Hearing on U.S. budget for Africa includes look at AIDS response

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The Senate Subcommittee on Africa hosted a hearing on the President’s fiscal year 2012 budget for Africa Thursday.  Sen. Chris Coons (D-DE), the new subcommittee chair, presided and was joined by ranking member Johnny Isakson (R-GA), Sen. Mike Lee (R-UT) and Sen. James Inhofe (R-OK).

Asst. Secretary of State for Africa Johnny Carson led off the all-government witness panel by noting that the administration’s request for Africa for the next fiscal year totaled $7.8 billion for a range of priorities, including strengthening democratic institutions, improving food security and the Global Health Initiative. Carson highlighted progress in the region associated with U.S. support in the form of an increasing number of democracies in sub-Saharan Africa and pointed out some of the U.S. security and economic interests in that part of the world.  For instance, nine percent of U.S. oil comes from Nigeria.  He illustrated ongoing challenges for the region and offered as examples that life expectancy in Nigeria is 48 years and the gross domestic product per capita in Ethiopia is $344.

In his testimony, Ambassador Eric Goosby provided the Committee with an overview of the President’s Emergency Plan for AIDS Relief (PEPFAR) program activity and progress in the region – home to 70 percent of all persons living with HIV in the world.  “I am humbled by the sheer numbers of lives we have saved and the families we have kept together,” said Goosby, while acknowledging that much work remains.  When asked by Chairman Coons about successes, Goosby reported that he had just come back from Ethiopia, Botswana, South Africa and Haiti, and the changes generated by investments from PEFPAR and the Global Fund to Fight AIDS, TB and Malaria have been transformative.  He described the early days of the epidemic as a time when HIV “had saturated and overwhelmed the entire medical establishment” and “created chaos in families, communities, and whole societies.”  Goosby described PEPFAR as helping to decompress the medical delivery system and ultimately to move HIV care from an inpatient terminal illness to an outpatient chronic disease. 

“The American people should be very proud of our contribution to stopping the deal and dying and returning people to the business of living their lives,” Goosby said.

Senator Lee, noting that 70 percent of U.S. resources to sub-Saharan Africa go to global health, asked Ambassador Goosby when the dramatic upward trajectory of funding for HIV could end.  Goosby responded by highlighting five countries that he thought could manage their own HIV responses within the next five to 10 years: Nigeria, Botswana, South Africa, Namibia and Angola.  He was emphatic in his support for the Global Fund, which he described as America’s most important partner in the fight against global AIDS and critical to the sustainability of the AIDS response.

Replying to a question from Coon about how the PEPFA R program is able to operate in conflict regions of Africa, Goosby used Cote d’Ivoire as an example.  Goosby described the response to conflict in the nation as ongoing, but indicated that they had been able to avoid drug stock-outs, ensure continuity of care for persons on antiretroviral therapy, and maintain program support for orphans and vulnerable children.

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