World AIDS Day at the White House

President Obama: Hello, everybody.
On this World AIDS Day, we pause to remember all those who have
lost their lives both here in America and around the globe.
And at a time when so many men and women are living with HIV
and AIDS every day, let's also recommit ourselves to building
on the tremendous progress we've made both in preventing and
treating the disease and ending the stigma and discrimination
that too often surround it.
That's why as President, my administration has developed the
first comprehensive national HIV/AIDS strategy for the United
States, and increased funding to fight HIV/AIDS around the world
to record levels.
Because it's my hope that together we can move closer to
the day when we eliminate this disease from the face of the earth.
Mr. Crowley: My name is Jeffrey Crowley, and I'm the director of the Office
of National AIDS Policy, and it's my pleasure to welcome you
to the White House for today's commemoration of World AIDS Day.
We're joined by several distinguished guests,
but I would like to give a special welcome to the members
of the diplomatic corps who are here with us.
You know, we rely heavily on our bonds of friendship and we're so
thankful for their partnership in fighting AIDS,
and we're glad that you could join us here today.
I also know it's risky to single out one federal official,
because we have so many strong leaders across the government,
but I did want to acknowledge Dr. Ronald Valdiserri from the
Department of Health and Human Services who is here.
Those of you that have been following closely know that when
we released the national HIV/AIDS strategy,
we've had a lot of activities across the federal government,
but we've really put a lot of responsibility on Ron's
shoulders, so we do want to acknowledge that you're here and
thank you for all your hard work.
(applause)
So President Obama has provided critical leadership in
responding to HIV/AIDS both in the United States and around the
world, and we hope that today's meeting will provide a
thoughtful dialogue to really take a look together about where
we've been and where we're going.
Now, before we get started, I wanted to pause for a moment and
acknowledge the passing of a friend of many of us in this room.
Randy Allgaier is a person with AIDS who died this past Saturday
morning, and, you know, he was a long-time advocate and policy
(inaudible) and friend of many of us.
You know, for years he was talking about Medicare when few
people in the HIV community were, and, you know,
it's the second largest source of health care for people with
HIV and AIDS.
More recently he's been part of a National Working Positive
Coalition, part -- really taking a look at some of these complex
policy issues that really become barriers for people living with
HIV reentering the workforce.
And so he was a close friend, but he also did a lot of really
important policy work, and so, his passing reminds us of the
important work that remains ahead of us.
So I would also just like to quickly acknowledge many people
here that help us pull together an event like this.
I have a great team in the Office of National AIDS Policy,
but James Albino who is my senior program manager helped
coordinate today's event, so I thank him.
Karen Richardson is a key partner in our Office of Public
Engagement, and she was heavily involved.
But this is really intended to really balance our work on
domestic AIDS and global AIDS, and, you know, we work closely,
and thank Gayle Smith and Mark Abdo of the National Security
staff and Dr. Zeke Emanuel of the National Economic Council
who are really part of our brain trust on global health issues,
so we acknowledge them.
Now, to get us started, I'd like to introduce the Reverend
Kimberly Brown Barnes who is going to offer a moment of reflection.
Reverend Barnes: Good afternoon.
HIV/AIDS -- what have we learned and where are we going?
For the past 29 years, we've learned about this AIDS pandemic
that has spread throughout the global community because of HIV infection.
We've learned that this disease started in one community and has
spread to all of humanity.
We've learned that over the years,
people have been fearful due to ignorance.
We've learned that people have been ostracized because of fear.
We've learned that everyone deserves to be treated with dignity.
We've learned that every life has meaning.
We've learned that, surprisingly,
some people do not think that this disease still poses a threat.
And we've learned that we still have a lot of work to do.
As we reflect on our professional and personal
journeys of dealing with this disease,
many of us do think about the many lives that have been lost.
We remember our friends and loved ones with joy and,
at the same time, sadness.
We hold memorials to honor those who have passed.
Yet, at the same time we honor the living.
We honor those who are HIV positive for their courage and strength.
We honor those who have and continue to dedicate their time
and effort to provide awareness, education,
counseling and simple human compassion to combat this disease.
As we think about all who are gathered today who have been
dedicating their lives to this great work,
I cannot help but see that we have a communal tenacious spirit
to not accept defeat.
I do not believe that it is an accident that December 1st is
the day in which we choose to recognize AIDS.
For me, it is God's hand moving among us,
for at this time of the year, our Muslim brothers and sisters
would have already celebrated Ramadan in which they take the
time to fast, to intensify their prayer life,
and to commune with God.
The Christian community is now in the season of Advent,
awaiting the birth of Christ and celebrating his life and gift of
God's saving grace to humanity.
Our Jewish brothers and sisters will be celebrating Hanukkah in
which they celebrate the rededication of the Holy Temple
that is a communal experience.
Whether Muslim, Christian or Jew,
we are looking to connect to God,
but we are also being reminded that we are connected to one another.
I believe that the African theological concept of ubuntu
captures this best.
Ubuntu means that my humanity is inextricably bound up with
yours, that we can only be humans together.
We are a human family, and as a family on this day,
we remind the global community that we stand firm and we are
each other's keepers.
Whether we shed tears and offer comfort to victims of sexual
assault who have been infected in the Democratic Republic of
the Congo and in Darfur in the Sudan;
whether we are working to bring awareness and education to young
people in New York, Chicago, New Orleans,
San Francisco or Washington, D.C.;
whether we are providing services in rural communities or
to our Native American brothers and sisters;
wherever we are serving and whoever we are serving,
we are demonstrating our inextricable connection to one another.
With the spiritual and religious richness that surrounds World
AIDS Day, we may be weary, tired and frustrated,
but we are hopeful, hopeful that through continued awareness,
education and campaigns, our human spirit is tenacious in
pursuit of not just a cure, but that every life is treated with
respect and dignity.
Now I would really like to leave you with some deep theological
thought, but I am an old-school rhythm and blues girl,
so I have to leave with you this wonderful song by Frankie
Beverly and Maze entitled "Before I Let You Go."
Now, if you don't know the song, Frankie Beverly is singing about
a woman he loves and refuses to let go.
I believe that as activists, advocates,
humanitarians and clergy, when it comes to combating HIV/AIDS,
we just cannot accept defeat.
We cannot accept letting go of the battle.
We cannot accept letting go of another life.
We cannot accept letting go of any person in need.
We cannot accept letting go of any orphaned child.
We cannot accept letting go, because we have learned a few
things along the way, and I believe that we are heading in
the right direction.
God bless each of you.
(applause)
Mr. Crowley: Thank you, Reverend Barnes.
Now it's my privilege to introduce Melody Barnes,
who is an assistant to the President and the Director of
the -- excuse me -- the Domestic Policy Council who is going to
provide some opening remarks.
Melody?
Ms. Barnes: Well, good afternoon, everyone.
It is a rare pleasure when a Barnes gets to follow a Barnes,
and we have to find out if we're related, in fact.
But I also want to thank Reverend Barnes for that really
lovely moment of reflection.
You know, I think we all probably rushed in here,
I know I did, crazy day, busy day,
and recognizing how important this is,
but that was a moment to stop and to think and to reflect,
and I personally appreciated it, so thank you very much.
And I want to welcome all of you to the White House.
Today we commemorate World AIDS Day,
and certainly not just through our words but also through our deeds.
We are recommitting ourselves to working for a world that exists
without AIDS.
And we're gathered here today to examine the progress that we've
made on two fronts, both ending the domestic epidemic while we
are also continuing our work around the globe.
We are desperate to end the pandemic that affects so many
people everywhere.
And these are really two sides of the same coin,
even though we don't often stop to think about the way,
as Kimberly so beautifully said, they are inextricably linked
together and how they are mutually reinforcing,
our work is mutually reinforcing of itself.
We've certainly come a long, long way since World AIDS Day 2009.
Last year, after President Obama eliminated the entry ban,
we announced that the International AIDS Society would
hold the 2012 international AIDS conference in Washington, D.C.
In the past 365 days, my colleagues in the White House
and our colleagues cross the administration have begun work
in earnest with the IAS to make the 2012 conference a success on
par with its importance.
And this time last year, many of you were also engaged with us as
we were starting to wind down our community conversations that
were sponsored by the Office of National AIDS Policy that Jeff
runs, and runs so well with a really terrific group of
colleagues in the Domestic Policy Council.
And since then, as you know, we've been able to release the
National AIDS Strategy, the first domestic HIV/AIDS strategy
our country has ever had.
And I think we're particularly proud of this for two reasons.
Obviously and most importantly because it puts us on the path
that we need to be on to reduce the scourge of HIV/AIDS.
At the same time, it is important because the President
made a promise on the campaign trail,
and he fulfilled that promise; he has stuck with all of us and
committed himself to refocusing attention on the domestic HIV
epidemic and to provide an essential road map for our
nation to move forward together.
From our perspective, we cannot say often enough that this is
not a federal plan, this is a national plan,
it is a national strategy.
We continue to be excited and grateful for all the work that
many of you have done with us, for the work that so many have
done across the government and in communities across the nation.
The level of commitment and engagement that we have received
from our external partners has really been unsurpassed,
so thank you for that and for all the work that is to come.
But I don't have to tell you that our work has only just begun.
We're now engaged in the most important part of this task,
and that's moving beyond the strategy development to the
meaningful implementation of the strategy.
In July when we released it, the President directed lead agencies
to develop operational plans for implementing the strategy.
Those are due to us next week, and we look forward to reviewing them.
He also tasked the Secretary of State with helping us to apply
lessons that we've learned from PEPFAR to our domestic efforts.
Ambassador Goosby is leading that charge,
and we are very much looking forward to his recommendations.
Last March, the President was also proud to sign into law the
Affordable Care Act.
And when you hold this important piece of legislation to the
light and you look at its many different facets,
what we realize is that this new law was really an essential
piece of HIV legislation.
The new law already provides meaningful support for people
living with HIV/AIDS by ending lifetime limits on benefits and
ensuring other critical consumer protections.
