- The Washington Times - Monday, March 4, 2002

Andrew Natsios, administrator of the U.S. Agency for International Development, spoke last week with The Washington Times State Department Bureau Chief Ben Barber on the Bush administration's support in the international fight against AIDS.

Question: The United Nations and other health advocates called last year on donor nations, including the United States, to contribute $10 billion a year to a new global fund to fight AIDS, malaria and tuberculosis. But less than $2 billion was pledged so far. What is your response?
: Because very few donors have funds specifically targeted to HIV/AIDS, the assumption was that all would go through this trust fund. The United States, although smaller than the amount the U.N. sought, has the largest bilateral HIV/AIDS fund in the world. The United States will spend in 2003 almost $1.2 billion on AIDS care, prevention and treatment between NIH [the National Institutes of Health], AID [Agency for International Development] and CDC [the Centers for Disease Control and Prevention].
The bulk of those funds goes through USAID, and all of the money is for the Third World; none of it is for domestic use.
The original [Global Fund] request was for $7 billion to $10 billion. We are contributing a lot, including technical people in the field. Since 1999, we've had a 500 percent increase in spending on AIDS in the Third World, a geometric increase. Spending doubled every year in the last three years in the Caribbean.
You don't just spend that much money. We are gearing up.
But you don't do it all through the trust fund. Don't put all your eggs in one basket, because it could fail. We will judge that as it goes along.
Meanwhile, Congress gave us more money for our bilateral programs, and we will spend it in an aggressive fashion.
Q: Aside from the U.S. contribution, were you disappointed by those of other countries?
Other countries don't target specific diseases. I'm not saying it's the wrong or the right way. Europeans tend to take a health care systems approach as opposed to a disease approach. Europeans contribute in a way that may not be rightly reflected as affecting the disease.
We donate to programs for HIV/AIDS, sexually transmitted diseases, women's health to pull out the disease is more a budget exercise than how we administer funds in the field.
Q: Secretary of State Colin L. Powell was criticized by conservatives for saying recently that condoms are vital for preventing AIDS in sexually active people. Yet you made even stronger comments on Capitol Hill that same week, pledging increased U.S. aid to spread the use of condoms. How did you avoid criticism?
Part of our strategy has been condoms. It has been abstinence, faithfulness and condoms, especially in one family where one partner is HIV-positive.
Q: What is the administration doing to overcome political obstacles to fighting AIDS, such as foreign leaders refusing to tell their people that sex spreads the disease and that they need to change their behavior?
We are having conversations with medical and other leaders. In some cases, leaders are doing things [to fight AIDS], and in some places not. It depends on the views of heads of state.
When heads of state do take an aggressive and sustained level of leadership, it does affect our ability to prevent the spread of diseases. …
Many of the leaders are way ahead of us. In other countries, they are not. There is only so much we can do as a government in convincing other leaders to do what we want them to do. We can't force them.
What has happened is some heads of state in Africa talk to other heads of state. That's why some heads of state are taking actions.
Q: Is the AIDS pandemic tapering off?
Infections are dropping in Uganda. There are programs that are successful. We know rates can drop if there is an aggressive prevention effort.
Those programs are scaling up in other countries. AIDS can be controlled, but it takes a multi-pronged effort.
The places of most concern now are Russia and India, where growth rates [of HIV/AIDS] are very high. And we are concerned about rates in Burma. We have no AID mission there. It is isolated, and the disease could be out of control.

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