I’d like to introduce the experts that will be joining us for this discussion. We are privileged to have with us Deborah Von Zinkernagel, Principal Deputy Global AIDS Coordinator in the Office of the U.S. Global AIDS Coordinator; Dr. Shannon Hader, Vice President and Director of the Center for Health Systems and Solutions at Futures Group; and Chris Austin, President of the Returned Peace Corps Volunteers of Washington, DC. Thank you all so much for participating in this program.
In 2002, fewer than 50,000 people in sub-Saharan Africa had access to lifesaving anti-retroviral treatment. An AIDS diagnosis was truly a death sentence. In May 2003, President George W. Bush signed the bipartisan President’s Emergency Plan for AIDS Relief bill into law, and under the leadership of President Obama the United States is now full committed to achieving an AIDS-free generation.
Deborah, could you start us off by talking about your role as Principal Deputy Global AIDS Coordinator?
MS. VON ZINKERNAGEL: Well, thank you, Cheryl. It’s a pleasure. Thank you for having us here today.
MS. BENTON: Absolutely.
MS. VON ZINKERNAGEL: We are very pleased and honored to have the opportunity to lead the PEPFAR program, which is now serving in roughly about 80 countries. So it’s sort of been America’s terrific gift, I think, in terms of outreach, in terms of global health, and really taking on the challenges of the AIDS epidemic in the world, and has saved millions of lives. So it’s been – it’s a rich program. We draw upon the strengths of our agencies across the government, from the Health and Human Services and USAID, Peace Corps, and others are all a part of this effort. And so it’s been going, as you say now, for a number of years and tremendous progress has been achieved. I think people can be extremely proud of what the taxpayers have allowed this government to do.
MS. BENTON: That’s nice. I like to hear that word, “taxpayer,” and people being happy about that. So can you tell us a little bit about your work, Chris?
MR. AUSTIN: Sure. I wasn’t sure what capacity I was going to appear here today because obviously I’m a returned Peace Corps volunteer, I served in Kenya from 2003 to 2005 as a health education resource volunteer. And my primary job, basically, was to help teachers in primary and secondary schools in rural Kenya implement an HIV/AIDS syllabus. So that was from 2003 to 2005, like I said. And then since then I’ve been working on Capitol Hill for a member of Congress who is also a Peace Corps volunteer. He served in Ethiopia from 1966 to 1968. His name is John Garamendi. He represents a district in northern California.
And on the side, the President of the Returned Peace Corps Volunteers of Washington, DC, which is a nonprofit that aims to bring our Peace Corps service back to the community here. DC is the largest concentration of returned Peace Corps volunteers in the world, so we have about 900 members. And it’s a fantastic organization that I’ve had the privilege of working with and leading for the last three years.
So I’m happy to – just thank you for having me here.
MS. BENTON: Absolutely.
MR. AUSTIN: It’s really an honor to be here on such a distinguished panel.
MS. BENTON: Absolutely. Shannon, can you tell us a little bit about your role and what the Futures Group does?
MS. FADER: Sure. Well, I think our 10-year PEPFAR trajectory, I was actually serving with U.S. Centers for Disease Control and Prevention in Zimbabwe, running our Zimbabwe AIDS program, when PEPFAR became real. So from the early days of our real global HIV expansion to what we see now, and when I came back I actually worked with Deborah’s office, Office of the Global AIDS Coordinator, before then transitioning back to domestic HIV/AIDS here in Washington, DC, where I found a lot of the work that we were doing globally, a lot of assistance we were building, a lot of large-scale interventions that PEPFAR was supporting abroad had some real lessons to be learned here at home too. Since then I’ve come back to the global world of Futures Group, where we provide technical assistance to governments, to community-based organizations, under the PEPFAR program. And increasingly, we actually also do programs funded by the U.K. Government or the Australian Government that either build on or leverage a lot of those initial investments that PEPFAR really brought to being.
MS. BENTON: Very good. We hear a lot of talk about an AIDS-free generation, and so I’m sure our viewers are curious, as I am, what exactly does that mean, and how is America helping to get to that place? Deborah, would you take that first?