Beginning this year, a $250 rebate will be provided to
people with HIV/AIDS in a Medicare coverage gap that's
commonly known as the donut hole as we work to phase out this gap completely.
In addition, starting in 2011, AIDS drug assistance program's
benefits will be considered as contributions toward Medicare
Part D's true out-of-pocket spending limit, the donut hole,
a huge relief to people who are living with HIV/AIDS.
It also includes a new preexisting condition insurance
program that creates a new option to purchase insurance
coverage for people who are uninsured due to a preexisting condition.
States also have new flexibility to extend Medicaid coverage to
low-income people, including people living with HIV.
Of critical importance, in 2014, the Affordable Care Act will
expand access to affordable insurance coverage by extending
Medicaid to all people with an income below 133% of poverty,
and giving higher-income people access to a choice of insurance
options with income-based subsidies through state-based
insurance exchanges.
Clearly expanding access to insurance coverage is a
cornerstone of our efforts to increase access to care in order
to provide the clinical outcomes experienced by people living with AIDS.
On the global front, in October, we announced an unprecedented
multi-year pledge of $4 billion for 2011 through 2013 to the
global fund to fight AIDS, tuberculosis and malaria.
This pledge represents a 38% increase in U.S. support for the
global fund, and is in addition to the more than $5.1 billion
provided to the fund to date.
And last month, the United States signed its 17th PEPFAR
partnership framework, laying out five-year joint plans
between the United States and partner governments for
cooperation in the fight against HIV/AIDS,
and helping to foster a shared response.
These frameworks help to strengthen the country capacity,
ownership and leadership building on successes achieved
to date and ultimately to saving more lives.
And last but certainly not least,
this past year has also been just a phenomenal,
exciting year in terms of research.
In the summer, we learned of promising results for the
development of an effective vaginal microbicide,
and just last week, and I don't have to tell you all there,
we were all just reading with interest and looking forward to
the new developments around the exciting results that were
announced related to pre-exposure prophylaxis or PrEP.
These findings are preliminary, and they raise many questions,
but they remind us of the payoffs that are available to us
from our research investments, and they promise that important
new tools for our HIV prevention toolbox are at hand.
We'll hear more about this from Dr. Fouchi later today,
and look forward to hearing more and more about the exciting work
that is to come.
The challenge of ending a pandemic is obviously large and complex.
We live in times of difficult choices and very painful
tradeoffs, and clearly there is much work ahead of us.
But as we think about our current challenges,
you should know that we have a president who is a committed
leader and partner in the work to save lives and to maximize
the results from our HIV/AIDS investments in the United States
and around the world.
So with that, it's now my pleasure to introduce one of our
phenomenal leaders in the administration,
someone who spends his days and nights working to promote the
health of people, both in developing nations and in the
United States, around the world, Dr. Rajiv Shah,
the administrator of the USAID.
Raj?
(applause)
Dr. Shah: Thank you, Melody.
And I also want to thank Reverend Barnes for that --
for those comments, which do, when you're coming in from the
cold and from the rain, set the tone in a very different way.
I want to thank Jeff Crowley for your leadership and for the
great work that you've done.
And, of course, Ambassador Goosby and Tony Fouchi who will
get a chance to speak to you today.
You know, I wanted to just highlight that over the past 30
years, we've all come to recognize,
mostly due to the great work of leaders in this room and in this
community, that HIV/AIDS is a virus, it is an epidemic,
it is a tremendous cause of loss of life and untold amount of
suffering, deep human suffering that many of us have had the
chance to visit with families and be part of communities that
have experienced that suffering.
But it has also come to be a symbol of the critical
development challenges that exist in the world as people
began to realize that societies and countries cannot effectively
develop without the human resources and the freedom from
such a ravaging epidemic.
And it has become, perhaps much more recently,
a story of innovation, progress, partnership and hope,
in part because of the great successes of so many of you in
this room who have seen those successes on vaccine research,
on microbicide research and breakthroughs that Melody spoke
about on PEPFAR's exciting and tremendous progress.
And I was thrilled today to receive the press release from
the State Department that Ambassador Goosby released
announcing that 3.2 million people have been saved worldwide
because of this effort.
It is the demonstration of what's possible when we all come
together against a specific goal and with this relentless
commitment to succeed and with an operational focus on making
sure we save lives, we count them and we report on them.
I think it also inspires all of us that we can reach the GHI
goal, the Global Health Initiative goal of treating more
than 4 million people by 2013.
USAID has the honor of implementing about 55% of the
PEPFAR program, and on a day like today,
it is an honor to recognize the great achievements that those
teams have achieved in implementation of that work.
We know and we'll have a chance to discuss, I'm sure, the panel,
the challenges ahead in terms of prevention, further treatment,
expanding the effort, and using the tremendous health platform
that PEPFAR has created to provide a broader range of
health services to people who are in desperate need and in a
way that can maximally improve the quality of life and the
reduction of suffering.
Just yesterday we were part of a --
yesterday or Monday, we were part of an exciting meeting that
was following up on the CAPRISA trial and following up on
developing a strategy forward.
And a number of the partners from South Africa, from the FDA,
from NIH, from CDC all recognized that, in fact,
global health is a field where even when we have great
breakthroughs and even when we have real reasons for hope,
we still too often see 10, 15, 20-year delays in getting the
kind of uptake and impact of promising new breakthroughs
around the world.
And I was so excited about the discussion during that day,
because by honing in on that reality,
it demonstrated that this community was going to be much
more serious with these important HIV prevention
breakthroughs, whether it's the CAPRISA trial and what that
leads to or iPrEx trial and what that may lead to,
or so many other applications of antiretrovirals and prevention,
that we can accelerate that work in a very fundamental way if we
take some learnings and lessons from the private sector,
from PEPFAR's successful program to date,
from the vaccine community that has tried to accelerate
introduction of new vaccines in complex,
difficult and resource-constrained
environments around the world.
And if we stay singularly focused on that and try to do
that with all of our effort and energy and demand more resources
and demand more excellence and demand more focus on making we
adequately protect people, we can actually achieve tremendous successes.
I'm pleased to note that USA will play a significant role
with NIH and PEPFAR and others in helping to usher in that
focus on HIV prevention and with some of those new prevention strategies.
I was very excited to learn about Swaziland's program where
we're all working in partnership to increase circumcision among
men between the ages of 15 and 49 to more than 80% in less than one year.
It's the kind of an example of rapid scale-up of data-based and
proven interventions that can really make a difference,
both in terms of health outcomes,
but also in terms of giving us all the confidence that when we
find things that work, we can scale them up rapidly and do
that in a successful and focused way.
I think that effort alone is modeled to avert 88,000 new infections.
And in addition to the huge savings in terms of life and
quality of life, that will generate more than $350 million
in savings to that society that can then be used for other activities.
So I don't want to go on today with a community of people that
know this issue much deeper than I.
I just want to share with you my deep respect for what you do,
for your work and your commitment,
for proving to the world that often didn't believe you could
reach such high treatment numbers or you could achieve
such rapid scale-up of circumcision or you could move
so aggressively to see successes on microbicides and other
applications of antiretrovirals for prevention and for
continuing to demonstrate that we're going to get a vaccine
some day by staying focused aggressively on that task, that,
in fact, when a lot of people say it can't be done,
you prove time and again it can.
And we take inspiration from that today.
And I'm honored to be here, and I appreciate your great leadership.
I have the opportunity to introduce Dr. Tony Fouchi,
who really needs no introduction in this environment,
a great scientist, the Director of the National Institute of
Allergic and Infectious Diseases,
the intellectual and father, amongst others,
of the PEPFAR program, and someone we all look to for
continued guidance as we seek the next level of breakthroughs
that will help change the world.
Tony?
(applause)
Dr. Fouchi: Thank you very much, Raj.
It's really a great pleasure and an honor to be here with you
this afternoon to commemorate World AIDS Day.
It's always for me, from someone who has been involved in this
issue since the very first day, to use this day to reflect in a
somewhat bitter sweet way both the suffering that we've seen,
the accomplishments that we've made, and more importantly,
the challenges that lie ahead of us.
I'm going to talk for just a few minutes about some of the areas
of HIV research importantly over the last few decades that
brought us to where we are right now that have enabled PEPFAR and
USAID and other agencies to implement some of the most
important advances that we've seen in any medical field,
and on the other hand, to be able to realize the challenges
that remain and try and forge a path in that direction.
I want to just mention briefly to you three issues that many of
us have been speaking about over the last several years.
One is the optimization of therapy,
the other is the seeking of a true cure for HIV infection,
and the third is the maximizing of prevention.
So let's take the first for a moment.
The optimization of therapy.
There's extraordinarily good news here, but as we all know,
we can do better.
You know the numbers, we have 30 drugs that are used in
combinations, probably the most impressive success story of the
rapid translation of fundamental basic research in understanding
the virus and its targets and the development of usable therapies.
I could not help but reflect when I made rounds this --
I make rounds three days a week at the NIH,
and I've been doing that for too long,
because I don't really want you to know how really old I am,
but I do it every week, Monday, Wednesday and Friday,
from around 10:00 to around noon.
And when I made rounds this morning,
reflecting on this being World AIDS Day,
I recalled with great clarity the first patients that I
admitted to the NIH clinical center,
which is just about five and a half miles north of here,
during the summer of 1981 when we didn't know what it was or
where it was going, but it was making these young men,
predominantly young men very, very ill and virtually all of
them were dying.
The life expectancy of a patient that would come into my ward in
the summer of '81, who albeit came in with advanced disease,
was 26 weeks.
I made rounds this morning at 10:00 on a bunch of patients
that we have been following,
and it was such an extraordinary feeling to look them in the eye
and know that if that person was a 20-year-old who came into the
clinic newly infected with HIV who we put on appropriate
therapy, that I could tell that individual that mathematically
modeling, they will likely live another 50, 5-0,
years to the age of 70.
That's the extraordinary news.
But many challenges remain.
There's always the great news and the challenge with HIV,
that seems to be our fate from the very beginning.
