Chapter 11 - Engendering Bold Leadership


President George W. Bush welcomes Cyriaque Yapo Ako, executive director of the Reseau Ivoirien des Organisations de PVVIH in C�te d�Ivoire, Africa, to the White House on World AIDS Day. White House photo by Eric Draper

�No country can ignore this crisis. Fighting AIDS is an urgent calling � because every life, in every land, has value and dignity.�

First Lady Laura Bush
Remarks at the UN General Assembly
High Level Meeting on HIV/AIDS
June 2, 2006

HIV/AIDS is a public health emergency that is global. Yet it is also local � taking a toll on individuals, families, and communities, one by one.

The leadership needed to defeat HIV/AIDS must come from every nation and from every sector of society within nations. Therefore, the President�s Emergency Plan for AIDS Relief (Emergency Plan/PEPFAR) has focused on fostering host country leadership in the governmental and non-governmental sectors, especially among people living with HIV/AIDS (PLWHA). Such leadership is critical in combating the stigma that continues to inhibit the fight against HIV/AIDS.

Public affairs outreach within the United States and public diplomacy abroad contribute importantly to the accountability and leadership goals of the Emergency Plan. Public diplomacy is the vital effort to share America�s story and ideals with others around the world. At the global level, the United States continues to play the leadership role it assumed in the world�s fight against HIV/AIDS when President Bush launched the Emergency Plan, by seeking to mobilize bold leadership and additional resources from other countries, entities, and individuals. Through diplomacy with other current and potential international partner governments and multilateral organizations, the Emergency Plan works to deepen other developed nations� commitment to the fight against global AIDS.

Supporting Leadership on HIV/AIDS in Host Nations
As senior U.S. Government (USG) leaders have visited host nations, they have made it a priority to participate in public events that support national HIV/AIDS responses.

In November 2006, the President and Mrs. Bush toured the Pasteur Institute in Ho Chi Minh City, Vietnam, a site supported by the Emergency Plan. During the visit, President Bush acknowledged the strides being made in the fight against HIV/AIDS as a result of the partnership between Vietnam and the United States. The visit and the President�s commendations of the U.S.-Vietnam partnership received extensive media coverage in Vietnam, as well as internationally. 

In St. Petersberg, Russia, First Lady Laura Bush participated in a roundtable discussion at the Pediatric HIV/AIDS Clinical Center of Russia. White House by Shealah Craighead In January 2006, the First Lady visited St. Mary�s Hospital in Gwagwalada, Nigeria, and reaffirmed the U.S. commitment on HIV/AIDS, noting: �We are all hopeful that one day an entire generation will be born free of HIV.� During the President�s visit to Russia for the G-8 summit in July 2006, the First Lady participated in a roundtable discussion at the Pediatric HIV/AIDS Clinical Center in St. Petersburg, Russia, highlighting the U.S. commitment to children living with the virus.

Along with her travels, Mrs. Bush represented the U.S. as an outspoken advocate in the fight against HIV/AIDS. Her advocacy has resulted in increased attention by policymakers, members of the media, and diplomatic leaders. In March 2006, Mrs. Bush announced an unprecedented public-private partnership for pediatric AIDS treatment (please see the chapter on Children). The Emergency Plan developed this initiative to promote scientific and technical discussions to devise solutions for pediatric HIV treatment, maximize the utility of currently-available pediatric formulations, and accelerate children�s access to treatment.

In June 2006, Mrs. Bush addressed the United Nations General Assembly High Level Review Meeting on HIV/AIDS. She proposed the designation of an International HIV Testing Day, arguing that �... [L]ife-saving treatment never reaches people who do not know they are infected.� In December 2006, the U.N. General Assembly unanimously adopted the concept of an International Counseling and Testing Day.

Mrs. Bush continued her HIV/AIDS advocacy in September 2006 at the Annual Meeting of the Clinton Global Initiative, where she announced a groundbreaking public-private partnership involving the USG, PlayPumps International, the Case Foundation, and other public- and private-sector partners. This alliance will work with 10 sub- Saharan African countries to bring clean drinking water to up to 10 million people by 2010 (please see the chapter on Building Capacity: Partnerships for Sustainability).