MS. VON ZINKERNAGEL: Yeah. Well, I think there’s – it’s sort of a progression that we look at. I think the first step is to be sure that no child is born with HIV. We have the tools, we have the – we know what to do. We have the prevention, we have the knowledge. And it’s just making sure we get those services out to women who need them so that their children can be protected. Then, as children get older and you move into youth, the important step is to keep them free from HIV, so effective prevention measures, there’s effective approaches that are getting to the age groups that are most at risk, early teenagers, adolescents. It’s a time where you have a lot to offer and you need to be very visible with your messages. And then as you get older, if you do become – if you do acquire HIV, then the important thing is to make sure you have appropriate treatment so that you can – both for your own health so that you can stay well and live a full life and productive, and also so that you don’t then pass on the virus to somebody else.
So at the end of the day, the goal is really to control the epidemic by preventing new infections, taking care of those who are, but using – we have a lot of – we know what to do at this point in time and now it’s really just making sure the services are there and people have the information they need.
MS. BENTON: So I’m curious; how is the United States working with partner countries to manage their AIDS response and how have the partnerships evolved since 2003? I’d like to throw that to you, Shannon.
MS. HADER: Oh, sure. Well, I think there’s a real diversity of ways we’re working with partner governments. Not to say that PEPFAR from the get-go wasn’t working with partner governments. It was, as well as new partners and civil society and a whole constellation of partners. But 10 years, it’s amazing how much has transformed in 10 years and how much further things are going. So we’re past the start-up phase, we’re past the discussions of whether to or how to or should we both to collectively as governments respond to HIV/AIDS, and we’re past the, well, how much can we really do, because we found out together we can do a lot.
So now we’re in this. Okay, so how do we, I think particularly as PEPFAR, support local governments to not just continue their leadership that is now there for the HIV response, but build their systems to scale so that they don’t crumble the first time the context changes or the political dynamics changes. So it becomes – I don’t want to say business as usual, because there’s nothing about PEPFAR that will ever be business as usual, but so that systems abroad, systems led by government, but also contributed by civil society, they become thriving, dynamic, continually learning or innovative systems that provide a stability of prevention, care, and treatment as we learn more and do more. That’s sort of what I think that we’re doing.
MS. BENTON: I know you’re wearing a couple hats, and working with the retired volunteers and then on the Hill. So the worlds must collide there from your perspective and working on the congressional side and then with volunteers.
MR. AUSTIN: Yeah. Well, let me say that I should probably just speak in my capacity as the President over the Returned Peace Corps Volunteers of Washington, DC here today. Yeah, on Capitol Hill, you’d be surprised how much – what’s portrayed in the media is often the gridlock and the polarization of the two parties. But behind the scenes, there is a lot of good spirit and goodwill between the members of – members and staff of different parties. And PEPFAR was started by a Republican administration.
MS. BENTON: That’s right.
MR. AUSTIN: So – and obviously it’s been continued very strongly by a Democratic one. So on PEPFAR and related issues, even the Peace Corps, there’s a very strong bipartisan feeling towards these programs, which is nice. And it’s nice for me because I’m so passionate about these two programs, so it –
MS. BENTON: Well, and it helps to become successful.
MR. AUSTIN: To see that support. Exactly. Yeah, yeah.
MS. BENTON: That’s very good. How is PEPFAR contributing to broader health systems?
MS. VON ZINKERNAGEL: I think if you think about what does it take to take care of a person who has HIV, it’s a complex disease, but basically you need a trained provider, you need to know somebody who basically can take care of you if you come and you have symptoms or if you have – you need care. So by training health care workers, by making sure there are (inaudible) doctors, there are nurses, there are health care workers, community health care workers available to sort of provide that basement level of health care, including HIV care. You’ve actually strengthened the much broader system.
You need to be able to have access to medicines and to a laboratory test that will tell you which way you – how the treatment needs to go. So in the course of putting a system in care for HIV, you’re also putting a system in for pharmacies and for laboratories. You are strengthening the blood safety systems of countries by – it is in the nature of putting that health care system together for HIV that you’re putting a much broader opportunity that can serve people with many other things as well in place. So I think it is a process. It’s very much, as Shannon said – we aren’t doing it for, we do it with countries, very closely. These are their people; we are there to help, and sort of identifying those needs and being helpful in responding to them, and they have the capacity to then do it themselves as well for the long time. But it’s an honor to work with them in that relationship.
