United States International Strategy on HIV/AIDS.

APPENDIX A: An Agenda for Action

The following breakdown by agency re-capitulates the action items outlined in the body of the document in their order of appearance. For actions in which more than one agency is involved, the action, in most cases, is listed according to the agency which will take the lead.

State Department

The State Department will ensure that the major tenets of this document are promoted in relevant international meetings of the U.N. and other bodies, including the IVth World Conference on Women, as well as within U.N. agencies themselves, and particularly in the Joint U.N. Programme on AIDS.

The State Department will develop policy guidance materials to ensure that U.S. international HIV/AIDS objectives are promoted in discussions between senior USG representatives and national leaders from key countries. In addition to encouraging leaders to join the United States in endorsing the 1994 Paris AIDS Declaration and the Joint U.N. Programme on AIDS, USG representatives will emphasize a range of concerns, including the urgent need for leaders to openly address the HIV/AIDS pandemic in their own countries, the need for governments to consider the adverse economic impact of HIV/AIDS in their countries, the need for other governments to increase spending on HIV/AIDS prevention and research, and the need to establish or implement National AIDS Action Plans.

U.S. ambassadors and other embassy representatives will meet with host country counterparts to describe the U.S. International Strategy on HIV/AIDS and to encourage leaders to expand HIV/AIDS prevention and mitigation programs. Emphasis will be placed on the important role that NGOs, business groups, people living with HIV/AIDS, and community organizations should play in an effective response to HIV/AIDS.

The State Department will transmit this Strategy on HIV/AIDS in a cable to all posts.

The State Department will seek to heighten the awareness of the foreign
policy implications of HIV/AIDS to the foreign service community through
all available mechanisms.

The Secretary of State will join the Secretary of the Department of
Health and Human Services in sending a joint letter to Congress

describing the broad impact of HIV/AIDS, including the implications for
U.S. foreign policy and national security interests. The letter should
describe the important role of U.S. biomedical research in the global
strategy to prevent infections. The letter should urge Members to
support fully the Administration's budget request for biomedical research
and international AIDS prevention.

The State Department will host a 1-5 day conference with U.S.-based
international business leaders to discuss a range of HIV/AIDS-related
issues, including the impact of HIV/AIDS on trade and investment
decisions and on sustainable economic development of trading partners.
The State Department will assist USG agencies as necessary in
strengthening or establishing international research and training
collaborations and will assist, as necessary, in gaining approval for
HIV/AIDS vaccine trials and other research efforts in host countries.

he State Department will convene a meeting of the National Science and
Technology Council's Committee on International Science, Engineering,
and Technology to address the global challenge of emerging and re-
emerging diseases, including HIV/AIDS.

The State Department, in collaboration with the CDC, will organize a workshop to examine surveillance and epidemiological issues and related policy concerns in the Former Soviet Union.

The State Department will emphasize to appropriate U.N. agencies, including UNICEF, UNDP, WHO and UNFPA, the importance which the USG places on prevention of HIV infection of children and youth and will urge U.N. bodies to prioritize their efforts for preventing infections and mitigating the impact of HIV/AIDS on children and youth.

The State Department will convene an interagency working group to discuss mechanisms whereby the USG may work more closely with development banks to reduce the spread of HIV/AIDS at development project sites.

1m The State Department and other appropriate USG representatives will promote the safeguarding of the protection under the law for persons living with HIV/AIDS with regard to access to health care, employment, education, travel, housing and social welfare in all appropriate fora. The State Department will continue to include HIV/AIDS-related discrimination and human rights abuses in regular embassy reporting. The State Department will convene an interagency meeting to address the impact of HIV/AIDS on international peacekeeping operations and humanitarian missions. Recommendations for action will be made to appropriate officials, including those responsible for U.S. policy on U.N. peacekeeping operations.

The State Department will work with the Departments of Commerce and Treasury and USTR to include AIDS as an agenda item at the G-7 and other appropriate international economic meetings.

1q The State Department will work to ensure that the objectives outlined in the present document support and complement those of the national HIV/AIDS action plan, now being developed.

The State Department and senior USG officials will support -- and will urge other governments to support -- the speedy establishment of the Joint U.N. Programme on AIDS. They will also urge other governments to increase their contributions to the U.N.'s efforts on HIV/AIDS to the already high levels being contributed by the USG.