Meetings and events attended by host nation government and civil society leaders also afford key opportunities to encourage action against the pandemic. In August 2006, the U.S. Global AIDS Coordinator, Ambassador Mark Dybul, led a USG delegation to the XVI International AIDS Conference in Toronto, Canada. Ambassador Dybul explained to participants how the USG is working with host nations, and in an interview with the Kaiser Family Foundation, he stressed the importance of sustainability and local capacity-building in meeting the Emergency Plan�s goals. He explained, �President Bush committed $15 billion over five years, so we could achieve those goals and so we�re on track to do it, and we�re going to do it by building local capacity, building the systems in country � in a multi-sector way.�

Ambassador Dybul and the Director of Kenya�s National AIDS/STI Control Programme, Dr. Ibrahim Mohammed, co-authored an opinion piece on USG support for Kenya�s HIV prevention efforts, which was published in the Toronto Star newspaper during the conference. Additionally, Kenyans discussed their role in implementing the Emergency Plan via a digital video conference from Nairobi which was attended by Canadian journalists in Toronto.

PEPFAR�s 2006 HIV/AIDS Implementers� Meeting in Durban, South Africa, was attended by numerous governmental and non-governmental leaders from host nations, providing another key outreach opportunity. This meeting is discussed at length in the chapter on Implementation and Management.

Fostering Leadership of People Living with HIV/AIDS
The Emergency Plan seeks to actively engage PLWHA in planning for, delivering, and monitoring the effectiveness of prevention, treatment, and care services. Emergency Plan in-country teams consult with national networks of PLWHA when determining priorities for annual Country Operational Plans, and involve PLWHAs in site visits and other efforts to assess program responsiveness. The leadership of PLWHA is also important for advocacy and social mobilization at the local, country, and regional level. PLWHA are the best advocates for HIV/AIDS interventions, and their involvement and visibility help to increase HIV/AIDS awareness and decrease stigma.

In December 2006, President Bush highlighted this issue by inviting Mr. Cyriaque Yapo Ako of C�te d�Ivoire, Executive Director of the R�seau Ivoirien des Organisations des Personnes Vivant avec le VIH/SIDA (RIP+), to a World AIDS Day roundtable at the White House (discussed further in this chapter). RIP+, one of the 22 initial grantees under the New Partners Initiative (please see the chapter on Building Capacity: Partnerships for Sustainability) is an association of groups for PLWHA. It employs integrated and comprehensive programming, in order to build the capacity of local organizations to provide care and support to PLWHA. Mr. Ako is a leader in the campaign for the rights of PLWHA and for the extension of HIV/AIDS prevention, treatment, and care services in C�te d�Ivoire.

PEPFAR supports numerous activities that engender leadership among PLWHA. A few examples include:

  • In South Africa, the Mothers to Mothers-to-Be program has received international attention for achieving striking results. This program employs, trains, and supports HIV-positive women who have received prevention of mother-to-child HIV transmission (PMTCT) interventions. These women educate HIV-positive pregnant women about PMTCT. Through the program, pregnant women learn the importance of knowing their HIV status, are given information about how to access PMTCT programs, and are told about steps to prevent mother-to-child transmission.
  • In Kenya, PEPFAR supports a number of efforts to link PLWHA who have similar interests. For example, a growing network of HIV-positive educators provides care for its members and works to improve the educational environment. Similar networks of HIV-positive religious leaders, Muslim women, and disabled people have also been effective within their communities.
  • In Nepal, a group of 15 Nepalese women founded Sneha Samaj, the first support group for women and children living with or affected by HIV/AIDS. Sneha Samaj means �community for love and affection.� The organization received start-up money to open a shop to generate income. With the funds, they purchased six sewing machines, sewing tables, racks, irons, scissors and lights, and employed seven women. Profits from the sale of products go toward Sneha Samaj�s treatment and care programs.

China: PLWHA Network Makes a Difference

With support from PEPFAR, a network of people living with HIV/AIDS (PLWHA) is changing local attitudes and policies concerning HIV/AIDS. The network is a significant achievement for the community of Wuzhou City, located in Guangxi Zhuang Autonomous Region � one of China�s most severely affected areas.

In China, where as elsewhere the fear of stigma and discrimination prevents many people from disclosing their HIV status, PLWHA networks are few. In 2005 and 2006, the Emergency Plan organized training workshops to build the capacity of a core group of PLWHA leaders. As a result, in March 2006, participants formed a network of PLWHA in Wuzhou City, which has grown quickly.