MS. BENTON: Yeah. I know that since we discovered the HIV/AIDS virus, things have changed drastically. And in the ‘80s, you never thought it really would get to the point where we’re even talking about an AIDS-free generation. And so I was just curious of what roles do Peace Corps volunteers actually play in promoting health and specifically HIV awareness? I think that’s –
MR. AUSTIN: Sure.
MS. BENTON: -- going to be a critical piece of information.
MR. AUSTIN: Well, Peace Corps volunteers, since the early 1980s when the pandemic sort of spread globally, have been involved with assisting communities, mitigate the effects of HIV. I think right now there are about a third of the Peace Corps volunteers serving, right this minute are out there in villages and cities and towns, working with schools, working with clinics, working with hospitals, working with local governments, youth groups, just almost any organization that you can think of that’s a part of a community, they’re assisting in one way or another to fight against HIV.
And in my particular instance, I was helping train primary school teachers and secondary school teachers implement the HIV/AIDS syllabus that was mandated by the Kenyan Government to be incorporated. Because of the stigma, teachers had a hard time doing that. So us Peace Corps volunteers were working with these teachers and saying, “Look, I know this is a hard subject to teach. It’s a hard subject for me –
MS. BENTON: -- to talk about.
MR. AUSTIN: -- to talk to you about. I’m a kid from the Midwest, out here talking about this very challenging subject. If I can do this, you can do this.”
MS. BENTON: Right.
MR. AUSTIN: And this is how you can subtly bring in HIV/AIDS education. If you’re a science teacher, you don’t walk into the room and write on the blackboard, “Ukimwi,” which is Swahili for “AIDS.” You come in and say, “Today we’re going to talk about the immune system, and this is how the immune system works. We have X number of white blood cells. And by the way, when you have HIV, you don’t have so many white blood cells, and then you have AIDS.” And then – so almost in every subject area you can talk about HIV/AIDS and you can educate.
So that was one area. That was my main job. And then I worked with – I started as a student counselors, student government, and we did some community stuff, community awareness stuff. I started a youth group. Actually, my counterpart, who was on the student government, after he graduated he started this youth group that I helped him lead. And in PEPFAR, we were – when I was working with the PEPFAR program as a Peace Corp volunteer, I was helping – actually AID, they were working with State. They were looking – they wanted to assist AIDS orphans. So that was my job, was trying to help these agencies locate AIDS orphans within the community that could be helped.
MS. BENTON: Right. And civil society plays a big role in that, doesn’t it?
MR. AUSTIN: Yeah, yeah, exactly. So Peace Corps volunteers – and that was my particular instance. I’s different in other countries and –
MS. BENTON: So as we look at PEPFAR, what is being done to improve health outcomes for particularly women and girls? Because we know that education, behavior change, but there are still circumstances within many countries that women and girls are more the object or the subject of negative behaviors. So I just wonder if – how PEPFAR and that whole piece was working there, Shannon.
MS. HADER: Well, I found a continued acceleration, I think, to the specific focus and attention on women and girls under – even in the last four years of PEPFAR. I think it’s been a key initiative. You know our Secretary made it a key initiative.
From our perspective in Futures Group, and one of the many partners that’s helping translate PEPFAR priorities to assistance on the ground and technical movement on the ground, there are a lot of areas that that gets worked at. So there’s policy level, and that doesn’t mean just highest policy level, but working with everything from governments, community grassroots organizations, to really understand what are the information needs and the policy needs that help protect, strengthen, and ensure women and girls don’t get overlooked. We have a whole portfolio that PEPFAR supported, What Works for Women and Girls. The fact that that’s a normal conversation piece now, “Oh, what’s going on, I’ll go to What Works for Women and Girls.”
But I think that sensitization also goes into clinical service delivery, figuring out how services need to be targeted differently in different countries. Some countries where who the healthcare provider is going to serve men versus women in a different way, and just sort of really focusing in on both what needs to be specific and empowered for women and girls, but also what needs to be done for men, because we have to address this full context of gender to really make progress for women and girls as well.
MS. BENTON: Right. And how does your office work with that?
