layered network of central medical centers (CMCs) that support satellite centers and mobile units, with varying levels of medical expertise as treatment moves from urban to rural communities. The model will employ uniform prevention, care, and treatment protocols and prepared medication packs for ease of drug administration. It will build directly on clinics, sites, and programs established through the U.S. Agency for International Development, the Department of Health and Human Services, non-governmental organizations, faith-based groups, and willing host governments. The initiative will be implemented through:

• Central Medical Centers (CMCs), which will be existing hospitals staffed by physicians with expertise in HIV and infectious diseases, doctors-in-training, nurses, nurse practitioners, and laboratory technicians. The centers will provide the highest level of care and will be capable of managing the most complicated medical issues. Primary Satellites, which will be independent medical centers with doctors, nurses, pharmacists, counselors and medical technicians, who will provide basic medical care, including the prescription of ARV treatment. 
• Primary Satellites could have doctors on staff or doctors rotating through from the CMCs. Many private and public clinics run by faith-based groups and non-governmental organizations will be in this category. 
• Secondary Satellites, which will be staffed by nurses and nurse practitioners, medical technicians and counselors, who will perform tests to diagnose HIV and other infectious diseases. Patients with the disease will be referred to Primary Satellites or CMCs for evaluation and initiation of ARV treatment. However, routine evaluation and care, including filling prescriptions, will occur at the secondary sites through standard protocols and prepared medication packs. 
• Rural Satellites and Mobile Units, which will be remote sites staffed by lay technicians, possibly rotating nurses, and local healers, who will be trained in standard clinical evaluations and distribution of medication pack refills.

Management of the Initiative 
To ensure accountability for results, the President will propose the creation a new, high-level Special Coordinator for International HIV/AIDS Assistance at the Department of State. This individual, who will be appointed by the President and confirmed by the Senate, will have the rank of ambassador and will report directly to the Secretary of State. The Special Coordinator will be responsible for overseeing all U.S. international HIV/AIDS assistance and coordinating the efforts of the various agencies and departments that deliver it.

The Administration's Commitment to Fighting HIV/AIDS 
President Bush has made fighting the HIV/AIDS pandemic a priority of U.S. foreign policy. The United States was instrumental in launching the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria in 2001. The United States was the first country to make a contribution to the Fund and leads the world in having committed $500 million to it-23 percent of total fund pledges to date. In 2002, President Bush launched the $500 million Mother-and-Child HIV Prevention Initiative designed to prevent mother-to-child transmission. At the same time, the United States spends almost $15 billion annually to combat AIDS domestically, including $2.6 billion for vaccine and cure research.

The President is also committed to ensuring that African and other developing countries have greater access to emergency life-saving pharmaceuticals, including advanced antiretroviral drugs and test kits needed to treat HIV/AIDS. That is why the United States announced on December 20, 2002, that it would permit these countries to override patents on drugs produced outside their countries in order to fight HIV/AIDS, malaria, tuberculosis and other infectious epidemics, including those that may arise in the future. This is an immediate, practical solution that will provide life-saving drugs to those truly in need.

[Source: The White House]