22 October 2002 Keralamonitor.com Features

Kenya : Focus on female vulnerability to AIDS infection

Many older men - known as "sugar daddies" - choose young girls for sex
in the belief that they couldn't possibly be infected with HIV. Another
reason is to avoid having to pay for it. The younger girls might be
satisfied with sweets, while a regular sex worker could charge anything
from 100 Kenyan shillings, or US $0.80, said Akinyi. Oral sex could cost
half that sum, she added. Mostly teenagers have many different boyfriends.

For those who don't go to school, they may have a different sexual partner every day. A nationwide study of Kenyan women aged between 12 and 24 found that one quarter had lost their virginity
because they had been "forced"," Full Report

Security Cooperation in a Post 9-11 World

Richard L. Armitage, Deputy Secretary of State
Remarks at the Defense Security Cooperation Agency Conference
Alexandria, Virginia

 

Integrating Prevention into Healthcare --WHO Special Report

Due to public health successes, populations are ageing and increasingly, people are living with one or more chronic conditions for decades. This places new, long-term demands on health care systems. Not only are chronic conditions projected to be the leading cause of disability throughout the world by the year 2020; if not successfully prevented and managed, they will become the most expensive problems faced by our health care systems. People with diabetes, for example, generate health care costs that are two to three times those without the condition, and in Latin America the costs of lost production due to diabetes are estimated to be five times the direct health care costs. In this respect, chronic conditions pose a threat to all countries from a health and economic standpoint. Many costly and disabling conditions - cardiovascular diseases, cancer, diabetes and chronic respiratory diseases - are linked by common preventable risk factors.

Tobacco use, prolonged, unhealthy nutrition, physical inactivity, and excessive alcohol use are major causes and risk factors for these conditions. Trends in tobacco use will increase in the foreseeable future especially in developing countries. The ongoing nutritional transition expressed through increased consumption of high fat and high salt food products will contribute to the rising burden of heart disease, stroke, obesity and diabetes. Changes in activity patterns as a consequence of the rise of motorised transport, sedentary leisure time activities such as television watching will lead to physical inactivity in all but the poorest populations.

CURRENT SYSTEMS OF HEALTH CARE

Many diseases can be prevented, yet health care systems do not make the best use of their available resources to support this process. All too often, health care workers fail to seize patient interactions as opportunities to inform patients about health promotion and disease prevention strategies. Most current health care systems are based on responding to acute problems, urgent needs of patients, and pressing concerns. Testing, diagnosing, relieving symptoms, and expecting a cure are hallmarks of contemporary health care. While these functions are appropriate for acute and episodic health problems, a notable disparity occurs when applying this model of care to the prevention and management of chronic conditions. Preventive health care is inherently different from health care for acute problems, and in this regard, current health care systems worldwide fall remarkably short.

HOW CAN HEALTH SYSTEMS RESPOND TO THIS CHALLENGE?

Given that many conditions are preventable, every health care interaction should include prevention support. When patients are systematically provided with information and skills to reduce health risks, they are more likely to reduce substance use, to stop using tobacco products, to practice safe sex, to eat healthy foods, and to engage in physical activity. These risk reducing behaviours can dramatically reduce the long-term burden and health care demands of chronic conditions. To promote prevention in health care, awareness raising is crucial to promote a change in thinking and to stimulate the commitment and action of patients and families, health care teams, communities, and policy-makers. A collaborative management approach at the primary health care level with patients, their families and other health care actors is a must to effectively prevent many major contributors to the burden of disease.

WHO's RESPONSE

WHO's Non-communicable Diseases and Mental Health cluster has created a new framework for assisting countries to reorganize their health care for more effective and efficient prevention and management of chronic conditions. The Innovative Care for Chronic Conditions Framework is centred on the idea that optimal outcomes occur when a health care triad is formed. This triad is a partnership among patients and families, health care teams, and community supporters that functions at its best when each member is informed, motivated, and prepared to manage their health, and communicates and collaborates with the other members of the triad. The triad is influenced and supported by the larger health care organization, the broader community, and the policy environment. When the integration of the components is optimal, the patient and family become active participants in their care, supported by the community and the health care team.