The strengthening of PLWHA leaders in Wuzhou is having a significant impact on the lives of HIV-positive people in the region. In addition to exercising leadership, network members also have gained respect from the community.

The Wuzhou PLWHA network has received two public �Praise Letters,� recognizing the group for its �noble� work. One letter from local police thanked the PLWHA network for

  Groups of people living with HIV/AIDS in China are breaking down barriers to stigma by becoming community leaders.
responding when police called in the network to care for an HIV-positive woman who was considering suicide. The other letter was from a local community committee, thanking the network members for putting out a fire in a nearby residence before the fire brigade could arrive. By being open about their HIV status, members of the Wuzhou network have received positive, public recognition � a groundbreaking achievement in a country where HIV-related stigma and discrimination are high.

The President considers the participation of PLWHA to be a critical element in the global HIV/AIDS response. On World AIDS Day 2006, President Bush directed the Secretary of State to request, and the Secretary of Homeland Security to initiate, a rulemaking process that would create a categorical waiver for PLWHA seeking to enter the United States on short-term visas. A 1993 law prohibits HIV-positive people from receiving visas to visit the United States without a waiver, but a categorical waiver will enable PLWHA to enter the United States for short visits through a streamlined process.

Uganda: HIV-Positive Journalist Leads in the Fight Against HIV/AIDS

Elvis Basudde, one of the attendees of the �Editorial Leadership in HIV/AIDS Reporting: Changing Hearts, Minds and Behaviors� workshop, is a Ugandan journalist living with HIV/AIDS. He is one of a growing number of prominent Ugandans who are openly disclosing their HIV status and who are actively involved in the fight against HIV/AIDS.

Basudde shares with others his experience as a person living with HIV/AIDS (PLWHA). �I have lived on because I refused to interpret my condition as terminal and learned to live positively. The first thing I did was to accept my status,� Basudde said.

Initially very ill, Basudde sought treatment. He recalled his weight was only 80 pounds when he was admitted to a clinical research center. �My face was sunken. I had full-blown AIDS. My relatives and friends cried, knowing there was not much time left,� he said. Thanks to antiretroviral treatment, his health was dramatically restored.

Today, Basudde is a leader in his country. �I have gone from the frightened �victim� to a spokesman for new views about HIV and AIDS, and I hope I can celebrate more birthdays,� he said.

He works to spread the message about HIV/AIDS. �I am sounding a serious warning, particularly to the young people, who are more vulnerable. They should avoid unsafe sex, by abstaining or using a condom. Never have a sexual relationship before testing for HIV. So many people look healthy, but may have the virus.� He added: �Using my experience I am encouraging those living with HIV not to give up on life. Many are dying psychologically.�

With support from PEPFAR for the journalist training workshop, Basudde�s message will reach a growing number of people. The bold leadership of people like Basudde is helping to turn the tide against HIV/AIDS.

Fighting Stigma and Discrimination Against PLWHA: Statement on World AIDS Day by Secretary of State Condoleezza Rice

Dead Sea, Jordan
December 1, 2006

On this World AIDS Day, we mourn the more than 25 million people who have died from AIDS in our world, and we remember the over 39 million people who are currently living with HIV. It is also a time for the world community to come together in commitment to the promise of partnerships that are creating new hope. President Bush�s Emergency Plan for AIDS Relief is making great strides as a result of partnerships with people in communities around the world. Success is possible only where there is leadership and commitment by governmental and non-governmental sectors in host nations, and it is exciting to see the growing leadership and commitment to fighting AIDS in hard-hit nations.

Creating a world free of HIV is one of the great moral callings of our time and one that requires a global response. On this World AIDS Day, I commend the people who are leading the fight in their nations and communities, and I especially call on the world community to rededicate efforts to prevent stigma and discrimination against people living with and affected by HIV/AIDS. The American people stand with the people of the world in the fight against HIV/AIDS.

Raising Awareness through Public Affairs and Public Diplomacy
In an effort to build awareness of the global HIV/AIDS emergency, reduce stigma, and encourage bold leadership, the USG employs a wide range of communications and outreach strategies to engage domestic and international audiences.

For example, World AIDS Day is observed on December 1st of each year. In 2006, the USG selected �the promise of partnerships,� as the theme around which to coordinate all its outreach and awareness endeavors. A variety of communication initiatives highlighted local people and organizations around the world that are creating hope in their own nations and communities, resulting in extensive domestic and international press coverage.

