US embassy cable - 05GENEVA1755

UNCLAS SECTION 01 OF 04 GENEVA 001755 
 
SIPDIS 
 
DEPT FOR OGAC, OES/IHA, IO/T 
PASS TO HHS, USAID 
NSC FOR COURVILLE AND SHIRZAD 
ONAP FOR THOMPSON 
 
E.O. 12958: N/A 
TAGS: TBIO, OTRA, AORC, WHO 
SUBJECT: WHO: 58TH WORLD HEALTH ASSEMBLY: MINISTERIAL 
MEETING ON THE PRESIDENT'S EMERGENCY PLAN FOR AIDS RELIEF 
 
REF: A. STATE 74933 
     B. GENEVA 1673 
 
1. SUMMARY.  Secretary of Health and Human Services (HHS) 
Michael O. Leavitt and Ambassador Randall L. Tobias, U.S. 
Global AIDS Coordinator, invited the Ministers of Health from 
the fifteen focus countries of the President's Emergency Plan 
for AIDS Relief to meet with them during the 2005 World 
Health Assembly (WHA) in Geneva, Switzerland, on May 17, 
2005.  This Ministerial meeting has been a feature of the WHA 
since 2003.  Dr. Julie Gerberding, Director of the HHS 
Centers for Disease Control and Prevention, and Dr. William 
R. Steiger, Special Assistant to the HHS Secretary for 
International Affairs, also participated. 
 
2. The purpose of the meeting was to brief the Ministers 
and/or their representatives on progress in the Emergency 
Plan, and invite questions.  The meeting provided an 
opportunity for the Secretary and Ambassador Tobias to have a 
candid discussion with these senior health officials on what 
is working well and what challenges remain at the country 
level as the implementation of the President's Emergency Plan 
for AIDS Relief moves forward.  It also enabled senior 
Administration officials to continue to strengthen the 
communication channels necessary for more effective operation 
and implementation of the Emergency Plan at the national 
level, and reiterate the President's commitment to alleviate 
the suffering from and devastating impact of the AIDS 
pandemic on these countries and around the globe. END 
SUMMARY. 
 
3.  Ministers of Health and/or representatives of the 
Ministries of Health from all the Emergency Plan countries 
except South Africa attended the meeting.  These included 
Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, 
Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, Viet 
Nam and Zambia. 
 
4.  Highlights from Secretary Leavitt's remarks included the 
following: 
 
(a) The United States Government (USG) is committed to doing 
all we can to end the suffering and death caused by AIDS. 
The United States is pleased to say that we are devoting 
unprecedented resources to this crisis, and combating AIDS is 
one of President Bush's major foreign policy goals. 
 
(b) The President's five-year, $15 billion Emergency Plan for 
AIDS Relief is the largest and most ambitious commitment ever 
made by a single nation toward an international health 
initiative. 
 
(c) The Emergency Plan includes both a pledge of support for 
a dramatic increase in our bilateral assistance in more than 
100 countries and a commitment to the Global Fund to Fight 
AIDS, Tuberculosis and Malaria of $1 billion over five years. 
 
(d) HHS is working with Ambassador Tobias and the U.S. Agency 
for International Development (USAID) to implement these 
commitments by adapting the Plan to local circumstances.  The 
U.S. five-year strategy outlines a strong blueprint for 
action. 
 
5.    Ambassador Tobias's key points included the following: 
 
(a) One of the vital tasks of the President's Plan is to 
provide support for in-country programs. 
 
(b) The USG realizes there is a long road ahead, and is 
already planning a course of action for when the initial 
period of the President's Plan ends. 
 
(c) The USG realizes the need to ensure the availability of 
drugs matches the speed with which people are put on 
treatment.  As such, O/GAC is working with the HHS Food and 
Drug Administration (FDA) in the review of generic drugs. 
 
