[Congressional Record Volume 148, Number 28 (Wednesday, March 13, 2002)]
[Senate]
[Pages S1853-S1855]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             GLOBAL HIV/AIDS: THE HEALTH CRISIS OF OUR TIME

  Mr. FRIST. Madam President, I came to Washington to the U.S. Senate 
in my heart to serve my home state of Tennessee and this great nation, 
but after arriving my steps have also taken me far from the floor of 
the United States Senate--on medical mission trips to Sudan, Africa, 
and most recently, in January, to Uganda, Kenya, and Tanzania.
  The purpose of my trip just a few weeks ago was to learn, for myself, 
more about the human impact that a simple virus is having on the 
destruction of a continent. Not a family. Not a community. Not a state. 
Not a country. But an entire continent.
  The statistics behind this global plague are shocking:
  Each year, a staggering three million people die of AIDS. Someone 
dies from the disease every ten seconds. About twice that many, 5.5 
million, or two every ten seconds, become infected. That's 15,000 a 
day. And what's even more tragic is that 6,000 of those infected each 
day are young--between ages 15 and 24. Globally, as many as 40 million 
are infected. Africa is hit particularly hard. Of those infected, 70% 
are in Africa. In Botswana alone, one out of every three individuals is 
infected.
  And the toll on families is incalculable. 13 million children have 
been orphaned by AIDS, mostly in Africa. Projections for the next ten 
years are sobering--the orphan population may well grown to 40 
million--the number equivalent to all children living east of the 
Mississippi River here in the U.S. But Africa is not alone. India, with 
over 4 million cases, is on the edge of an explosive epidemic. China is 
estimated to have as many as 10 million infected persons. The Caribbean 
sadly boasts one of the highest rates of infection of any region in the 
world. Eastern Europe and Russia report the fastest growth of AIDS 
cases, 11 times over during a three year period. And even worse--90 
percent of those infected do not know they have the disease. There is 
no cure. There is no vaccine. And it is increasing in numbers.
  As ranking member of the African Affairs subcommittee of the Foreign 
Relations Committee, I have a commitment to increase public awareness 
of the HIV pandemic in Africa, and most importantly, to develop a 
strategy to combat and eradicate the disease from the continent and the 
world. What I saw and learned in Uganda, Kenya, and Tanzania was 
extraordinary--coming face-to-face with the human tragedy of HIV/AIDS, 
and lives cut far too short.

  Madam President, Africa has lost an entire generation. In Nairobi, 
Kenya, I visited the Kibera slum. With a population of over 750,000, 
one out of five of those who live in Kibera are HIV/AIDS positive. As I 
walked the crowded, dirty pathways sandwiched between hundreds of 
thousands of aluminum shanties, I was amazed that everyone was a child, 
or very old. The disease had wiped out the parents--the most productive 
segment of the population--teachers, military personnel, hospital 
workers, law enforcement officers.
  In Arusha, Tanzania, I met Nema whose name means ``Grace.'' She sells 
bananas to survive and provide for her year and a half old son, Daniel. 
When Daniel cried from hunger, Nema kissed his hand because she had 
nothing to give him but her love.
  Margaret, also in Arusha, whose symptoms first came on in 1990. When 
her husband died, despite her illness, she found the strength to fight 
his family to keep the family property. Thanks to her brothers, she has 
a house for her six children.
  And I had the privilege of visiting with Tabu, a 28-year-old 
prostitute, who was leaving Arusha to return to her village to die. She 
stayed an extra day to meet with us, and I will never forget her 
cheerful demeanor and mischievous smile as we met in her small stick-
framed mud hut, no more than 12 by 12. Her two sisters are also 
infected, another sister has already died. Tabu will leave behind an 
eleven year old daughter, Adija.
  At home in Tennessee, or even here in Washington, D.C., Uganda and 
Tanzania feel very far away. But the plague of HIV/AIDS and the chaos, 
despair and civil disorder it perpetrates only leads to the demise of 
democracy in a country, in a continent, in the world. Without civil 
institutions, there is disorder. Last year in South Africa, one in 
every 200 teachers died of AIDS. In Kenya, 75 percent of deaths on the 
police force are from AIDS. HIV-related deaths among hospital workers 
in Zambia have increased 13 times in over a decade. In the wake of 
these losses, economies are devastated. Botswana's economy is projected 
to shrink by 30 percent in ten years. Kenya's economy will see a 15 
percent decline. Family incomes in the Ivory Coast have declined by 50 
percent while expenditures for health care have risen by 4000 percent.
  The orphans of Africa are left without parents, without teachers, 
without role models and leaders. They are susceptible to recruitment by 
criminal organizations, revolutionary militias, and terrorists. 
Terrorism could become a way of life--not only for maniacal cults but 
for a generation. September 11 taught us how small our world really is. 
And how great the responsibility before us.
  And that is why I'm devoting much of my time in the U.S. Senate to 
the issue of global HIV/AIDS, and in particular, to the impact of the 
disease in Africa. Just as our great nation is the leader in the war on 
terrorism, we must also continue to lead in the global battle against 
AIDS as we work to build a better, safer world. Then where do we go 
from here?
  It seems to me there are three key ingredients: leadership, 
prevention and treatment, and funding.
  I would like to elaborate a moment on each. The good news is we know 
a lot about how to reverse the epidemic. And as a first step, it takes 
strong leadership at all levels, but as with most things in life, that 
leadership must start at the top. President Museveni in Uganda, with 
whom I spent some time on my trip, has not been bashful about speaking 
very publicly to the citizens of his country about HIV/AIDS. Bakili 
Muluzi, President of Malawi, was in my office here in Washington just a 
few weeks ago. He told me that he opens every speech to his countrymen 
with an admonition about HIV/AIDS. These two presidents underscore the 
need to bring the disease out into the light, helping to eliminate the 
stigma often associated