The State Department will convene regular interagency meetings to discuss the international calendar and to develop common approaches on HIV/AIDS issues.

Using the HIV/AIDS component of the Common Agenda with Japan as a model, the State Department and USAID will pursue agreements with other donors to work more closely on HIV/AIDS in priority countries.

USAID

As outlined in the body of the present document, the following are some of the key elements of USAID's global HIV/AIDS strategy:

Identify successful prevention strategies and, through USAID missions
and U.S. embassies, publicize successes to government and community
health workers so that they may be duplicated elsewhere, including in
other regions of the same country as well as in other countries.
Continue to support behavioral research, with the aim of developing
culturally appropriate prevention strategies, and studies of the economic
impact of HIV/AIDS, particularly at the household level.

Continue to develop programs which underscore the linkage between
provision of reproductive health services, the treatment of sexually
transmitted diseases, and reduction in the spread of HIV/AIDS.

Address the socio-economic factors which contribute to women's
vulnerability to HIV infection through programs to increase the level of
education in girls and women and their economic potential.

Support efforts in the development of technologies such as microbicides
and the female condom and behavior strategies which will provide
greater options for women to protect themselves from infection.
Develop new and better male condoms.

When appropriate and feasible, incorporate HIV/AIDS prevention
activities into the overall health strategy for well-established refugee
camps.

With the goal of developing long-term treatment and care strategies for
HIV/AIDS affected persons, USAID, with support from the State
Department as needed, will continue and expand efforts to bolster health
care infrastructures in countries in need.

Continue to provide technical assistance to countries for the
identification and development of international procurement and
distribution mechanisms for drugs, vaccines and other preventive
technologies.

Work with other donors to establish innovative programs, including the
establishment of trust funds, in order to provide social services and
support for the burgeoning number of AIDS orphans in developing
countries.

DHHS AGENCIES

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NIH's Office of AIDS Research, in collaboration with the Fogarty International Center, will develop an inventory of NIH-supported research being conducted in both developing and developed countries.

NIH will continue its strong AIDS research program with the aim of developing effective behavioral strategies, drugs, vaccines and other preventive technologies and approaches, including vaginal microbicides, and low-cost diagnostics to reduce the spread and impact of HIV/AIDS. NIH will work with the private sector, as appropriate, in this endeavor.

FDA will work with product manufacturers to facilitate the rapid development of new agents for the prevention and treatment of HIVrelated conditions as well as medical devices for the prevention of HIV transmission.

CDC will continue to support behavioral research which provides information on risk behaviors and which assists in targetting prevention strategies more appropriately.

NIH's Office for Protection from Research Risks will continue its advisory and regulatory role in ensuring that international research is conducted in an ethical manner and one that is consistent with agreed principles for protecting human subjects.

DHHS will work with international partners, including NGOs and
international development agencies and organizations, to assist in
safeguarding the world blood supply.

FDA will work with manufacturers to facilitate the development of new
testing methodologies and other approaches to help assure the safety of
the blood supply.

PHS will prioritize efforts in the development of technologies such as
microbicides and the female condom and behavior strategies which will
provide greater options for women to protect themselves from infection.
PHS will prioritize efforts to develop new and better male condoms.
The NIH will place a high priority on following up initial studies which
could lead to methods for preventing HIV transmission from mother to
fetus, including antiviral therapy (AZT) and micronutrient treatment
(vitamin A) during pregnancy and on further defining the context of their

use.

With the goal of developing effective and affordable long-term
treatments and strategies to provide care and to assist HIV-infected
persons and their families, PHS, with support from the State Department
as needed, will continue and expand efforts to bolster health care
infrastructures.

DHHS agencies will continue to work toward the identification and
development of international procurement and distribution mechanisms
for drugs, vaccines and other preventive technologies.

3m CDC, in collaboration with other agencies, will work toward improved global monitoring of the spread of HIV/AIDS. This includes working with the U.S. Census Bureau to expand its international HIV/AIDS database to include statistics from developed countries and the Former Soviet Union.

Peace Corps

The Peace Corps' programs which incorporate HIV/AIDS education into other services, such as the teaching of English, should be viewed as models for successful and integrated interventions and should receive continued support.

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