What needs to be done?
We all know this.
Access to therapy.
Access that starts with finding out who is infecting,
getting to them, bringing them in to care and treatment if
necessary, and counseling them.
Again, getting back to my own personal experiences,
just last week we admitted someone who lives in the
District of Columbia, who presented with CNS lymphoma and
CMV enteritis with a CD4 count of 4.
That is completely unacceptable today,
but that's what we see every day.
So what do we do about that?
You talk about domestically access to care,
there are programs that have been launched that are
accelerating now everywhere, here in the District of Columbia
and cities throughout the country,
to get early penetration into the community,
testing and getting under care.
Globally, with the extraordinary work of PEPFAR and other
organizations, we have now over 5 million people in low and
middle-income countries who are receiving therapy.
When I first went down to -- not the first time I went to Africa,
but in the early 2000's when we went to Africa to put together
the PEPFAR program for President Bush, there was less than
50,000 people on therapy, mostly people who could afford therapy.
Now the numbers are extraordinary,
but there's much more to be done.
What about treating patients early?
There's no doubt now, no doubt at all in December of 2010,
that the earlier you put someone on therapy,
the better it is for the patient.
And we also know that it's less expensive in the long run to
treat somebody early and avoid the kinds of hospitalizations.
So what we need to do is to use that data to continue to
stimulate us to get people into therapy at an appropriate early time.
In addition, we need to optimize therapy and know now that we
have other things that go on with HIV infected individuals as
they live longer, heart disease, liver disease, diabetes,
psychiatric disorders, diseases of aging,
those are the challenges that are related to treatment.
What about cure?
I totally believe that we will be able to cure HIV in a subset
of individuals.
Now, what do I mean by a subset?
People get nervous when I say that.
I think a subset is someone who you can get into treatment early
enough so that they don't have an enormous HIV reservoir that
you're going to have to get rid of.
In my own lab, we've been doing studies over the last several
years that show if you look at the size of the reservoir,
and why do I bring up the reservoir,
the reservoir of HIV is that which you have to eliminate if
you're going to cure somebody.
And if you look at people who start therapy within six months
of getting infected versus people who start therapy after
years of being infected, the size of that reservoir is enormous.
If you start with a small reservoir,
then we could use the new therapies that are being
developed, the possibilities of gene therapy to eliminate that
and, in many respects, develop a cure.
And then finally, what about the issue of maximizing prevention.
We need in our scaling up prevention modalities.
And as was just said by Ms. Barnes,
there has been an extraordinary year.
If you push the year to about a year and a half,
three major transforming things have happened in HIV prevention.
The Thai trial that we're all familiar with,
which was the first real signal, modest though it may be,
that a vaccine can actually block acquisition in vaccinated individuals.
We need to do much better than that,
and a lot of effort is being directed towards doing better
than that.
The next was the CAPRISA study, another extraordinary proof of concept.
For the first time in the many years that we have been studying
topical microbicides, the big difference that this was
microbicide that had an antiretroviral in it.
The numbers of 39% efficacy, modest, but highly significant.
An important aspect is those who used it more did better.
And then the thing that has really excited so many of us is
the recent results from a couple of weeks ago on the PrEP study
iPrEx in which all comers, the results of oral Tenofovir in men
who have sex with men was 44%.
But I don't need to tell this audience that there's some
subtext to that that really tells us what our challenges are.
44%, if you look at everybody, if you read the paper carefully,
a substantial proportion of people who said they were taking
the drug in fact were not taking the drug.
So if you look at individuals who were saying that they take
the drug 90% or more of the days,
the reduction in risk of infection compared to the
placebo was 73%.
Even more importantly, if you divide it into people with blood
levels versus those who do not have blood levels,
and blood levels don't lie, the decrease in risk was 92%.
A, that tells us it's an important proof of concept,
but it also tells us with the CAPRISA study that adherence is
everything, and that's the thing that we need to combine with our
biological prevention modalities,
getting to individuals to understand the importance of adherence.
And I call that part of the combination prevention modalities.
And I want to really emphasize in my last minute that when we
talk about prevention, whether or not we get an effective
vaccine, which is a great challenge that I think we'll
meet, prevention will never be unidimensional,
it must be combination and multi-faceted.
So that's been a phenomenal year to a year and a half.
So let me close with the thing I say always when I talk about
HIV/AIDS, and that is there's much that we've accomplished,
but much to do.
So I'm very excited to be here today with you on World AIDS Day
and to talk about what has been accomplished,
but as I mentioned early on, I'm quite sobered about what
we still need to do.
So let us use this day to reinforce in each other the
commitment to sustain and increase the momentum so that
some day, and I hope in the not too distant future,
World AIDS Day will be a commemoration of something
in the past as opposed to a challenge that we still
need to face today.
Thank you.
(applause)
So now I'd like to take this great pleasure of mine of
introducing a very close friend of mine,
a person who really needs no introduction, Eric Goosby,
who is the United States global AIDS coordinator.
I had the privilege and the pleasure of knowing Eric from
the very, very early days of the AIDS epidemic when he was taking
care of patients at San Francisco General as I was
taking care of patients up the road at the NIH,
and we have been partners through it all over the last
several decades when he served in the Clinton White House and
the Department of Health and Human Services as the deputy
director at the White House of the AIDS Policy Office,
and the director of the AIDS Policy Office at HHS,
and now is serving in such a spectacular way that we're all
so proud of you, Eric.
Please come up.
(applause)
Ambassador Goosby: Well, thank you everyone.
It is a really kind introduction.
I appreciate it.
And it is wonderful to see so many people that I have known
for so many years in the audience.
And I thank you for coming today.
It is really a pleasure though to be here on so many levels
that we have heard from many of the distinguished speakers.
So many of you have been engaged in this work for really 30 years.
Many of the faces in this room, You have made huge contributions
both on an individual level and you know those contributions
well personally.
But also on a broader level.
Your work has been expanded at home and abroad.
Even though the challenges change from year to year and the
facts are that things are so different today from even a few
years ago, the advances we hear about and the implications for
these advances to move to implementation.
You are all still in the fight.
For that, I thank you humbly and acknowledge as Tony said that
there is much to do and we have much to look forward to in engaging.
I also would like to thank the President, President Obama,
Secretary Clinton, Secretary Sebelius,
I would like to thank Jeff for his leadership,
and all of the implementing agencies that we work with to
make this happen.
The Obama Administration's commitment to investing an HIV
AIDS Prevention Treatment And Care is unwavering.
The President has launched the Global Health Initiative which I
am convinced will make PEPFAR even more effective.
As this group knows so well, no one is defined by a single
health condition, even one as serious as HIV.
One of the major goals of the Global Health Initiative is to
better enable us to address the whole range of health problems
and needs of the people we already serve.
And that is an exciting opportunity.
For PEPFAR on this World AIDS Day,
our theme is "Smart Investments Building On Success."
It describes what we are doing everyday at PEPFAR.
The smarter we are about the prevention, treatment,
and care we provide, the greater the number of lives we are able to save.
This remains and always has been our bottom line.
Because our yard stick for measuring success is not
dollars, but the number of people we touch,
and the number of lives saved.
I am pleased to share with you today the brand new very
encouraging results achieved by our results.
Through PEPFAR, the United States is directly supporting
life saving antiretroviral treatment for over 3.2 million
men, women, and children.
An increase from less than 2.5 million one year ago.
In the coming years, the United States is committed to directly
support more than 4 million people on treatment.
This more than doubling the numbers supported during the
first five years of PEPFAR.
Support for prevention of new HIV infections and for care and
support for those effected by HIV,
are other areas of encouraging progress.
To date, PEPFAR supported programs to prevent mother to
child transmission, have allowed 600,000 babies of HIV positive
mothers to be born HIV free, including 114,000 infants in
the fiscal year 2010.
Through it's partnership with more than 30 countries,
PEPFAR directly supported 11 million people with care and
support, including 3.8 million orphans and vulnerable children
in fiscal year 2010.
In addition, to PEPFAR's impact, many also benefit from programs
supported by the United States and other donors through the
Global Fund to fight AIDS, Tuberculosis and Malaria.
The United States is the first and largest donor to the global
fund providing more than 5.1 billion to date,
and the administration recently announced an unprecedented multi
year pledge that Melody alluded to,
$4 billion to the fund representing a 38% increase
in the United States support.
As we build on this success, what is the way forward for PEPFAR?
Years of experience in the field have not gone unacknowledged and
indeed we have learned from these experiences to be
efficient and effective in the use of our money,
and investment in battling AIDS.
It means investing more in evidence based prevention and
supporting more effective and cost effective treatment regimens.
And leveraging our investments through effective collaborations
with partners.
It means strengthening the inter agency model that has been so
integral to our success.
In our model, each of our implementing agencies,
Health And Human Services, Department Of Defense, USAID,
Peace Corp, contributes unique core competencies to our work.
The global Health Initiative with it's own inner agency
structure builds on this success.
And finally building on success means continuing to work with
you and our partner countries to listen to your insights as we
pursue our shared mission.
I want to thank you for your partnership with PEPFAR,
as we pursue a future free of HIV AIDS.
I now would like to take this opportunity to introduce the
panel that will -- that can come up now as I am talking about you.
I think you can come up and have a seat in the chair.
Dr. Adaora Adimora is a physician epidemiologist at the
University Of North Carolina, School of Medicine.
She published the first national data on Concurrent Partnerships
in U.S. Women.
In the conceptual analysis of contextual factors that promote
concurrent sexual partnerships among African Americans.
Jenn Kates, well known to all of you,
is vice-president and director of HIV Policy at Kaiser Family
Foundation, non profit private operating foundation.
She oversees all of the foundation's HIV policy efforts
directing and conducting policy research analysis focused on
both global and domestic epidemics.
Chris Collins is Vice-president and Director Of Public Policy
for amfAR, the foundation for AIDS research.
He co-founded the AIDS vaccine advocacy coalition and is chief
adviser to Representative Nancy Pelosi on HIV/AIDS and health policy.