EXAMPLES OF INNOVATION FROM AROUND THE WORLD

The following three case studies demonstrate successful implementation of one or more components of prevention in health care. Brazil: Establishing preventive health services in low resource communities Cearr', a poor state in Brazil presents a model of care that may be achievable for other countries in which resources, income, and education levels are limited. In 1987, auxiliary health workers, supervised by trained nurses (one nurse to 30 health workers) and living in local communities, initiated once-monthly home visits to families to provide several essential health services. The programme was successful in improving child health status and vaccinations, prenatal care, and cancer screening in women. It was low cost, too. Salaries for the heath workers were normal wage, few medications were used and no physicians were included. Overall, the programme used a very small portion of the state's health care budget.

In 1994, the health worker programme integrated into the Family Health Programme that includes physicians and nurses on the team with the health workers. For the first time in Brazil, large scale integrated, preventive health services were in place. Svitone, EC, Garfield, R, Vasconcelos, MI, & Craveiro, VA Primary health care lessons for the Northeast of Brazil: the Agentes de Saude Program, Pan Am J Public Health 2000;7(5):293-301.

USA: Incorporating prevention into primary care

Kaiser Permanente, a large managed care organization in California, recently reoriented its primary care clinics to better meet the needs of patients, emphasizing the needs of those with chronic conditions. Multidisciplinary teams were created that include physicians, nurses, health educators, psychologists, and physical therapists. These primary care teams link with pharmacy, the telephone advice and appointment centre, chronic conditions management programmes, and specialist clinics creating a totally integrated system of care from outpatient clinics to inpatient hospital care.

Patients are enrolled in the chronic conditions management programs via outreach strategies that identify those with chronic conditions who have not sought primary care, and through physician identification during primary care office visits. Patients receive services from multiple disciplines, based on the intensity of their needs. The diagram depicts the three levels of care. There is an emphasis on prevention, patient education, and self-management. Non-physician team members facilitate group appointments. Biological indices have improved across conditions such as heart disease, asthma, and diabetes. Screening and prevention services have increased and hospital admission rates have declined. A recent comparison of Kaiser's integrated care system with the UK's National Health System found that although costs per capita in each system were similar, Kaiser's performance was considerably better in terms of access, treatment, and waiting times. Explanations for Kaiser's better performance included real integration across all components of health care, treating patients at the most cost-effective level of care, market competition, and advanced information systems.

Feachem GA, Sekhri NK, & White KL. Getting more for their dollar: a comparison of the NHS withCalifornia's Kaiser Permanente. British Medical Journal 2002;324:135-143

India: Integrating non-communicable disease prevention and management Cardiovascular and cerebrovascular diseases, diabetes, and cancer are emerging as major public health problems in India. Apart from a rising proportion of older adults, population exposure to risks associated with certain chronic conditions is increasing. Obesity is increasing, physical activity is declining, and tobacco use is a substantial problem in the country.

Although it is commonly believed that non-communicable diseases (NCDs) are more prevalent in higher income groups, data from India's 1995-1996 national survey showed that tobacco intake and alcohol misuse are higher in the poorest 20% of the income quintile. As a result, the government of India is anticipating that the prevalence of tobacco-related conditions will increase in lower socio-economic groups in the coming years. The government has adopted an integrated NCD prevention and management programme. The main components of this programme are:

· Health education for primary and secondary prevention of NCDs through mobilizing community action;· Development of treatment protocols for education and training of physicians in the prevention and management of NCDs;
· Strengthening/creation of facilities for the diagnosis and treatment of CVD and stroke, and the establishment of referral linkages;
· Promotion of the production of affordable drugs to combat diabetes, hypertension, and myocardial infarction;
· Development and support of institutions for the rehabilitation of people with disabilities;
· Research support for:

· Multisectoral population-based interventions to reduce risk factors;
· The role of nutrition and lifestyle-related factors;
· The development of cost effective interventions at each level of care. Planning Commission, India, 2002.

CONCLUSION

· Many of the costly and disabling conditions facing health systems today can be prevented. Additionally, with proper support many of their complications can be averted or delayed. Strategies for reducing onset and complications include early detection, increasing physical activity, reducing tobacco use, and limiting prolonged, unhealthy nutrition. Through innovation, health care systems can maximize their returns from scarce and seemingly non-existent resources by shifting towards activities that emphasize prevention and delay in complications. Small steps are as important as system overhaul. Those who initiate change, large or small, are experiencing benefits today and creating the foundation for success in the future. (keralamonitor.com)

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Kenya : Focus on female vulnerability to HIV/AIDS infection

NAIROBI, 21 October (IRIN) - When Marita Barassa's husband died in
1990, she knew he had died of an AIDS-related illness. She also knew she
was HIV-positive herself. So when his family announced that a cousin
would inherit her as his wife, she realised she had to make a choice.

