US embassy cable - 04SANTODOMINGO6524

UNCLAS SECTION 01 OF 03 SANTO DOMINGO 006524 
 
SIPDIS 
 
HHS FOR SECRETRAY THOMPSON; DEPT FOR G, OES, WHA, WHA/CAR, 
WHA/EPSC 
 
E.O. 12958: N/A 
TAGS: TBIO, SOCI, EAID, DR 
SUBJECT: U.S. COMS' HIV/AIDS CONFERENCE HIGHLIGHTS 
DISCRIMINATION AND STIGMA AND ELICITS NEW DOMINICAN 
COMMITMENT TO HIV/AIDS 
 
1.  Summary:  In a packed three days in early October, the 
U.S. Government's senior HIV/AIDS team and Caribbean-based 
U.S. Ambassadors, with the help of Dominican President Leonel 
Fernandez, his health team and the winners of an HIV/AIDS 
song contest for youth, threw the spotlight on HIV/AIDS in an 
effort to build awareness and to re-commit to treat and 
prevent the disease.  Ambassadors contributed and took home 
recommendations that will help HIV/AIDS programs in the 
region.  Suggestions for future COM regional conferences on 
AIDS included involving participant countries' Ministries of 
Health in the proceedings.  The U.S. Government also signed 
an agreement for additional assistance to the Dominican 
Republic for HIV/AIDS work, and Ambassador Hans Hertell and 
U.S. Secretary of Health and Human Services (HHS) Tommy G. 
Thompson called on the Dominican Government to put in place a 
management and financial accountability structure that would 
enable the release of Global Fund monies already approved for 
the Dominican Republic.   President Fernandez agreed to have 
his AIDS advisor take care of this at once.  Surgeon General 
Richard Carmona, Global AIDS Coordinator Randall Tobias, and 
USAID Assistant Administrator for Global Health Anne Peterson 
visited AIDS clinics in Santo Domingo and, at the last-minute 
request of President Fernandez, also visited the country's 
only trauma hospital; Surgeon General Carmona offered to work 
within the U.S. Government to consider providing technical 
assistance and traumatology training to this overcrowded, 
badly organized, and equipment-poor hospital.  End summary. 
 
 
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Third Annual Caribbean-based U.S. COMs HIV/AIDS Conference 
--------------------------------------------- ------------- 
 
2.  U.S. Secretary of Health and Human Services Tommy 
Thompson, U.S. Global AIDS Coordinator Ambassador Randall 
Tobias, U.S. Surgeon General Richard Carmona, and USAID 
Assistant Administrator for Global Health Anne Peterson 
joined the U.S. Ambassadors in the Caribbean and some 200 
others in the Third Annual Caribbean Chiefs of Mission 
Conference on HIV/AIDS, hosted by Ambassador Hans Hertell on 
October 4-5.  Dominican President Leonel Fernandez and 
Dominican Health Minister Sabino Baez were present at the 
opening of the widely televised conference.  Fernandez 
stressed the need for a comprehensive policy aimed at 
prevention.  He noted that while local government statistics 
show the number of Dominicans living with HIV/AIDS to have 
decreased, the situation in Haiti is dire, as a reported 5.6 
percent of the adult population is living with the disease. 
Note:  HHS and USAID officials in Haiti the day before 
indicated that recent survey data showed the HIV prevalence 
rate for 2003 to be approximately three percent.  End note. 
Public Health Secretary Sabino Baez, for his speech, 
recounted USAID's assistance and stressed the importance of 
education.  He said he hoped to lower mortality rates 
associated with AIDS and create a greater social acceptance 
for those living with the disease.   U.S. speakers described 
the disease as a leading challenge of our time, emphasized 
the U.S. Government's commitment to combating it, and 
described U.S. policy. 
 
3.  Most of the conference was devoted to discussion amongst 
the nine U.S. Chiefs of Mission and Principal Officers and 
other U.S. participants.  Each Ambassador shared information 
on the projects underway in his or her country and the 
lessons learned.  They discussed four major HIV/AIDS issues 
in the Caribbean:  Haiti as a challenge, the impact on and by 
tourism, the economic cost of the pandemic, and the effect of 
migration.  Participants discussed the need for coordination 
among agencies, as more actors get involved in fighting AIDS. 
 They also addressed the need to focus on medicine 
procurement and management issues.  Ambassador to Jamaica Sue 
Cobb noted that in the three years following the first COM 
Conference in Haiti, there has been significant progress in 
the region.  Participants agreed that the COM Conferences are 
useful forums for keeping this issue in public view. 
Ambassador to the Bahamas, John Rood, offered to host the 
conference next year. 
 
4.  The conference program concluded with a mass-media 
campaign launch of this year's theme, discrimination and 
stigma, that also featured HIV/AIDS song contest winners and 
included a reception for a largely Dominican guest list 
hosted by Ambassador Hertell. 
 