He developed the first legislation designed to provide
incentives for the development and delivery of vaccines against
AIDS, Malaria, and TB.
Dr. Rupali Das is a physician researcher at the University of
California, San Francisco, a place dear to my heart.
Dr. Das's research include HIV health and treatment
outcomes in the homeless and marginally housed urban poor.
Finally, my close friend and mentor Dr. Tony Fouchi who truly
has been in a leadership position since the beginning of
the epidemic and as Raj said has guided and advised us all at
points of confusion and clarity.
And we'll always be grateful for his continued contributions.
So I am going to move over to the table.
We are going to start with a couple of the questions that
allow each of the participants to focus on a specific question.
What I thought I would start with is Dr. Adimora,
since we are here and sitting next to each other.
You know, your work has really been impressive and illuminating.
It highlighted a lot of the issues that we have looked at
really since 1994 when we saw an increase in the African
Americans SERO-prevalence rates moving up and have stayed up
really since that date.
The vulnerability to infection that we have seen globally in
different populations is also reflected in people's ability to
be identified, to be entered in care,
to access therapy and treatment.
What concepts have you been able to kind of identify,
and steps that you might be able to articulate that would be
needed to better identify inner and retain especially black
women in the United States in care and treatment?
Dr. Adimora: Well, simple things.
I mean, some of the things I was thinking about are related,
but don't necessarily directly address that.
I would like to say first, thank you for asking me to be here.
I really do applaud the Administration's efforts in
combating the HIV epidemic.
Really, really and truly we do all do appreciate them.
Ambassador Goosby: Thank you.
Dr. Adimora: I think there are several principles.
One is that -- and several general principles.
Anything that effects black men effects black women,
because typically 80% of black women who have HIV have acquired
it through -- from heterosexual transmission.
Usually from a black man.
So that anything that effects black men,
effects black women ultimately.
Second principle is that some issues are very clearly out of
control of the federal government.
But I think that a really major task is going to be to
incentivize States' local governments and actually private
sector to comply with policies that are --
that are deemed advisable.
And the third thing is as Dr. Fouchi said,
no one intervention.
Even a vaccine is going to fix this situation.
So several things that I was thinking of are first,
all the stunning advances we have seen.
I think that one of the things that is going to be critical is
to answer some of the questions about how these latest advances,
iPrEx, CaPre trial, how are these advances to going to
benefit and how do they apply to black women in the US at all?
For example, what is the acceptability of these interventions?
What are the risk benefit ratios given that the black women in
the US are in a setting where risk of transmission is somewhat high?
But it is not as high as it is among MSN and it is not as high
as it is in South Africa.
What is the acceptability of pills?
Daily pills?
What is the acceptability of a gel?
These are all issues that I think are going to need to be
addressed in a research setting.
Secondly, you know here are some concrete things I think we need to do.
Again, anything that happens to black men effects black women.
I think you know -- a lot of these things are already known.
You have data for them.
Circumcision.
Like we need to make sure that circumcision is paid for.
You know, we clearly need to reimburse circumcision of male infants.
You know, it has been demonstrated that three quarters
of black men in the US are already circumcised.
So there is -- and people, you know,
I mean this is clearly an issue.
Third, concerning your -- one aspect of your question,
I do think that we need better information concerning the
SERO-prevalence of HIV infection.
In fact, I would really consider a return to something like the
studies of HIV SERO-prevalence among child bearing women that
were done in the US to have better information about really
and truly where HIV infection is in the general population.
Not just venue based and respondent driven sampling.
Another issue is and I mean again some of these issues are
so mundane, but the issue is implementation.
Condoms.
I mean, although condom use is inconsistent.
Part of the reason for their inconsistent use,
part of it is that many people simply can't afford them.
One thing and in fact this has been said by Tom Friedman,
one thing is that they need to be universally accessible.
To increase use among the many people who would in fact use them.
I can't resist this.
You know I am going to say this.
I am going to let other people move on.
But I think some of these social factors are really,
really critically important and they have to be addressed.
Look, for example, at incarceration.
I mean, incarceration, the disproportionate incarceration
of black men in the United States is linked to HIV
infection in the black population by so many very clear pathways.
We need to decrease that.
How?
Well, obviously I don't know.
But I would consider alternatives to incarceration
for non-violent crime.
I mean, the States are currently being crushed under the weight
of paying for incarceration.
And, secondly, really looking at the extraordinary racial
disparities in sentencings that exist not just for drug use,
but for sentencing for essentially all convictions
in the United States.
I think that really needs to be a focus actually in the Justice
Department to help with HIV.
Ambassador Goosby: Okay. Thank you.
Those are excellent points.
Let me just get the rest of the panel involved.
Dr. Das.
Your work with communities and looking at communities viral
load levels, How might you tie this in for high risk
populations within a larger community,
African American populations, MSN's, injection drug users, sex workers?
How would you use your tool that you are looking at and trying to
refine to help us better target populations?
Dr. Das: Thank very much.
First, I'd like to thank the organization for the opportunity to be here.
I think it is very important to remember the old performance
adage, what gets measured gets managed.
And community viral load is really a population level
indicater of how well we are doing with combination
prevention approaches for care and treatment --
prevention, care, and treatment in the United States.
As a clinician, I measure viral load in my patients to see how
well treatment is going.
As a public health official, I look at the overall measure of
community viral load, the aggregate number of virus
particles in a city, in a geographic region,
or the average number of virus particles among different sub
populations to look at how well we are doing in terms of optico
antiretroviral therapy, linkage to an engagement,
and retention and care.
So, for example, in San Francisco,
there are certain neighborhoods and sub populations,
groups within the larger groups of people at risk for HIV who
have extreme disparities in their average community viral load.
For example, transgender individuals, African Americans,
and Latinos have higher viral loads than the overall San
Francisco mean.
This not only allows us to highlight the disparities that
exist, but also allows us to better target our public,
diminishing public resources so we can help alleviate these
disparities and reduce new infections and improve care and
treatment outcomes in San Francisco.
Ambassador Goosby: Well, thank you.
Jenn, we have been at this a long time,
have seen both the domestic response both you and Chris were
really involved in pushing for this strategic plan,
the strategy, pushing that out.
I am curious if you with both your domestic and international
experience have identified some kind of lessons that might be
appropriate that go from both a PEPFAR foundation back to the
United States or from the United States to PEPFAR.
Ms. Kates: Yes.
Thank you Ambassador Goosby and Jeff Crowley and everyone else
who organized this and for including us today.
It is really an honor to be here.
There are many lessons.
Some of them are not rocket science all the time,
but they are lessons we always need to come back to.
And I was thinking about this.
One of the lessons that I was -- have been thinking about
recently is the connection between national and local.
And how a government overall approaches or prioritizes a
response and how that translates to local communities.
That is something that I think through PEPFAR was really
emphasized around focusing efforts in certain countries,
not at the exclusion of other countries,
but really saying we want to concentrate efforts and working
-- and increasingly working with governments as well.
So it is working with governments and working with
local communities, because HIV is local at the end of the day
as Adam was saying.
And in the US I think that has more recently been the marker of
the National AIDS Strategy, Where there has been such a
government wide approach.
But now an increasingly discussion of a focus on communities.
The twelve communities for example.
So I think that is an important lesson.
It may seem obvious, but it is not one we have always followed
in both places.
And it is one that I have noticed and think could benefit.
For example, one of the things that the foundation has been
quite involved in is media partnerships.
And I do a lot of policy work, but I get really excited about
getting to doing the media partnerships because it is some
of the most innovative areas we get to work in.
And it really is about public private partners.
And harnessing the power of the private sector in ways that has
been done I think internationally and hasn't
always been done here.
Now, one example.
We have long standing work in the US working with a media
company for example, MTV or other media companies on doing
outreach and information on HIV awareness.
We have not had success until recently in the US in creating
partnerships between media companies.
Globally, we were able to do that with the Global AIDS Media
Partnerships, with UN AIDS, and others and there was a real
sense of urgency that putting aside business rivalries and
competition was needed.
And that recently is happening here with the Greater Than AIDS Campaign.
So that is another lesson that when the urgency of something is
put forward, I think the private sectors and other partners are
really ready to step forward.
Ambassador Goosby: Well, thank you.
Chris, let me pull you into this with, you know, the strategy,
National AIDS Strategy is completed.
A lot of work went into it.
How do we best ensure that the thinking and the ideas that were
put forward in the document moved to implementation and to
ground and we benefit from it?
Mr. Collins: Well, I also want to say thank you very much for
the invitation.
It is an honor to be here.
I think that the strategy, the National HIV AIDS Strategy that
the President released in July, is a really bold step forward in
the domestic response to HIV in a lot of ways.
One is, it is focused solidly on achieving outcomes.
And that is something we have needed a long time in the
domestic response.
It is something I think we can take from PEPFAR that we need to
apply here.
The -- the strategy that we have got is certainly a very good first step.
To achieve the worthy goals that the President laid out in that
strategy, we are going to need implementation that is equally as bold.
And I think there is a few elements that go into that implementation.
One, for government, we are going to have to change the way
we do business in many ways.
We are going to have a much more coordinated and accountable
system, across the federal government but also with state
and local.
You know, I personally think that the twelve city plan that
CDC initiated and now HHS has adopted agency wide is --
can sort of be the Trojan horse of systems change that we need here.
Because if it is done right, it can really force coordination
between various agencies, HERSA, CDC, NIH, et cetera,
in the way we need.
A critical element though of that twelve city piece which is
an idea to really focus on epicenters, look at what works,
and then hopefully export that out to the rest of the country.
A critical element of making that work is scale.
You know, one of the things that we fail to do in this country is
deliver services at the scale we need to have the impact that we want.
So we heard several months ago from a survey of CDC that they
did in 21 urban areas in the United States among gay men.
71% of young gay black men who are living with HIV don't know it.
With that kind of coverage level we are simply not going to get
near the strategy goals the President has laid out for us.