"I knew I would infect him if he inherited me, and reinfect myself,"
Marita, a counsellor working with a Kenyan NGO, Women Fighting AIDS in
Kenya (WOFAK), told IRIN. So she accepted the consequences of saying no
to inheritance. "You are not allowed to inherit your husband's property
or land, you become an outsider, you and your children are no longer
part of the family, you lose everything," she said.

For many Kenyan widows, who are economically dependent on their
husbands, saying no is simply not an option.

So the age-old custom - originally conceived by communities as a means
of protecting widowed women and their children - can easily become a
death sentence. In some cases, the inherited wife lives with her
husband's family or other wives and is thus provided for, while in others a
husband simply "inherits" sexual rights. Either way, the new wife is
expected to produce several children, thus increasing the risk of
HIV-infection to herself, her husband, and her babies.

Some women end up being inherited several times. Each time a husband
dies of AIDS, or any other illness, his relatives arrive after the
funeral to claim their new "property".

"Women have no value without a man, you don't have any respect," said
Marita. "A woman on her own is deemed to be odd, or promiscuous."

Kenyan girls/women and HIV

At the end of 2,000, the Kenyan Ministry of Health estimated that there
were 2.2 million people living with HIV infection or AIDS. About two
million of those were HIV-positive, but did not know they were affected,
and were therefore probably helping to spread the virus.

While overall numbers of HIV-positive males and females are about
equal, women between 15 and 24 are more than twice as likely to be infected
as males in the same age-group. A study conducted in Kisumu, western
Kenya, found that girls from 15 to 19 years old were about six times more
likely to be infected than boys.

Studies have also shown that women are three times more likely than men
to be infected through sexual intercourse, because the vaginal wall is
prone to sores and abrasion, and the viral load in semen is higher than
that in vaginal fluid.

High rates of infection can therefore be attributed to a combination of
biological and social factors. Girls start sexual activity earlier than
boys, have large numbers of sexual partners, a high prevalence of
sexually transmitted diseases, and are victim to a high incidence of violent
sexual contact. On top of this - and much more difficult to combat -
are the age-old practices such as wife-inheritance, coupled with beliefs
about female roles in society, which make women and girls particularly
vulnerable.

Early sexual contact

Christine Akinyi, a social worker working with Slums Information
Development & Resource Centres in the capital, Nairobi, told IRIN that most
girls she worked with started sexual activity at around 10, while
pregnancy at 13 to 14 was "very common". Now and again, she said, she came
across girls who were pregnant at nine or 10, most of whom had
back-street abortions.

Marita, who in WOFAK works with a wider section of society, said many
girls who did not go to school were sexually active from 10 or 11, while
those who were better educated tended to wait until their mid-teens.

Daughters of poor parents were often given in marriage at 13 and 14 to
much older men, who could provide a dowry, she said. Parents who did
not marry off their daughters were often aware that they were having sex
with older men, but poverty made them turn a blind eye. "Maybe at home
girls never get proper meals so they are lured into having sex to get
food and clothing," Marita said.

Many older men - known as "sugar daddies" - choose young girls for sex
in the belief that they couldn't possibly be infected with HIV. Another
reason is to avoid having to pay for it. The younger girls might be
satisfied with sweets, while a regular sex worker could charge anything
from 100 Kenyan shillings, or US $0.80, said Akinyi. Oral sex could cost
half that sum, she added.

Poverty and lack of education are among the greatest contributing
factors to girls' early sexual activity. "The environment promotes a lot of
sexual behaviour. Children grow up knowing it's something you can do
for money," said Marita. Many children from poor households grow up in
cramped, run-down housing, seeing their mothers selling their bodies, so
it becomes a natural progression.

"And once they [the girls] start, they don't stop," she said. "Mostly
teenagers have many different boyfriends. For those who don't go to
school, they may have a different sexual partner every day," said Akinyi.
The health ministry cites a study in its 2001 "AIDS in Kenya" report
showing that 18 percent of women and girls were HIV-positive within two
years of becoming sexually active.

