"If we can concentrate in these geographies," said Dybul, "we can interrupt new transmissions, getting new transmissions down to very low levels. And we
can do it in a rapid time frame, effectively containing the epidemic."
Dybul said today there is "a remarkable series of confluences." Besides a better scientific understanding of the diseases, new tools offer the
opportunities to make a tremendous impact. These include the understanding that antiretroviral therapy (ART) for HIV is highly effective at lowering viral
load in infected individuals, making them far less likely to transmit the virus; pre-exposure prophylaxis -- the use of ART to prevent infection in
individuals who engage in high-risk sexual behavior; and male circumcision.
Since its formation in 2002, the Global Fund has been the world's main multilateral funder of global health, channeling about $3 billion annually from its
government and other partner organizations to countries most in need. The U.S. government provides approximately one-third of its funding. It provides
82 percent of all international financing for TB, 50 percent for malaria, and 20 percent of international financing for HIV/AIDS.
Dybul, who previously directed the President's Emergency Plan for AIDS Relief (PEPFAR), the U.S. government's global HIV/AIDS program, said the
Global Fund represents the leading edge of the new approach to international health and development efforts. He said that while the "old approach" was
based on donors and recipients and "a sense that we in the north knew the answers and were just coming to help," the new approach is a "switch from
paternalistic to partnership." Countries are now expected to assume responsibility for the health and development of their people.
This "paradigm shift" -- first modeled in the PEPFAR program -- also focuses on delivering measurable results, such as how much mortality has declined and how
many new infections have been averted. Dybul said there is also a new recognition that "everyone needs to be in the game," that the traditional
country-to-country approach wasn't effective. Not only governments, but civil society, faith-based groups that in Africa provide substantial levels of
health care, even businesses, need to be engaged.
Dybul said a fourth cornerstone of the new paradigm is an intolerance of corruption. "All countries, not just those we support, have to have zero tolerance
for money-shifting," he said.
At this point, said Dybul, "We can either seize this moment and save countless lives and billions of
dollars down the road by containing these epidemics, or we can tell our grandchildren why we didn't when we had the chance."