Good morning.

Today is World AIDS Day -- and I am very pleased to be here with the
Minnesota AIDS Project, with the students and faculty of Macalester
College. Macalester students truly help to change the world for the
better and in today's world it is more important than ever. It's great
to be here with my good friend state representative Karen Clark who will
be honored later this morning.

I want to thank the Minnesota AIDS Project for inviting me to
participate in this forum. I want to especially thank Bob Tracy and all
of MAPs fantastic staff. They dedicate their lives to serving our
community and I applaud their work and their tireless commitment.

Today is World AIDS Day -- a day to stand together as citizens of the
world to celebrate and reflect and recommit ourselves to

healthy, hopeful and full lives -- lives dedicated to living positively
with AIDS and overcoming AIDS.

As we all know there are many challenges facing our communities, our
state and our country which raises the question:

Why do we really need to look beyond our borders for more problems to
take on when we have plenty of them here at home?

Whether it is the lack of affordable health care, the high cost of
college tuition or keeping our homeland secure from terrorism,

we have serious issues to deal with here at home.

With regards to HIV and AIDS -- Nearly 1 Million Americans are infected
with HIV and infection rates are not declining.

Communities of color are under attack by AIDS across America. For
African American women age 25 to 34 AIDS is the leading cause of death
(UNAIDS) and 64% of all new infections are in African American women --
this is extremely troubling. Right here in Minnesota the AIDS Drugs
Assistance Program is under-funded 5 Million dollars and low-income
people who can least afford it - financially or physically - are under
stress.

We have work to do here at home and we need to get to work. It is
obviously unrealistic and in fact foolhardy to believe the rest of the
world doesn't matter.

We live in an **[interconnected and interdependent]{.underline}** world.

America needs the world and the world needs us.

The 21^st^ century's massive movement of

people and pathogens, technology and capital has the potential to
enlighten ... or enrage, to heal ... or to harm,

to inspire hope and opportunity ... or create fear and despair.

The choices we make as American citizens and leaders do have a
tremendous impact on governments, economies, the environment, and the
future for Millions and Millions of people around the globe.

Never before in human history have so many people, each of us, had
access to so much economic opportunity, political freedom, immediate
information and medical miracles. Never before in human history has the
human condition for so many been so good. Globalization is real and it
is powerful.

At the same time, billions of human beings continue to live their lives
in miserable circumstances. They endure tyrannical oppression, senseless
violence, gender persecution, preventable disease and hopeless poverty.
With half of the world's population living on \$2 per day or less, is it
any surprise that failed states, rogue nations, terrorism religious
fundamentalism and raging pathogens are the emerging challenges the U.S.
faces in this new century?

Among these challenges include the fate of 40 Million men, women and
children around the world infected with HIV or living with AIDS. This
year al1, more than 3 Million people have died of AIDS and nearly 5
Million more people have become infected with HIV -- mostly young people
ages 15 to 24 in the world's poorest countries. The cycle is not being
broken by our wealth or good will, in fact the AIDS pandemic is getting
worse.

Dr. Peter Pie-ought (Piot), executive director of UNAIDS said this
summer, "Overall, the world is failing in its response to AIDS and the
commitments that were made. The virus is running faster than all of us."
(07/07/04)

Globally there are 8,000 deaths every day from AIDS. This tragedy is
almost beyond comprehension. And, if these deaths al1 are not enough --

14,000 people are newly infected every day around the world.

AIDS is not going away, which is why the United States and the world
community -- must act urgently and aggressively because without a
massive intervention, it is estimated that some 85 Million people could
be infected by 2010. And, by the year 2020, 15 years from now, 100
Million deaths could result because of AIDS...this is the reality if we
don't act with h1sty and urgency now.

Africa at present is the home to more than 25 Million HIV-positive
people. Africa is being devastated by AIDS. With 10 percent of the
world's population, Africa has 70% of all people living with HIV
worldwide and the fewest resources to confront the disease.

2.3 million deaths in 2004 and14 Million orphaned children abandoned to
survive on their own show how severe the devastation is.

