22 June 2008
interview
Kampala — In 2004, the President's Emergency Plan for AIDS Relief (PEPFAR), a five-year global HIV/AIDS strategy was inaugurated. Arthur Baguma talked to Ambassador Mark R. Dybul, the Coordinator for the fund, on the progress, especially in Uganda.
It is four years since PEPFAR was launched in Uganda, are you happy with the outcome so far?
We are extremely happy with the outcome so far. President George Bush made a commitment of $15b over five years, but due to the support of Congress, it is going to be $18.8b. President Bush set specific goals for us. We are on track to exceed or meet all those goals. The financial and important goals of saving and improving lives are being met. But most important is the partnership that has been created between the American people and people in other countries, particularly here in Uganda. Lives are being saved because of a strong partnership and community response.
While opening the HIV/AIDS implementers meet recently, President Yoweri Museveni decried some of the conditions that come with donor support. Do you agree with him on this?
We are partners. That means we have mutual obligation and respect. And in any relationship, there is going to be disagreements. About the specific issue the President raised about the local factory for production of ARVs, we are already working on it. It is necessary to access the medicine at low cost, which President Museveni agrees with. So that process of partnership is already on. A member of our food and drug administration will be visiting the plant from June 8-14. Our ambassador visited the plant about a week ago.
Some organisations are threatening to pull out of the condom supply programme. They argue that the Government should pay for them.
I am not aware of anyone pulling out. There was an issue in Uganda of bad condoms that come with holes and bad smell being delivered and that caused a short fall. Many of us in the international community stepped in to significantly increase condom supply to make up for that. The US government went from planning seven million condoms to 45 million condoms during that time and others stepped in as well. I am not aware of any one removing condoms for cost issues. The American people over a five-year period are planning over $920m for HIV/AIDS activities and supporting the use of condoms as one of the approaches.
Uganda was in the spotlight over the mis-use of Global Fund money. Are you satisfied with the accountability for PEPFAR funds?
More than anyone else put together, we account for about 80 % of Uganda's AIDS response. And the money has been well used and we have seen the results. We have accountability and transparency measures for all our grants. I also served as chair of finance and audit committee of the Global Fund, and 30% of the Global Fund comes from the American people.
Congress has specified that at least a-third of the PEPFAR fund should be spent on "abstinence until marriage" programmes. Why promote abstinence at the expense of other initiatives such as distribution of condoms?
We have a very comprehensive programme that includes behavioural change, prevention of mother-to-child transmission, safe blood programmes, counselling and testing. That is what goes into 29% of the fund. Out of that, about 6% of the budget goes to being faithful and abstinence. About 5% goes to condoms, so it is a very balanced programme. That follows what was pioneered here in Uganda. As people grow older, you don't give the same message. To a 25-year-old, you do not give the same message you give to a five-year-old. And that is the programme Uganda has taken on in schools to appeal to the young school children. To teach them when they are young is essential so that when they are 15, they have already heard all those messages. And when they grow old, you add on the ABC. And that's the programme we have supported because that is the programme that has proven effective not only in Uganda but also in Kenya, Ethiopia, South Africa, Zambia and Botswana. We have got trouble when people talk about one of the letters being a solution - none of the letters is independently the solution; we need all of them. What we are fundamentally trying to teach is to respect yourself and others. And if you respect yourself and others, that has consequences in your sexual activity. It also has consequences in how men treat girls or how boys treat girls. Holding gender equality is a whole big piece of this as well. We support national strategies, and the national strategy here has been effective and we are trying to support activities here to make it more effective.
This fund is a five year programme, do you intend to extend it?
President Bush has called for renewal of the programme for another five years. Congress has endorsed that. It is not quite through the legal process yet. There is strong commitment, both of our political parties and our presidential candidates, to continue with this programme. The programme is also strongly supported by the American people. We believe we are part of a global community. As Ugandans would reach out to Americans in our time of need, we also reach out to Ugandans in your time of need and we believe that we remain partners in this fight for long.
Prevention of mother-to-child transmission remains the biggest challenge. Any significant progress?
There are a couple of challenges like ensuring that women are routinely tested for HIV if they are pregnant. It is not mandatory; women can still refuse. The second issue is effective use of rapid tests. You do not wait two weeks to give an expecting mother the results of her HIV test. We have drugs available to implement the programme and increasingly, we are pushing towards having four anti-retroviral therapy for pregnant women and not just a short course that prevents the transmission. The goal here is to keep people alive and families together. So, you need to keep the mother alive, as well as the child. We know that children without parents, regardless of whether they have HIV or not, are at more high risk to die because they do not have parents to care for them.
Where are the funds for family planning programmes in all this?
Family planning is a separate part of development. The US government has a fund for family planning. Our HIV/AIDS programme includes doing HIV/AIDS activities in family planning sites. Pregnant women are sexually active and are at higher risk of getting HIV, so we support and believe we should be having HIV-testing for pregnant women every where you reach them. But the actual product of family planning is not an HIV-specific activity; there is not a single area of development that does not relate to HIV/AIDS. Development, food, water, and general health issues, all relate to HIV/AIDS. Our initiative is specifically HIV/AIDS but then that needs to link with other things, so we are trying to link our programmes with others but we cannot take on all the development. So, things like family planning and nutrition and water are all aspects of development to which we should be linked but its not something we should do.
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