MS. VON ZINKERNAGEL: I think it’s been a very important part of our programming sort of coming on board, recognizing the particular vulnerabilities of women, I think social situations, cultural environments, and also just poverty, a lot of poverty. Violence, gender-based violence, has been a huge – it’s a huge risk factor for HIV. So I think both looking at the gender equity issues, looking at economic empowerment that give women other options for how to provide for their families, for themselves; policy range issues as well as kind of service delivery, making sure the services you’re providing are accessible to women and who often have children associated. And it’s a multipronged approach, but I think it’s one that’s been highly successful in developing, and countries themselves beginning to see the need for this, which is really important, the attention to sort of the gender issues.
MS. HADER: Can I jump in on that? (Inaudible) because it’s a laudatory thing. I have to say what PEPFAR has done for gender-based violence over the last several years is huge. They have a gender-based violence initiative specifically, but I’m not sure you might realize – might not realize how much that’s actually transformed the conversations at grassroots levels. I remember eight years ago when we were looking at the next rollout of health surveys in a country and you could add a gender-based violence module or not add a gender-based violence module, and everybody – and I’m not talking internationals – everybody around the country was, like, “Well, we don’t think we want to add it yet because it’s just too sensitive.”
With the programs and the policies that PEPFAR has really promoted the last few years, I don’t find that anywhere anymore. I don’t care which country I go to; people are willing to talk about gender-based violence. And admit we might not have all the solutions, but we can start that conversation, we can start trying to figure out – so I just have to say PEPFAR has made a huge difference in even the expectations over the last few years.
MS. BENTON: Right. And on that gender-based violence, you just – you have to start that conversation. And I’m just curious; how do governments react and deal with PEPFAR, the education, the – all the solutions that we’re offering? How does that work in other countries, and then why is that important to America’s safety and security?
MR. AUSTIN: Well, I’ll take the Peace Corps part of that. The foreign governments like Kenya, they welcome the Peace Corps and they ask for Peace Corps volunteers. So they’re – and they know what we do. They know what the programs are, and so they’re very willing to go along. And it’s just – it’s a great partnership. That’s the beauty of the Peace Corps and PEPFAR.net, as it’s been – how it’s been implemented in some aspects is because of that. It’s foreign – other countries, they genuinely want it, they want Americans to –
MS. BENTON: -- to be involved in it.
MR. AUSTIN: And work with them.
MS. BENTON: Do you find that with you as well, Deborah, in your program?
MS. VON ZINKERNAGEL: Most definitely. I think we – this is one of the – I think one of the special things that people deserve to hear, and that is that this program has sort of been the best goodwill face of America to other people. There isn’t a country that we go to where people say, “Thank you. Thank you to the – please tell the Americans how much we appreciate what you’ve done.”
I think if you think back, as Shannon was saying, in the early 2000s, in the ’90s and 2000s, Africa was a different continent. There was a whole generation that was dying. All of the people sort of – anybody who wasn’t very young and very old, all of the people in their late teens and 20s and 30s, people were dying everywhere. Hospitals were full. There was a sense of real fragility and chaos in many communities, and no one knew what to do.
I think now with the advent of treatment coming in with services, with the chance people see their neighbor getting healthy again, putting on weight, beginning to work again, families have been stabilized, communities have been stabilized, and countries. As a result, now you have economic growth in many countries, you have populations that are much more able to work, people are able to farm again, there are people back in schools again. It’s a different place. And I think that kind of – if you think of fragile states and you think of what kind of social stability can actually add, a health program has actually been a huge benefit in that regard. And again, it’s so deeply appreciated by people on the ground who will come up and say, “It’s because of the medicine I’m here or my father’s here or my mother’s here.”
MS. BENTON: Right. I think back – I lost so many friends in America early on with the pandemic, and it’s just been so gratifying to see how behavior has changed outcomes, how programs like PEPFAR and other interventions have changed outcomes and rearranging how people manage and take care of their business. So I just wanted to just say that personal thing.
But we’ve also received some questions from Twitter on today’s topic. @WaterAidAmerica asks: How will safe drinking water, sanitation, and hygiene contribute to an AIDS-free generation?
Who wants to take that?
MS. VON ZINKERNAGEL: I’d say there’s many parts of health. I think having access to safe drinking water, one of the leading causes of illness is diarrheal diseases, and often that is because of a clean water supply. So here’s where I think all parts of the U.S. Government and countries and other donors work together around how do we look at clean water access, how do we look at sanitation – very basic, digging wells in communities so that there’s a clean water supply.