Eugenio Pazar�n Osornio, who works with Consejo Nacional Empresarial sobre SIDA in Mexico, is an advocate for reducing discrimination in the workplace and increasing awareness regarding the prevention of HIV.

At the White House, President Bush discussed the global and domestic response to HIV/AIDS at a roundtable discussion with Mrs. Bush, Health and Human Services (HHS) Secretary Michael Leavitt, Ambassador Dybul, and HIV/AIDS community leaders from the U.S. and Africa.

On World AIDS Day, the White House also announced new partnerships under PEPFAR�s New Partners Initiative (discussed in the chapter on Building Capacity: Partnerships for Sustainability).

A wide range of media activities illustrated the promise of partnerships between the American people and the people of the world in the fight against HIV/AIDS. These included domestic and international press coverage, opinion editorials, and digital video conferences. Ambassador Dybul�s editorial on the �Promise of Partnerships� ran in seven U.S. newspapers, and a joint op-ed on public-private partnerships by Sir Richard Branson, Chairman of Virgin Group, and Ambassador Dybul ran in the Financial Times. Digital video conferences between PEPFAR principals and Malta, Taiwan, and Zambia, domestic and international media, and students from 10 universities were held leading up to World AIDS Day.

Other principals from the Office of the U.S. Global AIDS Coordinator participated in World AIDS Day activities around the world. Dr. Tom Kenyon, Principal Deputy Coordinator and Chief Medical Officer, participated in the Government of Tanzania�s World AIDS Day commemorations, which were attended by President Kikwete and U.S. Ambassador Retzer. The event was held in the rural town of Musoma and drew a crowd of close to 30,000 people, many of whom were young adults. Ambassador Jimmy Kolker, Deputy U.S. Global AIDS Coordinator and Director of Diplomatic Outreach, participated in a World AIDS Day roundtable discussion at the United States Mission to the United Nations in New York City.

C�te d�Ivoire: Fighting HIV/AIDS in War Zones

HIV-positive people living in war zones under the control of the New Forces in C�te d�Ivoire often face challenges when trying to access HIV/AIDS treatment. However, a recently launched partnership in the Northern and Western parts of C�te d�Ivoire is providing much-needed HIV/AIDS interventions in these war-torn regions. Supported by PEPFAR, the program is restoring health care services devastated by the country�s four-year civil war.

This program, which is the second of its kind, provides HIV/AIDS services to hundreds of villages and towns located in the country�s war-torn regions. Designed and implemented with PEPFAR support, the project was launched in Bouake on August 25, 2006, by U.S. Ambassador to C�te d�Ivoire Aubrey Hooks and Miss C�te d�Ivoire, Alima Diomand�.

To launch the program, Ambassador Hooks and Miss C�te d�Ivoire led a kilometer march with more than 300 Boauke residents to an HIV/AIDS testing center, where they were publicly tested for HIV. It sent a powerful message across the country about the importance of knowing one�s HIV status.

The program has engaged peer educators and supports campaigns aimed at preventing new infections, treating and caring for those living with HIV, and offering care for orphans and vulnerable children affected by the epidemic.

  In an effort to reduce the stigma about being tested, Ambassador Aubrey Hooks and Miss C�te d�Ivoire are publicly tested for HIV/AIDS in Bouake.

At the country level, U.S. Ambassadors are key public advocates for HIV/AIDS awareness and local partnerships. By meeting with PLWHA, visiting PEPFAR-supported projects, and being publicly tested for HIV, U.S. Ambassadors play active roles in raising awareness and advocating for HIV/AIDS initiatives. Around World AIDS Day, U.S. Ambassadors authored op-eds in local newspapers and participated in a wide range of events. Among the highlights:

  • The U.S. Ambassador to India, David C. Mulford, authored an op-ed entitled, �The U.S. and India � The Promise of Partnerships against AIDS,� in a widely read, national English daily in India. In addition, the Embassy team contacted key media outlets, including leading Indian newspapers and television channels, to offer use of a red HIV/AIDS ribbon they designed. On December 1, 2006, most of India�s major television channels superimposed the ribbon on their screens throughout the day. The team described sharing the HIV/AIDS ribbon as �one of the simplest, yet most effective strategies used this year.� The U.S. Embassy in Delhi, as well as U.S. Consulates in Calcutta, Chennai, and Mumbai, organized multiple, high-profile activities, including art exhibits and youth summits. In Mumbai, dabbawallas (couriers of boxed lunches) distributed bookmarks from a USG-supported youth campaign and red ribbons to more than 100,000 recipients.
    • On World AIDS Day, U.S. Ambassador to South Africa Eric M. Bost, traveled to a PlayPump site in Diepsloot in Guateng Province in South Africa. This pump�s billboard features Kami, the HIV-positive Muppet from Takalani Sesame.
    • The week of World AIDS Day, the U.S. Ambassador to Zambia, Carmen Martinez, opened a PEPFAR-sponsored, five-day workshop for editors and reporters from Zambia and 12 other Emergency Plan partner countries. The workshop, entitled �Editorial Leadership in HIV/AIDS Reporting: Changing Hearts, Minds and Behaviors,� attracted 32 editors and journalists from Botswana, C�te d�Ivoire, Ethiopia, Guyana, Kenya, Mozambique, Namibia, Rwanda, South Africa, Tanzania, Uganda, Vietnam, and Zambia. Via video conference from Washington, Ambassador Kolker spoke to journalists on the media�s vital role in raising HIV/AIDS awareness and decreasing stigma and discrimination.
    • In addition to being featured on the Department of State�s �Ask the Ambassador� web chat, the U.S. Ambassador to South Africa, Eric M. Bost, traveled on World AIDS Day to Guateng Province to see a PlayPump in action (please see chapter on Building Capacity: Partnerships for Sustainability). Complementing this PlayPump�s installation are positive living messages featuring the image of Kami, the HIV-positive Muppet from Takalani Sesame.

      One of the most effective new public diplomacy tools produced this year was a 30-minute documentary entitled, �Voices of Hope,� which was produced by Still Life Projects. The film features community leaders and recipients of services from Guyana, Kenya, Mozambique, South Africa, Uganda, Vietnam, and Zambia. Participants spoke about how PEPFAR�s prevention, treatment, and care initiatives are making a difference in their lives. To view �Voices of Hope,� visit

      On August 9, 2006, �Voices of Hope� premiered at the Eisenhower Executive Office Building in Washington. Ambassadors to the United States from Namibia, Swaziland, Tanzania, and Vietnam, as well as other members of the diplomatic corps from PEPFAR partner nations, were in the audience. Ambassador Dybul told attendees: �The Emergency Plan was the first quantum leap in commitment by the American people � to support the fight against HIV/AIDS.

    • The American people will stand with the people of the world in this fight, until the fight is won.� Dina Powell, Assistant Secretary of State for Educational and Cultural Affairs, stressed the importance of the Emergency Plan�s efforts to unite a variety of organizations in the fight against HIV/AIDS. She highlighted the importance of �Voices of Hope� as a public diplomacy tool.

      Since its release, the film has been used by U.S. Embassies to increase awareness of HIV/AIDS and of the partnerships between the American people and the people of many nations. It also was used to educate U.S. audiences about HIV/AIDS on World AIDS Day. It is provided free of charge, and high schools and universities across the United States requested copies of the DVD to play not only on World AIDS Day, but also in conjunction with lessons in health, science, and social studies classes throughout the school year. The film resonates with audiences because it features people and families living with HIV/AIDS who share their experiences in their own words.

      Ethiopia: People Living with HIV/AIDS Speak to the Nation

      �When Tizita discovered her husband�s notebooks, she wasn�t expecting them to change her life. As she leafed through them she was shocked to find that he was HIV-positive. Page after page, he agonized over how to tell her, but until now he had kept silent,� the radio rang out.

      This account, which sounds like the plot of a drama serial, is actually the true experience of one of Ethiopia�s HIV-positive radio diarists. Broadcast on national radio, the series gives millions of Ethiopians a chance to hear about the real-life experiences of people living with HIV/AIDS. On the show, six HIV-positive people talk about their lives openly during weekly installments.

      PEPFAR supports this initiative by providing training in radio programming. �What strikes me most is just how powerful the stories of the diarists have been,� advisor Jim Clarke said. �When we first got involved, I was a little worried that they might not have very much to say. But now I find the problem is that we get too much good material rather than not enough.�

      In addition to empowering HIV-positive people to tell their stories, this unique program - and the courage of the people featured on it - is breaking down the barriers of stigma and discrimination in both large and small communities throughout Ethiopia. These people no longer hide their status in shame, but work to educate others about the importance of preventing HIV.

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