To accomplish the scale we need in those twelve cities,
it is going to take resources.
Now, we all know this is a tough budget year.
But it is going to take money.
We are not going to get the strategy goals done without new investments.
There is a few ways I think we have got to loosen up money.
One, we need new money in the FY12 budget request.
I can't think of a year where you can better make a new
argument for funds.
We have got eight up waiting lines,
we have got a new strategy we are going to use funds more strategically.
In addition though, we need to make tough choices about
loosening up funds where they are not having impact.
Let's do an audit of funding and prevention and care and where we
are not having population level impact with our interventions,
we need to take a hard look at that kind of money.
We need to open up lending of resources so local and state
actors can use the 20, 30 different streams of money they
get in and can combine them and use them with more facilities so
they can go to scale.
So I think there is a variety of things we need to do.
Last thing I will say about this,
this isn't just about government as people in government are
always saying.
I think that is absolutely true.
Community actors who are the back bone of this whole effort
in the United States and globally,
also we have to be looking at changing our efforts just as the
government is.
And I think everybody's job is different if we do this right.
I think that some of the work that Dr. Das is doing
on community viral load, what we are hearing from prep,
what we are seeing about the impact of treatment on
prevention, it suggests that down the road community
providers are going to have an increasing role,
continually a critical role, but play more of a role in terms of
linkage to care and helping people stay in care.
Making the health care system work better for people who are
estranged from the health care system right now.
So roles are going to have to change,
everyone is going to have to be more transparent and accountable.
I think those are the places we need to go to make this strategy effective.
Ambassador Goosby: Thank you.
Tony, if I could ask, in having heard all of this,
and looking at the different types of interventions that we
make in an area that is a little outside of your central
expertise, but I know you are deeply experienced in thinking through it.
Is the combination therapy around prevention,
how do you decide in What is appropriate,
what combination to use?
Differences in populations?
Different opportunities presented?
I am just curious if you have thought --
what your thoughts are on how to figure out what that perfect
combination might be?
Dr. Fouchi: Yes. Thank you, Eric for the question.
I don't think there's going to be a perfect combination.
But when you're looking at a very bold concept of using
potentially, and in reality, toxic drugs to prevent
something, you have take certain things into consideration.
And those are the things that were actually considered for the
choice of Truvada for the PrEP trial.
First of all, you wanted to have something that you were pretty
sure worked.
And Truvada had close to ten years of experience as
two-thirds of the most popular combination used,
certainly in the developed world,
as we all know it's used with the favrins
or with a protease inhibitor or with another non-nuc.
So we know it works.
Secondly you want favorable pharmacokinetics, which is has,
you want to have an animal model in which it works in
and this drug does work in an animal model.
And you want it to have minimal toxicities,
which in fact every drug has toxicities.
Tenofovir with renal.
There was some nausea in the study.
So you try and weigh it in a way that, people have asked,
does this mean that Tenofovir/emtricitabine
is it after Truvada?
No, I think we'll continue explore as new drugs come online
those major characteristics.
Low toxicity, good pharmacokinetics,
and pharmacodynamics and efficacy.
So, to me that's the bottom line, scientifically based.
Ambassador Goosby: Very good.
Any reactions to what's been discussed around those
last two points?
It raises the question of how are we going to be able to
translate our scientific breakthrough into appropriate
applications in the field.
PEPFAR has really realized it has a central role to play in
being a strong platform off of which we can rapidly move to
scaled studies that also allow us to move to scale
in treatment therapies.
I'm opening it up now to just general discussion
around those issues.
Dr. Adimora: Well, one consideration is, again, these developments are
really, truly stunning, but the question is, becomes implementation,
how are people actually going to get access.
How are people going to pay for some of these treatments,
preventive measures.
How are we going to muster the political will in a very
difficult climate, well, actually it's always difficult
as far as I can tell.
But especially difficult now to get these things done.
I mean that's really the main -- a lot is known.
Even more as it's been repeatedly said,
even more has been discovered in the past 18 months.
But how do we actually implement all of these things?
That to me is actually the biggest question.
Dr. Fouchi: There are really some very important policy issues that
are emerging that I think everyone is aware of,
particularly around the issue at the point you made with your
question to me, Eric, about preexposure prophylaxis.
We have to be really careful how we begin to implement that.
I think it's going to be different.
There's not going to be one size fits all.
It's going to be different from country to country,
prevalence to prevalence, incidence to incidence.
How many people are infected and are not receiving therapy.
What is a good mathematical model, if any,
of cost effectiveness, if you prevent X number of infections
in a country that has X number of infections,
what is the cost effectiveness of really even trying to use
therapy to prevent infection?
I don't have the answer to that and I think it's
going to differ from country to country,
but what I would be disappointed at is if we didn't really get
the best minds, the best modelers to analyze that and
make it an open area for discussion.
Because there's a lot -- this is just a proof of concept.
Now comes the real work.
You know, I just, I recall when the model was brought forth from
the Granich Model of treatment as prevention.
It was kind of, gave the wrong impression to the world.
It was like treatment in a vacuum is going to have the AIDS
epidemic go away which had people sour to the concept of
treatment as prevention when I think that was a mistake because
there were certain aspects of treatment as prevention that
absolutely will work.
So we got to make sure that we take this incredible concept
that's come forth and analyze it and put it in the right context.
Ambassador Goosby: Chris?
Mr. Collins: I agree with that of course.
I think one thing that's going to be interesting about PrEP is
it's going to challenge the system that we've set up.
I mean PrEP is going to require targeted intervention,
it's not something everyone is going to want to use.
It's not cost effective to try to get to everybody.
It's just not going to be that kind of target.
It's for folks who want to supply with the regimen who
are at elevated risk.
It's very exciting.
I think it's important to point.
This result was in gay men and other men who have sex with men.
A population that has been neglected for many years around
the world that I certainly commend PEPFAR for increasing
efforts around the MSM epidemic.
But the fact that we have a new tool that can work in gay men is
very exciting, both in this country and internationally.
But again, it's really going to challenge all of us how do we
create health systems that can identify folks who feel safe
coming forward to use this and help them use the regimen.
Then also of course, monitoring, you've got to be in a doctor's
care to use this.
You need to be monitored on an ongoing basis.
HIV testing regularly.
All of those pieces.
So I think it pushes the system but in a perhaps a
very positive way.
Dr. Das: Hi. I wanted to follow up on Dr. Fouchi's comments about
treatment as prevention in thinking about antiretroviral
treatment as a way of reducing new infections.
In San Francisco, over the past several years we've initiated a
series of comprehensive combination approaches to
HIV prevention and care through the health department and our
community-based organization colleagues and partners,
and we have seen an increase in expansion and testing.
Identifying people at higher median CD4 counts.
We've seen a decrease in the number of people who are unaware
of their HIV serostatus from mid to higher 20 to 10 to 18%.
And most importantly, we have seen a massive increase in the
number of people, all people living with HIV in San
Francisco, who are suppressed in terms of having an undetectable
viral load from over half to approximately three quarters in
five years, from 2004 to 2008.
And that's only expanded with the newly available
antiretroviral regiments that we have had.
And during this time we have been able to follow community
viral load as well as these other surveillance markers to
show how well we are doing in terms of implementing these
combination approaches.
And it's also been able to highlight the places we could
do better, including retention and engagement and care,
and making sure that all San Franciscans
and all Americans share.
And people will worldwide share in the benefits of
antiretroviral therapy, not only for their own individual health,
but it's one time when the benefits for the individual
are lined with benefits for the community in terms of helping
people live longer and healthier lives as well
as reducing transmission.
Ambassador Goosby: Jenn, if you want to say something.
Ms. Kates: Just going to add three things, most of which have come out in
different ways that I think are essential to consider in
implementing this intervention or any other intervening that
is real bridging prevention and treatment in many ways.
First is assessing current access,
because current access as in San Francisco,
which is going to be much higher than other places,
current access to other treatment for those who are
infected has both an ethical relationship to introducing
something for prevention as well as a bearing on the modeling
that Dr. Fouchi was talking about.
Second is combination, combination, combination,
no matter what new intervention we have,
combination interventions will always be needed.
And the third is community engagement.
Going back to the local again.
Getting communities involved to understand and provide their own
input about what kinds of combinations actually work.
In reading the research that you do,
looking at social determinants and factors at age that elevate
people's HIV risk clearly understanding those within
communities is going to be critical to figuring out the
right combinations.
Ambassador Goosby: Yes, I think that our ability to move these advances into
benefiting the populations that we are attempting to serve has
always been a critical challenge,
both domestically and internationally.
Our PEPFAR has also been confounded by issues that really
move from discrimination into really human rights issues,
where the barriers that are being put in front of the
population trying to access services increase,
because of comments from political leadership or
legislatures, or from the community.
And the only thing that is going to move against this is really
our understanding of the critical role community
empowerment place in modulating and pushing back around those
belief systems and those points.
PEPFAR is very focused on trying to understand how we can move
that now into the next wave of focus,
for us to nurture and empower communities.
I'm curious if any of you can speak to some of the
discrimination barriers to care, both domestically, domestically,
probably, that you have seen and are critical in your mind
to diminish to allow for these issues of access
to be eliminated.
Dr. Adamora: Well, certainly we see there are lots of areas in which we
see discrimination that is a barrier to entry to care.
For example, in thinking about some of the problems of rural
areas, particularly the rural south, I mean we see not only
direct rational discrimination and class discrimination,
but in addition, we see problems related to geography,
just the incredible distance that people are from care.
I have patients actually who travel easily three hours in
one direction to get to me.
Another problem that people in rural areas face,
particularly the rural south is a problem simply related
to population density.
You know, under the current funding schemes,
their funding eligibility schemes, they may,
they often receive less funding by virtue of the fact that the
population density is lower.
Another issue is the fact that some of these poorer states
where there's a large rural population,
some of these southern states where there's a large rural
population are extremely poor, highly problematic Medicaid
eligibility and Medicaid funding.