Life expectancy in many African nations has been cut in half since 1980.
In Zambia, Swaziland and Lesotho life expectancy is now less than 35
years. At the current rate, if treatment is not made available 60% of
today's 15 year olds -- all across Africa -- will never reach their
60^th^ birthday (UNAIDS 2004 Facts). We hear these numbers as a
statistic, but Africa's young people hear these numbers and know this is
their destiny.

While South Africa has the largest number of AIDS cases of any country,
India is second with almost 5 and a half Million people infected.

While Africa is being destroyed by AIDS, scientists point to India,
China and Russia as the countries next in line for an AIDS catastrophe.
1 study projects a slow spread of the epidemic will infect at least 43
Million in these three countries by 2025, while the worst case scenario
could result in as many as 150 million infections.

The reality of the global AIDS pandemic is that we are 6 Billion human
beings inhabiting this planet and all of us -- every single 1 of us --
is living with AIDS and we need to stand together.

We need to stand together -- not just as Americans or Europeans,
Africans or Asians -- but as a human race determined to confront the
reality of the global AIDS pandemic with h1sty and urgency so our
brothers and sisters -- here in Minnesota, across this country and
around the world -- can live healthy lives and stop dying.

This forum is entitled "Untying our hands: A different direction for
fighting the global epidemic." The title begs the question, in the face
of the most destructive and deadly force attacking man on the planet
today, why are our hands tied?

Why would our government not be doing everything possible to liberate
and empower scientists and public health experts and educators to join
with the rest of the world in confronting HIV and AIDS --utilizing every
scientifically sound measure available and with the necessary financial
and human resources needed to save lives -- Millions of lives?

The answer:

The U.S. global leadership in fighting HIV and AIDS is being hampered
and too often gagged by a partisan agenda that prioritizes domestic
political ideology over common sense solutions.

The use of religious ideology over sound science, and a desire to
subsidize drug company profits over access to affordable lifesaving
drugs is limiting our nation's effectiveness in battling AIDS around the
world.

"Untying our hands", for me, means untying and unleashing the political,
economic, scientific and humanitarian leadership of the most powerful
nation on the face of the Earth America must engage the world community
-- rich and poor -- in a partnership that can save Millions of our
brothers and sisters around the world from misery, despair and death.

The fight against AIDS around the world is a calling and, in my
estimation as a political leader, a moral obligation of the highest
calling.

Yet while many of us believe we can and should do more, we need to
acknowledge the fact that the U.S. is leading the global fight against
AIDS.

President Bush and my Democratic and Republican colleagues in Congress
do deserve credit for recognizing and acting to confront the global AIDS
pandemic with the passage of the president's global AIDS initiative in
2003.

As a member of the House International Relations Committee,

I worked to pass this important bill with Chairman Hyde, whose strong
leadership gave us not a perfect piece of legislation, but in my
estimation, the best HIV/AIDS bill we ever could have passed the
Republican controlled House of Representatives. This 5 year, \$15
Billion commitment to battle AIDS in 15 countries in Africa, the
Caribbean and now Vietnam was a significant accomplishment.

Since becoming law in May of 2003, there have been numerous aspects of
this policy and its implementation that experts and policymakers
strongly disagree with.

My personal list includes the over-emphasis on abstinence-only
prevention, the failure to fully fund the program to the authorized
annual \$3 Billion level, the resistance to purchasing low-cost generic
ARVs for treatment, and the disturbing lack of emphasis on condom use as
the most common sense and cost effective safe sex and risk reduction
strategy available.

Nevertheless, the President's Emergency Plan for AIDS Relief,

or PEPFAR, is a real step forward in combating HIV and AIDS and I
support it. I will continue to work to improve it and ensure that we are
meeting the goals we have set out.

Looking forward, our job as citizens and activists is to work together
with Congress, the Bush Administration and NGOs and people living with
AIDS throughout this country and the world so together we can make our
country's AIDS policies and resources translate into success.

I believe more honesty is needed. More urgency is needed.