So I think to the extent that you’re looking at what people – what do people get sick from, how can you help, people who have compromised immune systems are more vulnerable to some kinds of illnesses and others. So you want to take care of their health and then you want to also take care of a clean water supply for the community as well, and we have a lot of good partners who help in that effort.
MS. BENTON: Very good. Maybe, Shannon, you can address this. @DJobling asks: Is there a formal relationship established between Australia and the U.S. on an AIDS-free generation program strategy?
MS. HADER: Oh, what a great question.
MS. BENTON: Yeah, that’s a good one.
MS. HADER: I might have to boot this one to Deborah.
MS. VON ZINKERNAGEL: Okay. That’s all right.
MS. HADER: I know I can say on an informal level, there is absolutely a lot of crosstalk, and I think in some countries that has led to specific synergistic programs. And there are plenty of opportunities – I know several are being explored in different countries – of even one donor like Australia putting money into a U.S. Government USAID program so that they can make a holistic intervention. But certainly at the country levels of how to have complementarity in the programs they’re supporting, how to not undercut inadvertently, or --
MS. BENTON: Right. Kind of work together synergistically.
MS. HADER: -- competition, is absolutely part of the focus. At a global level, I think that’s on the diplomatic negotiation side. I’m not sure where we’re at on that.
MS. VON ZINKERNAGEL: We are really appreciative of Australia. AusAID is their aid arm, and we work with them closely in the Global Fund context. The Global Fund is a major financing mechanism for AIDS, tuberculosis, and malaria.
MS. BENTON: Is that across the world or just focused on Australia?
MS. VON ZINKERNAGEL: Yes, it is. It’s based – it’s available grants that are available to countries hard hit by those three diseases. And we’re very much appreciate the partnership. I would say that Australia has been very active in Southeast Asia in supporting AIDS response in a number of countries where their proximity is closest, and they’ve shown tremendous leadership and it’s been greatly appreciated how much they’ve invested in the AIDS response.
MS. BENTON: Okay, very good. We have a number – another question from @djobling: What resources are available to the public for additional information on creating an AIDS-free generation?
MR. AUSTIN: Well, I’ll just put in a plug here. (Laughter.) The Returned Peace Corps Volunteers of Washington, DC, and part of our mission, as I said, is to bring our Peace Corps service back home here in the community. And we partner up with other nonprofits, because that’s what our asset is, is that we have 900 people, 900 members who are willing to devote their time and energy to working in the community. And as we all know here in Washington, DC, and this is one of the most – had just one of the most highest infection rates in the country. So I would say go to our website. And we work with other – if you’re a Returned Peace Corps Volunteer, even if you’re not, you can join. But that’s one way. Just getting involved here locally.
MS. BENTON: To educate people.
MR. AUSTIN: Yeah. And there’s a lot of collaboration here in Washington between different organizations.
MS. BENTON: Want to take it?
MS. HADER: Oh yeah. Well, I think in addition to, of course, PEPFAR.gov and reading a lot of the information there, I would just weigh in on – there are a lot – there’s momentum out there. If you find a group that has information or momentum that really gets you excited, that’s the way to link into ending AIDS, I think. There’s a domestic campaign, C2EA – Campaign 2 End AIDs – which is completely aligned with the broader AIDS-free generation priorities.
And I think it’s just good to, I think, look across these different same commitments and say, “Hmm, so how do I get involved with AIDS-free generation? Here’s what I can do internationally, but here’s how maybe also I can infuse that passion and that momentum here in my own neighborhoods at home, too.” So there’s a connection there of what our – this is really a global mission at this point to end – for an AIDS-free generation. So it’s not just an “over there” mission. So to me, the AIDS-free generation, this is our global mission right now, and so yeah, there’s a lot of places to explore.
MS. VON ZINKERNAGEL: And there’s a very good website, that’s www.aids.gov, which is for domestic --
MS. BENTON: Can you give that one again?
MS. VON ZINKERNAGEL: It’s www.aids.gov.
MS. BENTON: Okay.
MS. VON ZINKERNAGEL: And it’s run out of the Department of Health and Human Services, but it’ll have access to domestic information, local community opportunities, as well as the global pandemic as well. So a lot of resources, but I do hope every feels that they can get involved in some way, because it’s a great place to put your energy.
MS. BENTON: Yeah, and they can make a difference.