And these are some very concrete things that affect people's
ability to get medical care, ability to get HIV testing,
ability to get care, ability to get access to drugs.
People who in fact know they are HIV positive, for example,
were eligible for antiretroviral drugs,
and who wanted them in many cases during the past year
because of the problems with ADAP simply could not drugs.
Ambassador Goosby: I think, you know, the issue around women and girls be
disproportionately impacted by some of these barriers
to care domestically.
The Southeast corner of kind of going from Texas to Florida,
heavily dominated with rural issues around access.
It's been that way for 30 years.
And if you look at other disease processes in which you see huge
disparities, you have the same issue,
that same corridor comes up.
I'm curious if there are models or examples of attempts to
really minimize those barriers, either, really domestically,
I think we should focus that you may be aware of that you think
we should try to bring to scale, disseminate.
Please.
Dr. Das: I think one important intervention that's worked
in other diseases, started in Harlem,
with breast cancer and noting the disparities among breast
cancer diagnoses and survival among African-American women in
New York City, is the use of patient navigators and other
types of interventions to support navigating through
potentially hostile or discriminatory health systems
and complicated health systems.
I know helping my father navigate through Columbia's
lovely health care system, that's done great things in
keeping him healthy is a challenge for me.
And I was a doctor who trained at Columbia,
and sometimes it's hard for me to figure out what I'm supposed
to be doing and where I'm supposed to be taking him for
his labs.
So it's helpful to have.
And the concept of navigators or promotoras or Compenators
have been used domestically in inner city urban settings to
help address substance use, mental health,
discrimination and also internationally.
You know, with partners in health in Haiti, Rwanda,
et cetera.
So that's one intervention that's been successful both in
breast cancer.
It's being looked at for diabetes and other chronic
diseases and as HIV moves more into a chronic disease
management model we need to learn from other experiences and
other diseases on how to help reduce disparities,
and I think navigation is a great intervention for its
potential for improving engagement in care.
Ms. Kates: I want to actually expand our discussion around discrimination
and stigma to include the broader stigma that
still exists.
I'm usually a glass half full person,
but it's very disheartening that that there's still so much
stigma around HIV in this country.
And, that just has to be a continual battle that we all take on.
And that does have a national implication as well as, again,
local implications.
And there's no, you know, magic answer to doing that.
It just says, again and again as --
I think it's changing with younger generations.
One of the things I'm really excited that we announced today,
earlier today is a new partnership with the NBA and
something with Walgreen's, two very different kinds of private
sector partners, but ones that you don't usually associate with
HIV necessarily, both using the assets they have best.
NBA has basketball players and lots of attention and very
expensive seats or something --
(laughter)
And Walgreen's is the largest drug store in the country that
has, you know, Walgreens in almost every community,
are both using what they can do best to get out HIV information.
I think by virtue of doing that and making it much more common
to see information, to get HIV screening, it helps.
It certainly can't help alone.
But thinking about the stigma that still exists in this
country is how do we straddle the really focused intervention
for the patient, for the individual as well as change the
general culture in the country.
Ambassador Goosby: I think that the issues around discrimination permeate the
PEPFAR family of issues as well.
Our ability to engage them has been through the work of our
implementing partners and the patients that use the services
that we have put in place.
We have had the emergency response.
We were moving to more sustained responses.
Now the third wave as we were alluding to really is that
empowerment of community.
Because it allows the safe spaces to be created.
So the pushback and unacceptability of the behavior
is engaged and diminishes itself as a barrier.
I'm curious if there are thoughts on specific types of
strategies that you're aware of, the bringing in the public
private partnership strategy as another arm of resources that we
can converge on some of these issues.
PEPFAR has put a lot of effort into public private partnerships
to help support and deliver technical assistance through our
partner country's leadership in the ministries of health,
in their ability to set up reference labs,
surveillance capabilities; all of those types of technical
skills are frequently found in private sector multinational
organizations that actually are in and around all of the sites we're in.
We have been very gratified at taking advantage of that.
But I'd love to hear you kind of speak to the added utility that
a PPP-type approach may afford.
Or Chris, too.
Mr. Collins: Well, I mean I think part of the equation has to be community
based organizations, people who are trusted in the community who
can reach folks that government employees and people under the
general health sector can't.
You know, I think the move towards more country ownership
and health systems strengthening are absolutely
positive places to be going.
But as we go there we've got to realize that MSM behaviors,
criminalized in almost 80 countries around the world.
Many of them are where PEPFAR is operating.
So it's going to require the NGO sector to be playing a really
critical role as we move forward.
I think that's -- the fact that the AIDS movement has always
been about thinking about most at-risk populations in addition
to general efforts is one of the strengths here and why as I hope
that as we move towards the global health initiative and
broader delivery of broader health services,
which I think is a wonderful thing,
let's not lose the strengths of what this AIDS
response has been.
And all the strengths that we've seen in PEPFAR over the years
and under your leadership.
You know, I think that we know that AIDS has a tremendous
impact beyond the number of people personally affected on
family income, leading cause of death among women.
It is the most robust platform on which to build broader
health services.
And let's be honest in terms of politics,
PEPFAR has bipartisan support at a time when budgets are
really tough.
So I strongly support where the global health initiative
is going.
I think we need to be thinking about most at-risk populations
in GHI as we move forward and PEPFAR can be a big part of
that picture.
So I think the lessons of AIDS and the strength and the focus
of PEPFAR needs to be absolutely critical going forward.
Ms. Kates: Just add on, on the -- and to completely agree at the role of
NGOs and community partners, it's defining how the AIDS
response happened everywhere.
So it's critical.
Just to add on the PPPs public private partnerships,
it's an obvious thing and you alluded to it already,
but it's really understanding that different private sector
partners have their own niche, their own specialty and it's not
asking them to do things that they don't do.
It's asking them to do what they do but potentially have the
broader application.
I think what we found, private sector partners,
whether it's you know the NBA, Walgreen's, CVS, Fox News,
and actually a new partnership focusing on gay and
bisexual men with Logo and peer media to, they want to do things.
They really, really, do.
They just want to have it fit more with what their
approach is.
We are public health experts, they are not.
They know how to reach people or how to, you know,
provide information in different ways.
So it's a simple thing.
But I think that's a really critical piece.
Ambassador Goosby: It is a really critical piece.
When I think about this at the point when you came into the
Kaiser Family Foundation, that epiphany seemed to be very much
part of the shift that we saw in the Kaiser family,
realizing the importance of engaging journalists and media,
but also the private sector in a different way to look and tease
out, define their responsibility to that larger burden.
And I would just commend the Kaiser Family Foundation for
having seen that many years before most of us.
But also really very much want to find an entity in many of the
countries that we are in this PEPFAR that can play that same
kind of catalyst role; the honest broker,
the agent that will present the information so we can't ignore
it and have to continue to look at it.
We are very actively trying to figure out how we can kind of
generically institutionalize and infuse that capability in many
of the settings.
Ambassador Goosby: Any other thoughts that people were just dying to put out there
that I didn't tweak?
Chris?
Mr. Collins: I want to congratulate you on the treatment numbers that you
announced today.
I think that what PEPFAR continues to accomplish is
something that we should all be really proud of.
And I know that a lot of that is because of your leadership,
leadership of your staff finding efficiencies and drug pricing
and supply chain and those sorts of things.
And I know that it's -- that's what's allowed scale up to
happen in a place of little funding growth.
And the future efficiencies don't last forever.
So I'm really hoping that as we move forward we see this as a
great investment for the United States,
a great place to increase investment to accomplish our
humanitarian goals, but also our diplomatic and security goals.
It's paid off in the past and I think it will in the future.
So thank you for your leadership.
Ambassador Goosby: Thank you for saying that.
It's very kind of you to say.
I think that we are acutely aware of the moment we are in
historically as the Congressional leadership has changed.
And the importance of all of the things that you point out now,
really identifying programs that allow for bipartisan dialogue
and approach to move forward.
We hope that PEPFAR can continue to play that role as we really
try to address the large burden of unmet need that we are all
looking at and all speaking to today.
So thank you.
So, I guess that we want to go a little further on and give
another opportunity to cover some of the issues of the --
I guess I would ask, are there lessons that you have identified
from your work domestically that you feel are effective at
eliminating barriers, especially for the African American
population, for women in particular,
girls that you've kind of identified in your work that you
would think we know this, we should bring this to a scale in
not only this city or this neighborhood,
but really more broadly.
I'm just curious if there are those types of issues that
you've identified.
Dr. Adimora: Well, I guess, again, what I would answer is something that's
related to that, although it doesn't necessarily speak
directly to it.
There are two things.
I think that we really do need to make much more effective use
of the mass media for informing people and also for changing
people's behavior, not simply through what people perceive as
sort of tired public service announcements.
But really use the lessons of advertising to develop more,
you know, effective ways of changing behavior and changing norms.
Another thing, again and -- so that's one thing I would say.
Another thing that I would say is that you know, actually,
in looking at the lessons from Africa and how they apply to the
United States, in thinking about the success of Uganda,
actually, in decreasing HIV infection,
I mean one of the things that has been pretty universally
agreed on is that a fundamental aspect,
a fundamental component of their success was a tremendous
political commitment and political will where they really
marshaled their efforts for social marketing of condoms,
for mass media campaigns to decrease concurrent partnerships
and other forms of multiple partnerships where they really
went all out and had, actually, incredible political commitment
to do this.
Well, certainly, I think we in this room would agree that there
is a commitment on the part of the administration.
What we need is somehow to get the rest of the nation on board.
If we had the political will, I mean there really is absolutely
no telling of what we would be able to do to get rid of AIDS in
this country and certainly in the world.
Ambassador Goosby: You know, I've been impressed with there's a role for
government, there's a role for private sector,
both in the PPP context but also in the health profession context.
What have you identified in the teasing out the responsibility
from the community itself?
And I mean specifically talking about African-American
communities, Hispanic communities in the United States.
It's a dialogue and a two-way street.
What can the community be challenged with that they need
to focus on and integrate into their behaviors?