(d) Under the expedited review process Aspen Pharmacare of 
South Africa has been granted tentative approval by HHS/FDA 
for its anti-retroviral treatment blister pack.  HHS/FDA 
tentative approval makes this product eligible for 
procurement under the President's Emergency Plan.  (NOTE: 
Since May, HHS/FDA has given tentative approval to several 
other anti-retroviral drug products from manufactures in 
India. END NOTE) 
6. All Delegations in attendance spoke with the exception of 
Mozambique.  The participating Ministers of Health were 
well-prepared; some spoke from prepared remarks.   It was 
clear the Ministers were much more positive than they had 
been in past years, which indicates progress and increased 
understanding about the President's Plan.  All expressed 
great appreciation of the U.S. support through the 
President's Plan; many invited Secretary Leavitt and 
Ambassador Tobias to visit their countries; and some 
expressed hope Secretary Leavitt will continue the momentum 
created at HHS over the last several years to work closely 
with countries in the fight against HIV/AIDS. 
 
7. Several consistent themes emerged from the Ministers' 
presentations, comments and questions: 
 
(a) Coordination - Ministers asked  for the U.S. Government 
to redouble its efforts to coordinate Emergency Plan 
activities with those of the Global Fund to Fight AIDS, 
Tuberculosis and Malaria, the World Bank, the World Health 
Organization (WHO), the United Nations Joint Program on 
HIV/AIDS (UNAIDS) and independent non-governmental 
organizations (NGOs). 
 
(b)  National Capacity-Building - Ministers urged that the 
Emergency Plan create standard modules for training 
healthcare workers. 
 
(c) Extension of Activities into Rural Areas - Ministers 
asked for the Emergency Plan in 2005 and 2006 to make even 
greater efforts to move beyond urban areas and capital cities 
to provide care and support to rural populations. 
 
(d) Management and Leadership Training for Ministry Staff - 
Ministers asked for the Emergency Plan to support specific 
management and leadership training for key personnel within 
Ministries of Health and Provincial or District Health 
Departments. 
 
(e) Drug Procurement - Ministers asked a number of detailed 
questions about the policies that govern the Emergency Plan's 
procurement of anti-retroviral medications.  The level of 
misinformation to which the Ministers had been exposed and 
their lack of knowledge regarding U.S. policy spoke to the 
need of better and clearer communication with government 
officials in Emergency Plan focus countries around 
pharmaceutical issues. 
 
8. Excerpts from the Ministers' remarks include the following: 
 
Botswana:  Appreciated the contributions of the President's 
Emergency Plan for AIDS Relief and reiterated the need for 
human resources development for sustainability.  The Minister 
is working actively to implement the President's Plan, which 
includes active work with  NGOs. 
 
Cote d'Ivoire: Shares many of the problems of the other focus 
countries, including the need for equipment and 
infrastructure, expanded human resources for health and 
increased availability of anti-retrovirals and antibiotics; 
 
Ethiopia:  Making reasonable progress, but the Minister is 
not satisfied and sees room for improvement from the Ministry 
and the President's Plan, with renewed commitment and 
flexibility needed.  He stressed the need for closer 
harmonization and collaboration, with sustainability at the 
forefront as implementation moves forward.  The USG needs to 
help build capacity and strengthen health systems at the 
country level. 
 
Guyana:  Working closely with the USG, but the U.S. 
partnership is one among many.  Guyana has a national 
coordinating mechanism for all HIV-related programs and views 
success against HIV/AIDS only possible if placed within the 
context of overall development.  Like Ethiopia, the Minister 
requested help with capacity-building to strengthen the 
health sector overall. 
 
Haiti:  The Minister is grateful for U.S. assistance, and 
stated that with assistance from the President's Plan, six 
out of ten districts have anti-retroviral treatment for 
persons living with AIDS.  Their reference laboratory will 
soon have safe blood-transfusion capacity.  In Haiti, there 
is a high and increasing prevalence of HIV infection among 
females. 
 
Kenya:  While the Minister hopes to have 95,000 on 
anti-retroviral treatment by the end of 2005, 200,000 people 
need therapy.  National HIV prevalence rates have decreased 
from 14 to seven percent.  Kenya needs help to track funding 
so as not to duplicate efforts and maximize all resources 
coming into the country.  He cited a number of other 
challenges that have a negative impact on sustainability: 1) 
the World Bank/International Monetary Fund caps on hiring of 
civil servants limited the ability to hire health care 
workers, 2) the lack of infrastructure and of equipment, and 
3) a lack of generic drugs. 
 