Rape is another contributing factor. A nationwide study of Kenyan women
aged between 12 and 24 found that one quarter had lost their virginity
because they had been "forced", the ministry reported. Many Kenyan
women say this figure is grossly underestimated; the incidence of rape,
normally perpetrated by relatives, neighbours or family friends, is much
more widespread, they say. And where force is used, abrasions and cuts
are more likely, thus making it easier for the virus to enter the
bloodstream. (keralamonitor.com)

The politics of marriage

Many Kenyans admit that unfaithfulness within marriage, among both
sexes, is extremely common. If a husband is providing for his wife
materially, he is commonly perceived to be a good husband, irrespective of how
he treats her, said Marita. "It is expected that men have girlfriends.
A man that has only one woman is no man among the others," she added.

The practice of polygamy, coupled with many sexual partners outside
marriage, renders the spread of HIV within families extremely easy.
Furthermore, rape within marriage is neither recognised by Kenyan law, nor by
the vast majority of men, Kenyan feminists point out. Neither is a
wife's right to say "no" to sex. "You're his wife, you're supposed to give
in to him," Marita told IRIN. "You are his property, his belonging. You
have no rights over yourself - your body is his. It doesn't matter
whether you are participating or not."

In cases where wives suspect that their husbands are unfaithful, or
that they may be HIV-positive, there is little they can do to stop being
infected themselves. While condom-use has increased in recent years
thanks to billboards and advertisements promoting safe sex, most people
agree that condoms are unpopular except with a minority living in urban
centres. "They say sex with a condom is not sweet, they can't feel each
other. They won't even talk about it," commented Marita.

People's reluctance to admit to their spouses that they are engaging in
risky behaviour outside marriage also prevents them from taking the
necessary precautions within it.

HIV/AIDS denial and stigma

Despite the numbers of infected people in Kenya, the stigma attached to
HIV/AIDS remains intense. Some continue to deny its very existence,
especially in rural areas where superstitions are common. "People see
others dying of AIDS but they still don't believe in it. Some say they were
bewitched, they don't believe it's AIDS," Marita told IRIN.

Some considered it to be a punishment for past sins, such as
promiscuity or unfaithfulness, or a result of the evil eye, she said. In turn,
many others continued to believe that "decent", churchgoing people, or
"good" spouses, could not possibly be HIV-positive, and that there was
therefore no risk to themselves.

The culture of secrecy in this staunchly Christian society remains
strong. Despite the huge risks to young Kenyans - especially young girls -
from risky sexual behaviour, sex education in both schools and homes
remains practically nonexistent. "It's just something you don't talk
about," said Akinyi. Kenyan women are supposed to be virgins when they
marry, and that's how people like to think of them. -(keralamonitor.com)

Security Cooperation in a Post 9-11 World

Richard L. Armitage, Deputy Secretary of State
Remarks at the Defense Security Cooperation Agency Conference
Alexandria, Virginia

October 17, 2002

Thank you very much, General Walters. Good afternoon, ladies and gentlemen.
That was a kind introduction, I m very much in your debt, sir. I am in your
debt as well for your superb leadership at DSCA, and for the spirit of
partnership that has characterized your work. It has certainly characterized
your work with our Department of State and particularly our Assistant Secretary
for Political Military Affairs, Linc Bloomfield.

General Walters, as you suggested in your introduction, I am no particular
stranger to security cooperation. In fact, as we were discussing out in the
hall, I am starting to feel my age -- I go back to the days of Howie Fish. I
don t know how many of you remember General Fish. [inaudible] and Jim Ahmann,
Phil Gast and Charlie Brown, [inaudible] and Glenn Rudd. People like Herb
Morris [inaudible]. I must say, pulling those names out of the back my mind
today is an exercise in making people guess my age.

I suspect, sir, however, that the business has changed somewhat since I served
as Assistant Secretary of Defense. If nothing else, your agency has gone
through several name changes. But some things don t really change.
International cooperation has long been the cornerstone to our security
architecture and that has rarely been more apparent than in this post 9-11
world.

