PEPFAR, USAID and HIV/AIDS: Much Ado About Randall Tobias
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I frequently feel amused and occasionally disappointed at the
comments that come from a cross section of HIV/AIDS stake-
holders, regarding Mr. Randall Tobias' activities as the US
Global AIDS Coordinator and now President George Bush's nominee
to head USAID. I feel amused because most of the comments ex-
hibit clear ignorance or neglect of the President's mandate to
Mr. Tobias, and/or the latter's background. I feel disappointed
because some of the brains behind these comments know better or
so I erroneously believe.
When, on 2 July 2003 President Bush announced Mr. Tobias' ap-
pointment, the President made it clear that Mr. Tobias will
function at the rank of an Ambassador. Mr. Bush described his
nominee as "a superb leader who knows a great deal about life-
saving MEDICINES (emphasis mine)", and applauded his great en-
ergy, resourcefulness, good judgment and integrity. In that po-
sition, President Bush listed as the new ambassador's responsi-
bilities viz: to "coordinate all of (America's) international
HIV/AIDS activities for all of our government departments and
agencies, ...WORK WITH THE FAITH-BASED AND COMMUNITY GROUPS to
get the job done, work quickly to get help to the people who
need it most by PURCHASING LOW-COST, ANTI-RETROVIRAL MEDICATIONS
AND OTHER DRUGS that are needed to save lives, (and) DELIVER
DRUGS to the farthest reaches of Africa, even by motorcycle or
bicycle (emphasis mine)".
President Bush continued "we will train doctors and nurses and
other health care professionals so they can TREAT HIV/AIDS PA-
TIENTS,... ensure that CLINICS AND LABORATORIES WILL BE BUILT OR
RENOVATED AND THEN EQUIPPED. CHILD CARE WORKERS WILL BE HIRED
AND TRAINED TO CARE FOR AIDS ORPHANS AND PEOPLE LIVING WITH AIDS
WILL GET HOME-BASED CARE". We will PROVIDE HIV TESTING, SUPPORT
ABSTINENCE-BASED PREVENTION EDUCATION. FAITH-BASED AND COMMUNITY
ORGANIZATIONS (again) will have our help as they PROVIDE TREAT-
MENT AND PREVENTION AND SUPPORT SERVICES IN COMMUNITIES AFFECTED
BY HIV/AIDS. And we're developing a system to monitor and evalu-
ate this entire program, so we can be sure we're getting the job
done (emphasis mine)".
In his response at the occasion witnessed by General Collin
Powel, Secretary of State; Tommy Thompson, Secretary of Depart-
ment of Health and Human Services; Andrew Natsios, the adminis-
trator of USAID; Joe O'Neill of the US Office of National AIDS
Policy; Elias Zerhouni, director of the NIH. Richard Lee Armit-
age, Deputy Secretary of the Department of State; and Tobias'
family; Mr. Tobias promised to "approach (his assignment) with
enthusiasm". In very clear terms, President Bush's (nay USA's)
international HIV/AIDS activities are set up to work with the
faith-based and community groups, purchase and deliver low-cost,
anti-retroviral medications and other drugs that are needed to
save lives, treat HIV/AIDS patients, build/renovate and or equip
clinics and laboratories, hire and train child care workers to
provide home-based care for orphans and PLWAs, and provide ab-
stinence-based prevention education, treatment and support ser-
vices in communities affected by HIV/AIDS. It is noteworthy that
the only prevention component of "one of the largest humanitar-
ian undertakings in our history" is abstinence-based education,
and nothing more. In clear terms also, abstinence-based preven-
tion education does not include any reasonable access to condoms
no matter the level of infection or enthusiasm of potential us-
ers. As a good ambassador, Mr. Tobias has put in place HIV pre-
vention policies focused on "abstinence". The statements he made
about condoms were quite unfortunate, but they go beyond his
mandate, or so I think. Our assessment of his performance must
be guided by the mandate given to him by his employers and
whether he has also been a real good medicine man and renovator
in executing his assignment. Or didn't they say that he who pays
the piper dictates the tune.
My opinion is that Mr. Randall Tobias has done excellently well
as the United States Global AIDS Coordinator, based on the man-
date given to him by President Bush, the American congress and
people. Had President Bush not promised at the announcement of
Ambassador Tobias' nomination, that his government was develop-
ing a system to monitor and evaluate this entire program, so we
can be sure we're getting the job done? Isn't Mr. Tobias' new
appointment to head USAID a clear indication of the very posi-
tive and satisfactory outcome of the monitoring and evaluation
process?
Why don't we give it to him? Congratulations Ambassador Randall
Tobias for doing what you were mandated to do, for being a wor-
thy ambassador of President Bush and the American people. As re-
gards the new assignment at USAID and what it will hold for the
scores of millions of people in Africa and the developing world
who are daily dying from hunger and diseases especially
HIV/AIDS; I would have to study President Bush's mandate for you
at that desk. For now, as we would say in this part of the
world, well done!
Dr. Uzodinma A. Adirieje
Programmes Director
Afrihealth Information Projects/Afrihealth Optonet Association
P.O. Box 4127, Oshodi 100010, Lagos, Nigeria
Office address: 32c Adetola Street, Aguda-Surulere
101014, Lagos, Nigeria
Phone/Fax: +234-1-452-0333
Mobile: +234-803-472-5905
mailto:afrepton@yahoo.com
http://afrihealthoptonet.kabissa.org
http://uk.geocities.com/afrihealthoptonetassociation/AfrihealthOptonet.html