Namibia:  Latest sentinel survey indicated HIV prevalence 
rate of 19.4 percent, down from 22 percent in 2002.  In 2001, 
Namibia began its prevention of mother-to-child transmission 
program; and in 2003 initiated both opportunistic infection 
and anti-retroviral treatment.  By the end of 2005, they plan 
to have 10,620 people on anti-retroviral treatment.  Namibia 
is using its own funds to purchase anti-retroviral 
medications, and funds from the President's Plan are 
underwriting capacity-building.  The Minister stressed the 
need for flexibility in drug purchasing policies, including 
generic drugs. 
 
Nigeria:  Nigeria currently treats 28,000 people with 
anti-retroviral medications and projects to scale up to 
treatment of 40,000 people with anti-retroviral medicines by 
June 2005, 100,000 people by December 2005, and as many as 
350,000 people by 2007.  Nigeria has strengthened laboratory 
services in six states, and is training additional health 
personnel.  Ongoing challenges include 1) coordination among 
implementing partners; 2) tracking activities and 
information; and 3) building capacity at both the state and 
federal levels.  A major challenge is sustainability of 
treatment, including the need for generic anti-retroviral 
medicines as soon as possible.  They are very appreciative of 
the HHS/FDA fast-track approval process. 
 
Rwanda:  Noted less stigma for people with AIDS, that local 
conditions for people with AIDS are improving and more of 
them are able to continue to work and contribute to their 
community.  The Minister cited the need for more treatment, 
including psychological treatment, as well as epidemiological 
surveillance for HIV.  Rwanda's current HIV prevalence rate 
is 11 percent, down from 13 percent.  Rwanda would like to 
strengthen health systems and build capacity to ensure 
sustainability of ARV treatment and tuberculosis treatment, 
and expressed concern about antimicrobial resistance. 
 
Tanzania:  Noted a 7.7 percent HIV prevalence rate and hopes 
to enroll 200,000 people in anti-retroviral treatment 
programs in the coming year.  They requested additional 
assistance with 1) the provision of drugs, including 
anti-retrovirals; 2) the building and strengthening of 
laboratory capacity; 3) help in the development of programs 
that jointly target HIV and tuberculosis; 4) increased 
voluntary counseling and testing; 5) expanded home-based 
care; 6) information systems development; 7) the 
implementation of monitoring and evaluation systems; and 8) 
the training of health workers. 
 
Uganda:  Expressed appreciation the President's Plan is 
helping to meet the challenges of HIV/AIDS, and reported its 
program is on track.  The Executive Office of the President 
leads the national efforts with strong support from the 
Ministry of Health.  Uganda needs sanitation and clean water 
to help with treatment.  The Ugandan HIV/AIDS prevention 
program is based on "ABC" with all three strategies 
emphasized -- abstinence emphasized for youth, monogamy 
emphasized for married couples, and condom use emphasized for 
others; the current HIV prevalence rate is seven percent at 
the national level.  By end of 2005, Uganda projects that 
60,000 people will be on anti-retroviral treatment, and, by 
2007, all in need will be on treatment, with a plan to give 
free anti-retroviral medicines to the poor, and a fee system 
for those who can afford to pay.  Among the challenges are 
reaching people deep in the countryside and increasing 
treatment rates for malaria and tuberculosis. 
 
Viet Nam:  The increasing rates of HIV/AIDS are causing a 
great burden on Viet Nam, and the Government has invested 
resources for prevention and control initiatives.  Viet Nam 
would like a bilateral framework agreement with the United 
States for HIV/AIDS and wants to work with the U.S. 
Government to develop a joint HIV/AIDS strategy for 2006. 
Viet Nam is considering tax waivers for the importation of 
drugs and medical supplies. 
 
Zambia:  The Minister stressed the need for better 
coordination among all donors, to maximize the existing 
resources for HIV/AIDS and development. 
 
 
 
 
 
 
 
 
 
 
 
 
Moley