The Department of State, of course, is in the business of international
cooperation. That s our stock in trade. Today, we need the specialized skills
and well-honed talents of our workforce not just in order to engage in
statecraft, but also to play a more direct role in facing the immediate and
urgent threats to our security. Because if we are to prevail in the war against
terrorism and in disarming or if necessary, destroying the regime in Iraq,
we will, as a nation, find it necessary to rely on collaboration with other
nations. So there can be little question that the Department of State is
playing a central role in safeguarding our immediate interests and there should
be no question that the Department of State is up to playing such a part. That
means our people must have the training and the tools they need to face these
21st century challenges, which is why Secretary Powell and I have made
management reform a top priority. And that includes the area that concern all
of you most directly, our administration of the defense trade.

As I suggested, we would not be gaining ground in the war against terrorism
without effective multilateral collaboration. After all, this war had
international implications from the outset. Consider that al-Qaida, the network
of al-Qaida, had active cells hidden in the dark corners of some 60 countries
and that the citizens of more than 90 nations perished on September 11th. It is
fitting, then, that we swiftly saw an international agenda for countering
terrorism and this agenda was unprecedented in its scope and in its scale. In
the days after the attacks on 9/11, the Department of State was instrumental in
coordinating this concerted response. At the highest levels of statecraft, this
led to the most comprehensive anti-terrorism measure ever adopted by the United
Nations, United Nations Security Council Resolution 1373, as well as similar
conventions and measures from a full range of regional organizations, from the
OAS to ASEAN.

But we also used our diplomatic muscle to pull together an extensive coalition
to implement the letter and spirit of this resolution. Indeed, most nations in
the world continue to contribute something to this war consistent with their
capabilities. Many nations are receiving some kind of assistance, according to
their needs.

More than 180 nations are part of the coalition to fight terrorism. 25 nations
are engaged in military operations and 132 have signed the International
Convention To Suppress Terrorism Financing. 136 have contributed some other
concrete assistance, running the gamut from humanitarian supplies to the use of
airspace and base access rights.

This international cooperation has produced many victories. Some are well
known, but most are more discreet and nearly daily. Of course, we also continue
to face challenges, as we were reminded by the killing of a US Marine in Kuwait
and the horrific bombing in Bali over the weekend, which cost so many of our
Australian friends their youth. So many families were devastated by that
horrible attack. I think it is obvious that this is not going to be an easy
fight. It will take time and determination to prevail but we should not allow
the recent violence to detract from our overall and ongoing success in this
war.

Now, ladies and gentlemen, I realize it is somewhat reassuring to talk about
armies clashing in decisive battles, where there are clear winners and losers,
but what we are engaged in today is no less effective and far less lethal for
our own forces. Beyond just routing the Taliban and al-Qaida out of
Afghanistan, we are actually building the permanent capacity to counter
terrorism all around the world. So this means not just freezing and seizing
financial assets, but giving our partners in other nations the tools and skills
to permanently destroy and disrupt the money trails that keep the terrorists in
business. We have seen a string of high-profile arrests in dozens of nations.
In recent weeks alone, we have seen the capture in Karachi by Pakistani
officials of a key figure in the 9/11 attacks, the indictment in Germany of the
guiding light of the Hamburg cell where Mohammad Atta finalized his plans, and
the detention in Singapore of 21 more members of the Jemaah Islamiyah, who were
planning attacks against American targets in southeast Asia. And who we suspect
may have played a role in this recent attack in Bali. But we are also working
with local law enforcement officials around the world to provide the training
and the technical skills to make a long-term improvement in their ability to
prevent such criminal activity in the first place.

Perhaps the most visible of our victories to date, and one of our most visible
long-term investments in countering terrorism, is the redemption of
Afghanistan. Don t forget that it was little more than a year ago that al-Qaida
and the Taliban held such terrible sway over the lives of 23 million people,
and despite ongoing unrest and ongoing challenges, that is simply no longer the
case today. Today, President Karzai presides over a representative government.
Roads are being built and houses reconstructed. Women are back at work and
children are back in school. And in the ultimate vote of confidence, more than
2.5 million refugees have returned home from hiding places across the region,
the largest refugee repatriation in modern history.

Of course, with that repatriation, it is obvious that the needs continue to be
overwhelming, including for basic necessities such as food, water and shelter.
And while the United States has committed significant funds, the fact is that
the only hope of meeting these needs on the scale required is the collective
will of the international community the international community which
committed $4.5 billion to reconstruction in Afghanistan last January in Tokyo.

Such international collaboration will continue to be critical to our war
against al-Qaida and other terrorist organizations, but it will also be
critical to dealing with the situation in Iraq.