Dr. Adimora: So unquestionably, you know we talk about social factors that
play a role in setting up people for getting HIV infection.
But certainly there's no question,
but that people have a responsibility for their own behavior.
I mean, there's no question about that.
And I think that clearly one thing, and it's being done,
is working with, for example the black clergy,
we have a project that does that,
it works with the black clergy to specifically address safer
sexual behaviors.
And you know the point of -- because their voice clearly
needs to be heard.
There are a respected force in the black community.
And they have a considerable amount of power to help change
people's behavior.
But I think unquestionably we, there is a clear responsibility
for people to change the behavior,
make their behavior safer, to change norms in the community.
And it's my impression that people don't disagree with that.
In fact, we have actually been pretty successful in getting
clergy on board to help with that effort.
I don't know what other --
Dr. Fouchi: Well, I would like to ask you, Adaora,
if years ago when it was very clear that the trend was towards
more and more relative percentage of African Americans
getting infected.
And now you know, the new infections it's 53%,
men who have sex with men, half of whom are African American.
From your vantage point with a lot of the experience that you
have in your own position, what do you think we can do as a
community to catalyze a bit more the African American leadership
to come out?
Because I remember right on 16th Street giving this fiery talk to
African American clergy about what they really need to do to
come out and really reinforce the need for people in the
African American community to take the responsibility of
avoiding getting infected.
I felt a little bit awkward, you know,
a white guy in a suit going telling a bunch of
African Americans who know a hell of a lot more about their
community than I do.
But I've been disappointed in seeing that I don't think
they've stepped to the plate as much as they should.
And if not, how do we get them to step to the plate a little
bit better?
Dr. Adimora: Yeah, that is a great question.
You know, and I mentioned that, actually I do have this project
that works with -- and it's NIH funded, in fact --
that works with --
Dr. Fouchi: That's why I asked you.
(laughter)
Dr. Adimora: You helped fund it.
That works with clergy.
I have to say that I think it is probably quite difficult as a,
you know, person of different ethnicity to sort of --
it can be seen as kind of an indictment of people.
And one way that we did this is through, first of all,
I'm obviously black.
And also working with a co-investigator on this project
who is also a black pastor.
So sort of, you know, explaining the whole context of problems,
and not simply approaching them with, you know,
a single message of people need to use condoms,
people need to use condoms.
Part of the focus is actually getting them to understand that
there are measures that they can recommend that are really
consonant with their theology and consonant with public health.
And that they need to do that.
And they actually end up agreeing.
Now, I have to say, this is not huge numbers of pastors.
But there certainly are, you know, this is the south,
this is North Carolina.
People did get on board when they were approached by,
you know, a black physician and another black pastor.
And when they got, you know, sort of epidemiology background
that's geared at, you know, African Americans and HIV,
they actually were very interested and did develop the sermons.
Mr. Collins: You know, I think another yes, and another important element of
this is I would just like to reference research done by Greg
Millette who now works at the office of national AIDS policy.
This was I think three years ago,
he published a meta analysis on black gay men in the United States.
He looked at the evidence and it suggests that black gay men
aren't any riskier than any other type of gay man in the
United States in terms their risk behavior.
But there are some things that are different about black gay men.
They're less likely to know that they have HIV if they're living
with HIV.
If they're living with HIV, they're less likely to be in
treatment, so less likely to have the viral load controlled.
They're less likely to have an STI diagnosed and to be treated
for an STI.
So we're all human.
And when a black gay man enters into that world,
there may be a higher community viral load in the field in which
he's playing.
And so, I mean, I think it's also not about just saying,
this isn't just let's not stigmatize behavior of black gay men here.
And a lot of what's going on here is people don't have the
same access to treatment historically and presently.
There's higher community viral load in this community,
it appears.
And so in addition to these social things that we've got to
do, we've just got to do better at getting treatment and other
health services to people to control community viral load so
that if people occasionally slip,
which it turns out people do sometimes,
the risk is greatly brought down that they'll be exposed to virus.
We can do this.
It's -- Dr. Das is looking at doing this kind of thing.
It's happening in Massachusetts.
It's happening in other places.
There's a lot of hope here that this approach can be really important.
Ms. Kates: I would just add and underscore something that you brought out a
few times, which is community empowerment.
And I think if we approach this as not problematizing but really
about empowerment from a community perspective,
actually the thinking behind the greater than AIDS concept,
which came from something that President Obama himself said,
but we can be greater than this.
And that sense of empowerment versus an individual feeling
stigmatized or problematized or in it alone actually is,
I think, a motivating contribution.
Ambassador Goosby: Thank you.
Speaker: We'd like to take an opportunity and give the audience a chance
to ask some questions, Ambassador Goosby, if that's --
Ambassador Goosby: Okay.
Let me open it up to anyone who had a question.
We can take a couple of questions.
You know, I think I would ask with the national strategy,
was there a component that teased out the role for private
sector PPP type strategies to move forward or was that kind of
left up more to how the individual 12 kind of sites
might relate to it and at the local level or was there a
larger planning thought to that?
Do you know, do either of you know?
Mr. Collins: I mean, well, you know, the strategy speaks to the critical
role of the private sector.
I don't know that -- and I think actually private sector elements
are part of the implementation plan we got in July.
And it's also important to point out that ONAP has organized
private sector, they had private sector folks and funders here
for a meeting several months ago.
They organized a follow on discussion about how the private
sector can be engaged.
So I think that's in development.
I don't work at ONAP.
But my sense is, you know, certainly they're engaging on
those issues and it's going to be central.
Ms. Kates: But I do think that is one challenge of the implementation.
It's hard enough to implement across government.
But to get the private sector and communities engaged is --
it can't be the federal government doing that itself,
but there has to be a partnership.
Speaker: We have a question.
Audience Member: Thanks very much.
I just would like to, first of all,
also thank Ambassador Goosby for your leadership on the MSM
issues in developing countries.
That has, you know, it's kind of incredible 30 years on that we
are sort of discovering that there are gay men everywhere in the world.
Some of us kind of intuited that.
And, you know, that that population,
or those populations, are so markedly underserved and really
are in some ways going to be, I think,
an enormous challenge for the next phase of the response.
I guess the question that I have is that this is one of those
areas where you think about the lessons learned from PEPFAR and
lessons we'd like to learn from PEPFAR for the U.S. epidemic.
And in some ways when you look at the rates in African American
and other minority MSM in this country and what we're seeing in
developing country MSM, you really wonder if there are not
unlearned lessons all around with how we're going to,
you know, respond to these challenges.
I think that community empowerment,
community capacity building piece is critical.
But of course what we're faced with in a lot of settings,
the recent attacks in Kenya, the prime minister speaking out yet
again against gay people, are governments that are hostile to
community empowerment for this group.
And I guess I would ask you wearing your ambassadorial hat,
you know, what ways forward you see for this part of the response?
I mean, we all know that this is an immensely tough challenge.
Ambassador Goosby: Well, thank you.
I know you know as well as anybody how difficult it is to
push this agenda.
I do believe that it is acknowledging that our ability
to partner with the NGO community frequently plays a
critical role in putting program to ground and creating safe
space so individuals can feel free to reveal themselves to
their medical providers and not feel as if it's revealing
themselves to community or to authority.
It's a fine line to walk.
We had to walk it domestically initially.
We got reasonably good at it in the United States.
But it is because of that community empowerment that it
became truly safe space.
I think the legislative complement to that is in our
Disabilities Act, allowing individuals to have a legal
foundation on which to prosecute discrimination.
It should be acknowledged and looked at that way.
I believe the multi- -- the WHO in a normative role has a role
to play in defining that, the human rights issues around that
need to be prominent in discussion and leadership.
Secretary Clinton has been articulate in challenging
ambassadors in the State Department to include this in
their portfolio of dialogue with country leadership.
She's enforcing that.
And we have seen progress with it.
It is clear to me, though, that we will not win that discussion
with a U.S. government imposed dialogue,
but that we put and keep the pressure on to have the
dialogue, and then we look for opportunities and ways to create
conduits to support that empowerment kind of evolution
that needs to occur with indigenous community-based
organizations to give them the knowledge and understanding of
colleagues in other countries that have already walked this path.
And to try to support, again, that complementary legislative
legal framework in which it becomes the grid against which
this really does move forward.
It's a challenge that I think is front of all of us with MSMs,
with injection drug users, with sex workers,
and in the lack of empowerment frequently seen in women in many
other countries, in almost all of the countries that we work in.
They can be viewed in the same way,
needing the same type of opportunity and structural
support to create those safe spaces.
I'd be curious of any thoughts on this.
I know this group has been in and amongst these issues for
many years.
But if there were.
Yeah.
Any other questions?
Yeah, Seth?
Audience Member: Like others, I want to commend you and everybody for the
leadership that's been shown.
Globally, it's not only concerned here, because the U.S.
is the largest funder, but globally we're beginning to see
declines in interest in HIV.
Recently a prominent European country that has been a very
strong supporter of HIV recently has downgraded that as an
important priority, and that's the Netherlands,
a place you wouldn't have thought that to happen.
There's a lot of movement to the right of governments.
What are we doing and how do we think about that as a factor
that could have enormous influence on the global issue,
particularly at a time when we've got all these fabulous new
interventions that make it possible to talk about,
being able to finally really control this epidemic and be
able to treat every person that has the disease because of the
fact that we'll be able to control it.
I worry enormously about that.
Ambassador Goosby: Well, I know -- Chris, did you want to react to that?
Sorry.
Mr. Collins: I will, yes.
Ambassador Goosby: Go right ahead.
Mr. Collins: Well, I mean, I think that's really concerning.
And, you know, I think a few things.
One is, I think the science is leading us to a place where we
can change the curve of this epidemic.
And I think we have to get better in talking with policy
makers about the opportunity here.
It's not growing programs for the sake of growing programs.
It's investing where we've seen payoff in order to change the
course of a terribly devastating epidemic in the United States
and around the world.
So, I mean, this is a good investment.