[[Page S1854]]

with the disease, and opening the way for public education.
  Others have also been doing their part--governments, the U.N., the 
World Bank, world leaders, corporations and philanthropies. From 
President Bush to Kofi Annan and Secretary Powell, world leaders 
support a call to action, and all recognize the need to do more. It's 
also leadership from people as unlikely as Bono, lead singer of the 
Irish rock band, U-2. With his passion for Africa and his ``bully 
pulpit'' as a celebrity, he's a credible and accomplished spokesperson 
on the issue. He joined us in Uganda and Kenya for a couple of days, 
and I was impressed with his knowledge, his commitment, his caring.
  It's the role of leadership at all levels to ensure that our efforts 
are well coordinated, understanding the importance of enlisting all 
stakeholders in the fight against HIV/AIDS. We must coordinate within 
national governments as well as across them. We must leverage our 
precious resources and avoid duplication of effort. As I saw first-hand 
in east Africa, many of the best ideas come from those working in the 
trenches to fight this disease. Local community participation is 
essential to this process, and local leadership is critical, 
particularly as we work to prevent and treat the disease. Let me cite a 
couple of examples.

  In Tanzania, Sister Denise Lynch runs the Uhai Center for the Roman 
Catholic Diocese of Arusha, providing a range of services to village 
schools and churches. Father Bill Freida, a physician at St. Mary's 
Hospital in Kenya, tells me they serve over 400 patients a day, and 
their chapel and bakery are anchors for the community. And Dr. Ebenezer 
Mawasha, also in Tanzania, promotes the teaching of spiritual and moral 
values in addition to health and hygiene education.
  The work that these individuals have accomplished, coupled with their 
faith and commitment, are a true inspiration to me. And their efforts 
in preventing the disease will have positive repercussions in the years 
to come. Their leadership on the ground, in the trenches, each and 
every day, is fundamental to our ultimate success. I also want to 
salute the leadership of those with the CDC and U.S. AID on the ground 
in east Africa. President Museveni told me that our government's 
investment in Uganda, for example, of $120 million over the last ten 
years has been instrumental in their success in bringing new infection 
rates from 32 percent to just over 6 percent. Our presence through 
these two federal agencies is making a difference.
  Until science produces a vaccine, prevention through behavioral 
change and awareness is the key. And once again, cultural stigmas must 
be overcome. With a combination of comprehensive national plans, donor 
support and community-based organizations, progress can be made. 
Uganda, Thailand and Senegal are these examples of solid success. We 
must encourage people to be tested, for here is our real opportunity to 
save countless lives. The more people know about infection, the more 
likely they are to do something about it. I believe we should increase 
investments in rapid HIV testing kits and counseling for developing 
countries. Access to these testing tools helps to reinforce prevention 
messages and guide treatment options.
  As I saw in Africa, testing centers become centers of hope for a 
community, a place where those struggling with HIV/AIDS can share 
ideas, support each other, learn coping strategies, and receive medical 
treatment and nutritional support. I was particularly impressed with 
the work in the Kibera slum of Nairobi at the Kibera Self-Help 
Programme, run by the Centers for Disease Control. Officials there told 
me that a negative test provides a powerful incentive to stay healthy, 
and gives people an opportunity to receive counseling on risk behavior 
that will ultimately save lives. A positive test removes the burden of 
not knowing and allows for timely treatment and counseling, an 
important first step in living longer and healthier lives.
  In recent months, pharmaceutical companies sent a message of hope by 
slashing prices on anti-retrovirals for poor countries. Other treatment 
regimens may make an ever bigger difference in extending life and 
holding families together. Just as importantly, the hope of some kind 
of treatment will encourage more people to have themselves tested. And 
there are other potential public health advantages to treatment that 
require further research and evaluation. Treatment with anti-retroviral 
drugs lowers the amount of virus in the blood, potentially decreasing 
the risk of transmission, both among adults and mother to child 
transmissions.