I don t believe I need to spend much time convincing the people in this room
that Saddam Hussein and his collection of nuclear, chemical and biological
weapons and intentions present a clear and imminent danger, not just to the
people and interests of this nation but to his neighbors and all nations. We do
still have to convince our friends and allies, however, as well as a few
nations that are perhaps somewhat less than friendly, and we continue these
efforts daily.

Their reluctance is understandable. No one wants to go to war. But no
responsible nation can afford to shrink from battles that must be fought, no
matter how much we wish to avoid conflict. And this is inescapable: every day
we add to the decade-long delay in disarming Iraq is one day closer to a
catastrophe.

A military operation itself, going into Iraq to take out this regime, is
certainly something we would be capable of handling on our own, should the
President so decide. But I doubt that Saddam Hussein will go down without a
fight and his sordid past suggests that he does not exactly fight fair. He has
a long history of extraordinary brutality when he thinks he can get away with
it. This includes the mistreatment of his own Iraqi people -- political
opponents and even ordinary people have been rounded up and jailed, beaten and
burnt with cigarettes or electric shocks, executed or made to disappear -- his
attacks on his neighbors; and his use of chemical weapons against his enemies
and on his own people. Clearly, we are going to need a coalition of like-minded
nations that is today fighting together against terrorism if we are to prevent
the nightmare scenarios that Iraq could visit on the world.

But consider, too, that if it does come to war, this will not be a fight that
can be won solely on a battlefield. This is a fight that must also be won in
the aftermath. There must be change in Iraq, but the international community
needs to come together to shape and realize that change, to rebuild an Iraq
with a vibrant middle class and a viable government, one that respects human
dignity and the rule of law. Iraq is a nation too long in the shadow of
repression and with too many fractious pieces to pull together easily or to
pull together overnight. It is incumbent on us to collaborate with other
nations in reaching a more stable, a more peaceful and a more prosperous Iraq.
And indeed, I believe that the lines of communication and habits of
collaboration we have developed in defeating al-Qaida and the Taliban, as well
as in reconstructing Afghanistan, will be essential to this effort, as will the
untiring work of my colleagues at the Department of State.

Now, I realize that most of you here today have extensive business with the
defense and intelligence agencies, Perhaps some of you are a little less
familiar with operations at the Department of State, beyond the fact that we
regulate your export business. But I want to clarify that while we are very
focused on building and maintaining the international effort to counter
terrorism and the proliferation of weapons of mass destruction, we are also
engaged in cooling the hotspots all over the world where U.S. interests are at
stake -- from Israel and Palestine to India and Pakistan, from North Korea to
Colombia to Kosovo. Moreover, our routine, day-to-day business is nothing less
than the construction of positive relationships with the rest of the world. As
Secretary Powell puts it, our people at the Department of State are the first
line of offense for our nation.

In such a world, we simply can t afford to defer basic improvements to our way
of doing business. And indeed, Secretary Powell has given a great deal of
attention and resources to reform. We have concentrated on adopting best
business practices and improving our human capital, upgrading our facilities
and our financial management, and bringing our information technologies up to
21st Century standards. We have been extraordinarily fortunate in this effort
in that we have found a very willing partner in both houses of the U.S.
Congress.

A key target of this agenda for modernization has been defense trade controls.
I recognize that our licensing of the defense trade has attracted more than a
little color commentary over the years and I suspect [inaudible]. And when he
took office, Assistant Secretary Bloomfield was greeted by a tower of reports
and papers recommending change. For Linc and the Secretary, that was a clear
warning sign that we needed to pay some serious attention to this area.

And indeed, today, we are paying attention. The Department of State s role in
defense trade controls is an important element of US foreign and security
policy. At the same time, defense industrial cooperation has become
increasingly complex and technologically sophisticated and it has required an
increasingly skilled workforce. We have worked to improve our recruitment, our
retention and our quality for life of our staff and in the process we have
begun to transform the defense licensing function itself. We are making
fundamental changes, and everything is on the table: our policy; our processes;
our technology; and our management structure.

Many of you are aware that last week President Bush called for a comprehensive
policy review of defense trade controls, and while it is premature to draw any
conclusions about the result of this review, we will look at everything, and it
is reasonable to expect that changes will result. I know the possibility of
change pleases some people and upsets others who might prefer the status quo.
But defense trade is an important element of our foreign policy and we want to
be sure that our approach to defense export controls is in tune with our
overall security goals. Indeed, President Bush s National Security Strategy
calls on us to "transform America s national security institutions to meet the
challenges and opportunities of the 21st Century." That is exactly what we re
going to do.