And the new tools we're getting online,
they've got to be used strategically.
We have to be more strategic in the way we use them.
But if we do that, we can really change the way this epidemic looks.
And in the process, you know, again,
the response to AIDS is the health system's builder.
It has been that.
It has been a way to get health services to people who didn't
get them before.
It's changed many people's relationship with the health
system, knowing the treatment is available.
It's changed what it means to be a health care worker in many countries.
So, I mean, I think we need to talk to policy makers about how
we've seen payoff from the investments here,
the enormous opportunity to slow down this epidemic and build
health systems while we do it.
Dr. Fouchi: You know, Seth, you bring up a really good point that's really
very troublesome and particularly the issue with the
Netherlands, which is not a country anymore or less involved
themselves, but had the foresight for years to make
investments and now have decided because of the economic
situation to pull back.
I'm not so sure there's anything we can do about that given the
economic times.
So what I think about is maybe the possibility of getting the
countries with extraordinary involvement,
namely the countries in which there is a major problem in
their own country, to realize as we get better tools that we were
talking about this afternoon, that, you know,
it's almost like a drug company where drug companies tell us you
do the research, you give us a concept.
Once we get a concept and we can see the light at the end of the
tunnel, we'll invest all the money you need to go after it.
Maybe we could use a little bit of a modification of that
argument for some of the countries that have the real big problems.
That if we now have the tools that every year we get more and
more tools, that then they will see that it would be for their
benefit to make a major investment of their own domestic
-- national domestic product and to put money in to make that happen.
I think we're going to see that with vaccines.
I think we're going to see that with microbicides.
I mean, we're seeing it with circumcision.
So I think that as we get more and more proven tools,
we can get the companies -- not the companies --
but the countries that are most heavily involved to actually
step to the plate.
Speaker: Ambassador Goosby, thank you very much,
and thank everybody on the panel.
We're going to it back over to Jeff.
(applause)
Mr. Crowley: Great.
Thank you, everybody.
I thought that was a really rich discussion and I am glad we had
the opportunity for it.
Now it's my pleasure to introduce the Secretary of the
Department of Health and Human Services, Kathleen Sebelius.
Madam Secretary?
(applause)
Secretary Sebelius: Well, good afternoon, everybody, and thank you, Jeff,
for your work and leadership in this area.
And I'm really happy to be with all of you today.
I want to thank Melody Barnes and certainly our great leader
at HHS, Dr. Tony Fouchi, Ambassador Goosby,
it's nice to always join you, and other panelists who have
been here today.
I know that this is a gathering of advocates and care providers,
stakeholders, policy makers and others looking at where we've
been and where we need to go in the fight against HIV/AIDS.
And we're talking about efforts not only here in the U.S.,
but around the globe.
And I think there's some very good news to share and also a
lot more work to do.
I know today is World AIDS Day.
And it really represents a special moment.
A moment to remember those who have lost their lives,
honor those who are in the fight,
and also rededicate ourselves to an effort moving forward.
But at HHS, every day is World AIDS Day.
We have a lot of talented folks who spend each and every day
focused on these issues and these initiatives and our effort
to move it forward.
We have a lot of gains to celebrate.
And I think it's a time to look ahead with hope,
but also rededicate to the purpose of our collaborative efforts.
Now, since we were together a year ago at World AIDS Day,
there are a number of significant milestones,
important advancements in scientific research and a
historic increase in testing across the U.S.
And certainly the passage of the landmark health reform
legislation, which will provide a base of coverage under
millions of Americans who never had that opportunity before.
So a lot has happened over the last year.
But we certainly need to keep that momentum going.
We need to keep the scientific endeavors moving forward.
We need to redouble our efforts on prevention and make sure the
care and treatment is provided to individuals living with
HIV/AIDS.
So we've come some important distance,
but we have a long way to go.
In the last year, with the President's leadership and the
dedicated work of lots of scientists, policy makers,
people living with HIV/AIDS, again,
there are some steps forward.
Lifting the entry ban on HIV positive travelers was an
important step forward, and one long overdue in this country.
Now families can be together and we can once again welcome
people to the United States who should have been able to travel
here years ago.
The President signed a law ending the longstanding ban on
most federal funding for needle exchange programs,
giving us more opportunities to stop the spread of HIV against
-- among -- I'm sorry injecting drug users.
Again, an important initiative forward.
We reallocated an additional $25 million this year to extend care
to people on state waiting lists.
Now, I know that there's still a lot of frustration that that
additional resource still didn't keep up with the drop,
the precipitous drop in state and local budgets.
But we're continuing to work with states on how to make sure
those allocations reach the most affected populations.
And in the last year, we're beginning to use new medium to
build a cutting edge response to the epidemic,
targeting HIV prevention, testing,
and treatment messages to the people who need them the most.
It's the first time in a long time that we've really focused
on a domestic AIDS strategy.
And reaching out through channels like aids.gov to meet
people where they are, to educate Americans about HIV and
to reduce the stigma and discrimination.
Now, our scientists, as you probably heard,
have had a good year, as well.
In July, the U.S. government scientists and policy makers
joined colleagues from around the world in Vienna for the
international AIDS conference and they heard exciting news
about the successful trials of microbicides that will one day
protect vulnerable individuals, particularly women,
from HIV infection.
And in the same month, HIV led scientists have found antibodies
that prevent most HIV strains from infecting human cells.
Growing optimism is there that we're getting closer to find a
way to stop HIV before it gains a foot hold in the human body.
And a little over a week ago, NIH announced the results of a
large international study, which found that HIV negative men who
have sex with men and transgender women who have sex
with men, who took a daily HIV treatment drug were
significantly less likely to become infected with HIV than
were the test group who took the placebo.
Now, the implications for this research,
for preventing HIV transmission in an at-risk population are
really exciting.
And the one common thread that runs through all the
accomplishments is the power of investment and collaboration.
It is evident in the new health care bill we passed in March,
the Affordable Care Act, which provides better and more
comprehensive care to people living with HIV/AIDS,
and is perhaps the most significant piece of HIV/AIDS
legislation since the Ryan White legislation was passed.
And that's why when we began working to develop the national
strategy, we started reaching out to doctors and people living
with HIV/AIDS around the country -- researchers,
health workers, activists, community leaders and academicians.
Over and over again, we've seen that we make our greatest
strides when we work together, guided by the most up-to-date
science, sharing and understanding of the challenges
we face, and building on a platform to take them on.
But there's a difference between knowing where you need to go and
actually getting there.
So implementation makes all the difference.
And we know we have to get it right.
HHS has a lead role in implementing the new strategy.
And we're working closely with our colleagues at the
Departments of Housing and Urban Development and I saw the
Secretary walking down the driveway as I was coming up,
so I know he had a chance to speak with you.
The Secretaries of Labor, Justice, Veterans Affairs,
and the Social Security Administration are all part of
this collaborative strategy.
Next week, all the departments and agencies will submit
operational plans to the President detailing how we
intend to implement the strategy in 2011 and 2012.
We've already committed $30 million from the Affordable Care
Act's new prevention and public health fund to support new and
existing HIV prevention efforts, and will continue working under
the new law to provide better and more comprehensive care to
people who are living with HIV/AIDS,
by expanding Medicaid and creating new health care
marketplaces in 2014 where affordable coverage will finally
be available to all, and plans finally in this country will be
forbidden from denying people coverage based on a pre-existing
medical condition.
In addition, benefits under the AIDS drug assistance program
will be considered as contributions toward Medicare
Part D's out-of-pocket spending limit,
a huge relief for low income seniors living with HIV/AIDS.
But having insurance doesn't necessarily mean that you're
going to get a doctor.
So the new law also makes a huge new investment in our health
care work force, with a specific focus on getting more doctors
and nurses in underserved communities and that remapping
is being done right now, so we have the most up-to-date
snapshot of underserved communities,
and making sure they have the cultural competency to
communicate and deal effectively with all types of patients.
We're doing this with the support and guidance of health
care providers, community organizations,
patients and advocates, who bring their experience and
perspective that's absolutely essential to inform our work and
for that work to take root and thrive.
You can see the coordination across our department and with
local partners in our HHS 12-city project,
an innovative effort to support comprehensive planning and
cross-agency response in the 12 communities that are hardest hit
by HIV and AIDS.
At the program's core is the idea highlighted in the new
national strategy, that by concentrating resources where
the epidemic is the most severe, we can make the most significant impact.
Together with local grantees representing 44% of the HIV
epidemic in the country, we'll be able to support coordinated
planning, mapping federal resources in every jurisdiction
and addressing how our HIV resources and services can best
be distributed.
Now, that's a really exciting opportunity to take the best
science, medicine, and behavioral information that we
have and use it to make a real difference for people living
with or at risk of HIV and AIDS.
So the lessons we learn from the 12 cities will be disseminated
across the U.S. to keep improving and refining our
response to HIV and AIDS.
It's just one of the many innovative steps we're taking
today that we think will really pay great dividends in the long run.
Now, it's been 23 years since the first World AIDS Day.
And this year we do have a number of reasons to be optimistic.
But none of this will be possible without those of you in
the room today and countless people around this country and
across the globe who have made this fight their daily cause.
When he introduced the strategy, President Obama said that the
success will require everyone's commitment and everyone's participation.
And together, we finally have a roadmap,
and now we look forward to going forward together.
Thank you all very much.
(applause)
Mr. Crowley: Well, this concludes today's event.
Thank you very much for coming.
You know, as we wrap up, clearly we have significant challenges
ahead of us, but we're also making significant progress.
And I think, you know, in Dr. Fouchi's words,
it's a bittersweet day.
But I do want to leave you with the idea that, you know,
we have a firm and consistent leader in President Obama.
And him, working along with Secretary Sebelius,
Melody Barnes, Secretary Clinton, Ambassador Goosby,
Dr. Fouchi, and so many people across the federal government,
I think you see that you have strong partners who are working
every day on the HIV pandemic, and so we just want to say thank
you to all of you for your ongoing partnership with us.
Thank you very much.
(applause)