The political landscape in Congress is decidedly more conservative and
President Bush will be in the White House for four more years. Our
collective goal must not be to reject PEPFAR because it has failings,
but to improve it, to expand it both financially and to include
additional countries in both Africa and Asia, and to make sure that
congressional oversight is in place to ensure that every dollar invested
is actually yielding results that are improving and saving lives.

Only about ten days ago, Congress passed an appropriations bill for 2005
that included \$2.9 Billion for global AIDS, TB and malaria.

This was a \$500 Million increase over 2004, which is good news but we
are still \$100 Million shy of our \$3 Billion goal.

What was extremely troubling to me was that to achieve this \$2.9
Billion for to combat AIDS, the Child Survival fund was reduced by \$274
Million from last year's level.

Only \$250 Million in new m1y was allocated to the Global Fund which
needs our support and deserves more support. It is hard to believe that
while our country can afford to spend \$5 Billion every month in Iraq we
also need to cut programs that save children's lives.

We can do better.

Looking forward, I believe we must make PEPFAR a success,

That means we must help make all global HIV interventions more
efficient, effective and sustainable for the long-term -- for as long as
we are battling the pandemic.

Resources in this battle must be maximized, not diminished by
duplication. PEPFAR as the largest global AIDS initiative has both a
technical and a moral obligation to coordinate its HIV/AIDS strategies
more comprehensively with every aspect of U.S. foreign development
assistance as well as the United Nations, the Global Fund, the World
Health Organization and the World Bank.

Poverty remains the largest contributing social factor to HIV
transmission in the developing world so it must be addressed in a
comprehensive manner All people, but especially people living with HIV,
need access to clean water, food security, family planning, economic
opportunity, education and basic health care services. Poverty
reduction, building human capacity and investing in social capital is
lacking in countries devastated by AIDS and poverty.

1 critical aspect of building infrastructure in which both donor and
national investments must take place is the training, placement and
retention of skilled health care workers -- clinicians, nurses, midwives
and especially community based counselors. These workers are essential
for the counseling, testing, and treatment and must be in place before
any massive distribution of ARVs can take place.

PEPFAR's goal of getting 2 Million HIV-positive people on ARVs by 2008
can only succeed if Africa's healthcare infrastructure is strengthened,
particularly by helping to build capacity into a locally trained work
force.

The next critically important reality that must be confronted by
Washington for treatment to be successful and lives to be saved is for
this White House to agree to a cost effective treatment strategy that
does not rely on expensive and complicated name brand drugs.

There are six Million people in the developing world who need ARVs now
if they are going to stay alive. It is estimated that only 440,000
people or 7% of those who need ARV treatment are receiving it.

PEPFAR must agree to allow U.S. funds to be used to buy existing WHO
approved ARVs as well as locally available, approved drugs for
opportunistic infections.

PEPFAR's preference for name brand drugs appears to be more suited to
guaranteeing pharmaceutical company profits than to the needs of the
Millions who could benefit from immediate access to low cost fixed dose
combination therapy which is 1-third the cost of the name brand drugs.
We must act with urgency to save lives first and worry about patent
protections later.

Third, the plight of women and girls, around the world,

but particularly in Africa is an immediate crisis. Women are now 50% of
the infected population worldwide, but close to 60% in Sub-Saharan
Africa. Most alarming is that 75% of infected young people age 15 to 24
are girls.

The plight of women is often complicated by PEPFAR's flawed prevention
messages emphasizing ABC or Abstinence, Be Faithful and then condom
usage.

In fact according to UNAIDS, in some African countries,

married 15 to 19 year old young women have higher infection rates than
unmarried sexually active females their same age.

Marriage itself is not a safe behavior but actually increases a woman's
likelihood of becoming HIV infected.

Last year in South Africa I attended a number of ante-natal clinics and
watched as pregnant women lined up for their check-up. Many were getting
tested for HIV for the first time. It is shocking to know that 1 out of
every 3 or 4 of the women in line would be HIV-positive.

These women never had been given the knowledge or tools to protect
themselves for infection. Thanks to interventions to prevent the
transmission of HIV from mother to child the frightened but determined
moms who I met with were doing everything possible to take the simple
two pill treatment needed to help keep their newborn healthy and free of
HIV.