We have already been making a number of improvements in our licensing process
in advance of the policy review. And I want to report to you today on some of
the developments you can expect to see in the coming days and the coming months
as we move forward. I also want to recognize my colleague from the Defense
Department and former business partner, Assistant Secretary Linc Bloomfield s
leadership, since he is the who has been charged by Secretary Powell to develop
an effective defense trade licensing process, one that clearly reflects the
President s foreign policy objectives.

You may be aware that Secretary Powell has made e-government a top priority. In
the most general sense, this means making sure that every one of our employees
has a good computer with classified and Internet access. But at a more specific
level, this means that we are close to offering you fully electronic licensing
for defense exports. And soon, you can expect to see the rollout of our 6-month
pilot program involving industry.

While I am sure this innovation will help modernize the way we process
licenses, that is not all we are doing. As most of you are doubtless well
aware, on September 4th, we notified a major portion of the Joint Strike
Fighter program to Congress. What some of you may not realize is that this was
the first-ever use of the Global Project Authorization. While the GPA concept
has been on the books since the summer of 2000, we worked very hard with our
colleagues at the Department of Defense to make it a reality. What this means
is that a project that would have taken 110 separate technical agreements
spread out across 40 US exporters and 200 defense companies in several
countries was consolidated into a single package, thanks to the spirit of
cooperation exercised by so many good people at the Department of State and the
Department of Defense.

We are also involved in the ongoing review of the munitions list, which is
ahead-of-schedule. We ve knocked out five categories already, we are about to
publish two more, and we are now turning our attention to Category Eight
which is aircraft and aircraft parts. While we will continue to take security
and law enforcement concerns for aircraft parts exports very seriously, we plan
to cut some of the red tape that is now tying up legitimate exports of aircraft
parts by increasing the dollar maximum for this trade tenfold. While now any
export over $500 requires a license, we are going to increase that limit to
$5,000, with a limit of 12 exports per year.

All of these improvements will, of course, benefit our security cooperation
with friends and with allies, but we continue to seek out other steps that will
more directly benefit such collaboration, such as the possibility of bilateral
ITAR exemption agreements with Australia and the United Kingdom. Both of these
nations have recently made substantial progress in promoting export controls
and protecting sensitive defense items and technologies and I believe our
negotiations with each are close to fruition.

Finally, we are not stopping at policy and process reform. In the coming
months, we also plan to update our organization and our management structure.
As I noted, the defense trade has grown tremendously in recent years, both in
quantity and in the level of sophistication. In turn, the Department of State
has needed a growing team of well-trained people in order to meet the demand.
So today, the Office of Defense Trade Controls alone has over 100 highly
skilled staff, which makes it larger than some of our bureaus at the Department
of State run at the Assistant Secretary level. It is fitting, therefore, that
we add another high-level official to the Bureau of Political Military Affairs,
after I consult with Congress. We re going to give Linc Bloomfield a total of
three Deputy Assistant Secretaries in PM. This will allow Linc to put a Deputy
Assistant Secretary in charge of the Office of Defense Trade Controls in the
near future, raising the stature of the office so that it will be on par with
its policy counterparts at DoD, the National Security Council and the
Department of Commerce.

We are going to continue to pursue improvements in our process, workforce and
in our management and will provide the President our best judgments on how to
align defense trade controls with his foreign and defense policy. These are
difficult times. We must make the most of our opportunities to improve our
international cooperation.

On the 12th of September this year, President Bush presented the world with a
stark choice. He said: "We must choose between a world of fear and a world of
progress. We cannot stand by and do nothing while dangers gather. We must stand
up for our security, and for the permanent rights and the hopes of mankind."
Today, the choices are clear, if not always easy. And for the Department of
State, in the end, our mission is quite simple: to continue tirelessly in our
daily business of building beneficial relations with the rest of the world, of
reaching together for a common vision of stability, respect for human dignity,
and realized hopes for societies everywhere, and to stand up for our security
wherever it is threatened in cooperation with a community of like-minded
nations.

General Walters, thank you very much for your invitation to be here today.
Ladies and gentlemen, thank you very much for your kindness in listening.