1. (U) Per reftel, an interagency committee, comprised of
participants from the Health Unit, Public Affairs, the
Political and Economic Section, and DOD's Office of Defense
Cooperation reviewed the GOT submission to the Global Fund.
The following comments are keyed to reftel para 8 questions:



A. (U) Proposing group and amount: Tunisia Country
Coordinating Mechanism, 17.383 million USD



B. (SBU) Overall comments and recommendations for the U.S.
Government delegation position: Embassy Tunis recommends that
the U.S. delegation support the Tunisian proposal. Despite
what is currently a low reported prevalence of HIV/AIDS in
Tunisia, growing urbanization and a continued lack of
awareness of risk factors and prevention methods on the part
of Tunisians increase the likelihood that the disease will
continue to spread. The absence of effective epidemiological
data collection and monitoring make it difficult to assess
the true extent of infection in the country. Embassy Tunis
believes that the GOT proposal represents a sound strategy
that will begin to address deficiencies in the GOT's
epidemiological data collection and monitoring, educational
outreach, and medical services for persons living with
HIV/AIDS. Educational outreach is critical in the GOT's
efforts to prevent not only the spread of HIV/AIDS, but also
to removing the stigma currently attached to those suffering
from the disease. For these reasons, educational outreach
must extend beyond high-risk groups and touch all segments of
Tunisian society. The proposal also involves the
participation of health-related non-governmental
organizations. Such activities would help further the
Embassy goal of supporting and strengthening Tunisian civil
society.



C. (U) Comments on TRP review: Post agrees with the analysis
provided by the TRP.



D. (U) Public health and scientific considerations: The GOT
has proven its ability to implement effective health care
initiatives in the face of potentially sensitive social
issues. Launched in the 1950s, Tunisia's revolutionary
family planning program successfully led to a reduction in
the birth rate through widespread educational campaigns, as
well as contraceptive distribution. Due to a relatively
effective public health system and well-trained medical
personnel, Tunisia's technical assistance requirements should
be minimal. Embassy contacts have reported, however, that
the Ministry of Health has little funding available for
specialized treatment and prevention programs beyond the
scope of primary health care.



E. (U) Coordination with other partners: The project
activities outlined in the proposal represent activities
which have not been undertaken by any other entities in
Tunisia on a large scale and will therefore not duplicate
current HIV/AIDS programs in country. In addition, the CCM
includes members from a wide-range of health-related civil
society organizations, which should encourage successful
coordination between the GOT and other organizations with a
stake in HIV/AIDS prevention.



F. (SBU) Political considerations: Consistent with the
President's Freedom Agenda, strengthening and supporting
Tunisian civil society represents a core objective of Embassy
Tunis. The inclusion of health-related civil society
organizations in the CCM will further this important Embassy
goal.



G. (U) Additional Comments: Director of UNAIDS in Tunisia,
Jean-Michele Delmotte, recently contacted the Embassy to
convey UNAIDS Tunisia's support for this proposal and to
request Embassy backing as well.



H. (U) Embassy point of contact: Economic Officer Victoria
Taylor, E-mail: TaylorVJ@state.gov, Phone: 216-71-107-431
BALLARD