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Signing Ceremony for Increased HIV/AIDS Assistance for the DR 
--------------------------------------------- --------------- 
 
5.  On the margins of the conference, Ambassador Hertell and 
President Fernandez, along with Secretary Thompson and Dr. 
Carmona witnessed the signing of an amendment to the current 
U.S.-Dominican agreement for HIV/AIDS assistance.  The 
amendment increased U.S. Government assistance for HIV/AIDS 
work in the Dominican Republic by USD 13 million during the 
five-year strategic plan period of 2002-2007.  With this 
addition, the total USAID assistance for HIV/AIDS will reach 
$28 million. 
 
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HHS Secretary Tommy Thompson Calls for Better DR Accounting 
to Release Global Fund Allocation 
--------------------------------------------- --------------- 
 
6.  In a bilateral call on President Fernandez and his 
HIV/AIDS team, U.S. HHS Secretary Tommy Thompson, in his 
capacity as Chairman of the Board of the Global Fund to Fight 
HIV/AIDS, Tuberculosis and Malaria, noted that the Global 
Fund Board had approved a two year, $14 million grant to the 
Dominican Republic for HIV/AIDS programs, but that problems 
in setting up management and financial accountability on the 
Dominican side have long delayed the distribution of funds. 
Secretary Thompson asked that the President turn his 
 
SIPDIS 
attention to getting the proper mechanisms in place to ensure 
an appropriate degree of fiscal responsibility and 
accountability.   Thompson noted that a team from the Global 
Fund Secretariat in Geneva is scheduled to visit the 
Dominican Republic to re-examine the role of COPRESIDA. 
Note:  The problems with COPRESIDA's management of the grant 
during the Mejia Administration years recently led the Global 
Fund Secretariat to conclude an emergency bridge agreement 
with the Clinton Foundation instead, to procure 
anti-retroviral drugs (ARVS).  End note. 
 
7.  Fernandez reiterated his message from the conference that 
his administration is fully committed to fighting HIV/AIDS. 
He immediately directed Dr. Alberto Fiallo, director of the 
President's Council on AIDS, or "COPRESIDA," to put in place 
the necessary financial accountability structure to enable 
release of the Global Fund allocation and to keep in touch 
with HHS and USAID staff.  Fiallo agreed. 
 
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What the Dominican Republic Needs Most: Better Hospital 
Management 
--------------------------------------------- --------------- 
 
8.  Speaking more generally, Fernandez told the group that 
the most urgently needed health-related assistance in the 
Dominican Republic is guidance and training in hospital and 
healthcare management.  He said he would welcome training 
assistance from the United States, and suggested the 
possibility of both U.S.- and Dominican-based training for 
local healthcare workers.  He noted that just one trauma 
hospital exists in the entire country, and requested that 
Surgeon General Carmona and others visit it during their stay 
with an eye to seeing what assistance and training the United 
States might be able to offer the hospital.  They did visit, 
finding a hospital that was poorly organized, over-crowded, 
under-equipped, with inadequate sanitation.  The USAID 
mission in Santo Domingo is currently developing a scope of 
work in coordination with HHS to address some of the issues 
found during the trauma hospital site visit. 
 
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AIDS Patients Speak Out 
----------------------- 
 
9.  Also on the margins of the conference, AIDS Administrator 
Tobias, Surgeon General Carmona, and Assistant USAID 
Administrator Peterson, accompanied by their Dominican 
counterparts, visited several AIDS treatment sites, including 
a model AIDS wing in a public hospital and a private clinic. 
Members of an organization representing persons living with 
HIV/AIDS met with the Dominican and U.S. Government visitors 
at one stop.  They explained their outreach activities in 
rural communities on treatment and prevention, their concerns 
that HIV/AIDS was severely under-reported by the GODR, and 
the shortage of anti-retroviral drugs.   They described the 
life-and-death consequences of the shortage of ARVs. 
 
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Comment 
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10.  The conference demonstrated strong U.S. Government 
interest and support for combating HIV/AIDS.  It focused 
President Fernandez's attention on HIV/AIDS at an early stage 
of his presidency, and helped make the disease a priority for 
his administration.  Frank talk from AIDS patients about the 
consequences of ARV shortages created some welcome future 
accountability for the new Dominican government, which has 
now promised greater attention to the needs of patients.  The 
U.S. Government's equally frank talk about the Dominicans' 
management and financial accountability problems that blocked 
 disbursements from the Global Fund have since led to 
follow-up meetings to deal with the problem, and we are 
optimistic the GODR will put the right mechanisms in place 
soon.  As for the U.S. Chiefs of Missions, they left the 
conference newly energized and updated, and the pertinence of 
the dialogue led to a recommendation that the conference be 
held again next year.  End comment. 
KUBISKE