MS. VON ZINKERNAGEL: They can make a difference.
MS. BENTON: And we can see that over historically how the whole face of AIDs has changed.
MS. VON ZINKERNAGEL: Yes.
MS. BENTON: So now we’re at my very least favorite part of the program, and that means it’s just time to conclude this episode of Conversations with America.
I’d like to begin with Deborah with – if you would share your final thoughts, and if – then move on to Shannon and to Chris. And if you have a website, if you have information you want to get out there, please take this opportunity to share that with our viewers.
MS. VON ZINKERNAGEL: Well, thank you again. This has been a wonderful opportunity to have this conversation. I think the message that Shannon just gave is the best. This is everybody’s opportunity. I think we have made tremendous gains in the past. I think we can look forward to even doing more and actually getting ahead of this, making AIDs something that’s in the rearview mirror and a chapter of history which will be wonderful if we can close it and move on and have done a lot of good in the process, I think, of supporting our partner countries and people to resume their lives in a wonderful way. So we do have a website, www.pepfar.gov, where a lot of information, country-specific information, is available. And we would welcome all visitors to that.
MS. BENTON: Good, good. Chris, can you give us your final thoughts and plug one of your organizations’ sites? (Laughter.)
MR. AUSTIN: Absolutely. If you want to be – to all of those people who are watching who want to be leaders on this global health issue or any public issue, consider the Peace Corps. Consider the Peace Corps. It’s a tremendous opportunity, the best two years of my life, best decision I ever made. It really inspired me to pursue a path in public service afterwards and I can’t say enough good things about it. So if you want to work on HIV/AIDS or tuberculosis or malaria or whatever, consider the Peace Corps. I don’t work for the Peace Corps --
MS. BENTON: That’s okay.
MR. AUSTIN: -- but I promote the Peace Corps, and I think their website’s peacecorps.gov.
MS. BENTON: Okay. And do you have – yeah.
MR. AUSTIN: And then if you’re a returned Peace Corps volunteer and you want to continue to be involved, rpcvw.org is --
MS. BENTON: Say that one again. That was fast.
MR. AUSTIN: Rpcvw.org is our website.
MS. BENTON: That’s the retired –
MR. AUSTIN: Returned Peace Corps Volunteers of Washington, DC.
MS. BENTON: There you go.
MR. AUSTIN: But if you’re in Seattle, there’s a local group there, or if you’re in New York. So there are regional groups and it’s a great way to continue your service back here.
MS. BENTON: Okay, perfect.
MS. HADER: Yeah, I think what I want to end with is just expressing actually how grateful I am for this 10 years of PEPFAR. You mentioned in your story, back in the ‘80s, you couldn’t even imagine the possibility of where we’re at now with the tools and the success in responding to HIV. And just 10 years ago, when we looked at the absolute devastation of HIV in the poorest of nations, most people didn’t believe in the possibility of making it anything different, and PEPFAR absolutely brought both that belief in possibility along with the commitment that drove results. That saved lives. That accomplished things.
And when I look at the 10 years of PEPFAR, and when I talk to my friends and my colleagues around the world, that’s the piece of America that has now become part of PEPFAR. People see possibilities and then see the ability to drive forward to results. And so I guess as I express gratitude for that and just remember that, I think it also goes along with – and now’s not the time to back off. An AIDS-free generation, that’s the next possibility. And so don’t think we’re done.
MS. BENTON: Okay. (Laughter.)
MS. HADER: Don’t think that we can just sort of relax now. Now’s the time to push forward, because this is a great possibility and we know we can get it to results.
MS. BENTON: Good deal. Do you have a website you want to put out there where people can get more information?
MS. HADER: Sure. Www.futuresgroup.com. We do a lot of the implementing partner work and technical assistance and link to a lot of other partners that do the same kind of support work around the world.
MS. BENTON: Very good. Well, clearly PEPFAR has been a game changer around the globe. I want to thank Principal Deputy Global AIDS Coordinator, Dr. Zinkernagel – sorry, Dr. Shannon Hader, and Chris Austin for sharing their work and knowledge with us. I’d also like to thank each of you for joining us today. We hope that Conversations with America will continue to inform citizens about the Administration’s efforts to address the challenges of the 21st century. We look forward to engaging with you again soon. Thank you.