Abstinence only education is appropriate for children and early teens --
but young women deserve the right to be fully informed about the risk
factors they will be confronted with and understand the knowledge and
skills required to remain healthy before and during marriage.

PEPFAR's prevention strategies need to be revised to ensure sound
science, not wishful thinking, is the basis for risk reduction and
reproductive health.

It is estimated that 95% of HIV-positive persons in Africa do not know
their status. Therefore in countries with HIV rates as high as 20, 30 or
40 percent among 15 to 49 year olds sex itself --

including in a faithful, married relationship \-- is a high risk
activity.

Finally, there is the issue of sustaining the leadership required to
fight against HIV and AIDS. Earlier this year, I was asked to serve as
co-chair of the HIV/AIDS working group for an international
parliamentary network.

Our working group's role is to bring parliamentarians from developed and
developing countries together to share information, build capacity, and
evaluate HIV/AIDS programs.

This may sound insignificant but it is a matter of building both
national and local capacity in the host country -- empowering the
leadership class at the local level to speak directly to their
constituency about AIDS -- an issue that is too frequently otherwise
taboo or impolite to discuss.

Winning the battle against AIDS requires policy makers, not just from
the U.S. and Europe, but from the developing world to take ownership of
their respective national AIDS responses and shape appropriate local
answers. Parliamentarians from recipient countries are rarely included
in discussions between ministries and donors about project goals and
implementation.

In both Africa and Washington I have met with dozens of African
parliamentarians and they want their voices heard in the decision making
process with and they want Congress to be their partner.

This is important. In emerging nations across Africa, democracy is also
being threatened by AIDS.

In Malawi, for example, by 2010 it is estimated that 1 Million children
or 1 in 10 Malawians will be a child orphaned by AIDS.

This stunning figure begs the question,

How can a democracy function when its population is too ill or too ill
prepared to participate in the democratic process?

Or, if local elected leaders are ill prepared to understand the needs of
people with AIDS or fear the political stigma of working on AIDS issues?
The voices of local leaders are critical to building a civil society
that can articulate their own needs to through established democratic
channels.

My own leadership commitment is focused on a serious matter that will
start in 2008 but has never been addressed by President Bush or
Congress.

It is my belief that the promise made by this initiative morally and
ethically dictates that every beneficiary of PEPFAR who receives ARVs
must be provided treatment for the rest of their lives. PEPFAR is not a
five-year plan for ARVs that then packs up and goes home when contracts
expire and Washington possibly has new priorities.

In my opinion, the Bush administration has made a lifetime commitment to
providing life saving ARVs to 2 Million HIV-positive beneficiaries.

As Americans, we must keep this obligation and President Bush must
address this critical issue now by articulating a strategy that both
Congress and recipient nation's can examine and evaluate the long-term
sustainability of lifetime treatment. Again, this is a moral and ethical
issue that must be addressed.

**Let me conclude** by sharing with you a statistic that reflects both
the challenges and opportunities ahead. Today, **[half]{.underline}** of
the world's population is under the age of 24 years.

Ninety percent of these more than 3 Billion children and young adults
live in the developing world -- 500 Million live in India al1.

This year I will turn 50 years old. And imagine, there are more people
under 24 years of age in the developing world today than the entire
population on the planet in 1954, the year I was born.

The challenge ahead is that the AIDS pandemic is not waning,

it is widening.

Every day these Billions of children and young people need clean water,
food, shelter, healthcare, education, jobs, and hope.

World AIDS Day is about their future and ours and all of us standing
together. These young people are the future but they are also the most
vulnerable to the AIDS pandemic. They need and deserve the knowledge,
skills and resources to live healthy lives -- just as young people here
in Minnesota do. This is our world, HIV and AIDS is part of our world
and we need to untie everybody's hands, and act with real urgency and
invest our collective skills, energy and resources with selflessness and
wisdom.

We have so much work to do, but real progress is within our reach if we
work together to untie our hands.

I am determined and committed, just like you, to keep working to untie
our hands to overcome one of the greatest challenges facing our planet
and our species.

Thank you for asking me to join you today and thank you for your
commitment.

Thank you.