  In addition, access to treatment and drugs is also needed for 
opportunistic infections, such as tuberculosis. For all the damage that 
HIV/AIDS does, TB kills more people in Africa with AIDS than any other 
opportunistic infection. CDC officials in Kenya told me TB has 
increased six times over in the last ten years, and it's impossible to 
separate HIV and TB. I've seen first hand in Sudan the reemergence of 
TB in strains more resistant, move virulent, than any we've seen 
before.
  And finally, support of health care delivery systems, with a special 
emphasis on personnel training, is essential to effective treatment 
programs. Let me add that on the subject of vaccines we must continue 
to search for the tools to finally reverse the spread of HIV/AIDS. 
Research and development must continue, and I'm pleased to report that 
NIH currently has over two dozen vaccine candidates in the pipeline. 
Someday, and hopefully very soon, we will have a vaccine to prevent 
this disease.
  In sum, I believe there are eight goals we must pursue in this global 
fight.
  1. We must continue to encourage the political, religious and 
business leaders of the world to unit in an international commitment to 
halt the spread of HIV/AIDS and to help those who are afflicted with 
the disease.
  2. We must continue to embrace the new Global Fund for HIV/AIDS, TB, 
and Malaria. This is not a UN fund, or an American fund. It is a new 
way of doing business.
  3. We must better leverage America's public health care resources and 
talent to address the challenge. There must be a ``call to cure'' for 
our health care professionals to use their talent and expertise.
  4. We should encourage and empower coalitions of governments, multi-
lateral institutions, corporations, foundations, scientific 
institutions and NGO's to fill the gap between the available resources 
and the unmet needs for prevention, care and treatment.
  5. We must continue to put community-based organizations, both 
religious and secular, at the forefront of action on the ground by 
getting funds to them quickly so they can most effectively do their 
jobs in reaching out those who need help most.
  6. We must make certain that international research efforts on 
disease affecting poor countries is reinforced in a manner that assures 
the best scientific work in the world will lead to real benefits for 
the developing world--at a cost they can afford.
  7. We must focus on prevention, and also support care and treatment 
options that combine reasonable cost pharmaceuticals with appropriately 
structured health care delivery systems.
  8. Finally, we must do all we can to provide comfort to the families 
and orphans affected, to give them hope and dignity.
  I can still hear young Daniel's cries of hunger and know that his 
young mother will not live to see him grow into adolescence, much less 
manhood; can see Sister Denise as she patiently and capably answers my 
many questions about the best ways we can help; still hear the pride in 
Father Freida's voice as he describes his hospital as a place to 
provide dignity and comfort to the inflicted and dying; and I think of 
Tabu who has returned to her home village to face death. These images 
will remain with me; these images strengthen my resolve to win the 
fight against HIV/AIDS.
  History will judge us as to how we as a nation, as a global 
community, address and respond to this most devastating and destructive 
public health crisis we have seen since the bubonic plague ravaged 
Europe over 600 years ago.
  The task before us looms large, but by pulling together, with 
leadership from all, we will eliminate the scourge of HIV/AIDS from the 
face of the globe in our lifetime.

[[Page S1855]]



                          ____________________