**[VERBATIM]{.underline}**

**INTERNATIONAL SUBCOMMITTEE OF**

**THE PRESIDENTIAL ADVISORY**

**COUNCIL ON HIV/AIDS**

**TOWNHALL MEETING ON THE**

## PRESIDENT'S EMERGENCY PLAN

**FOR AIDS RELIEF**

**WELCOME AND INTRODUCTION:**

**ABNER MASON,**

**CHAIR, INTERNATIONAL SUBCOMMITTEE, PACHA;**

**LOUIS SULLIVAN, MD, CO-CHAIR, PACHA**

**OPENING REMARKS:**

**AMBASSADOR JOHN E. LANGE,**

**DEUPUTY COORDINATOR,**

**OFFICE OF THE GLOBAL AIDS COORDINATOR;**

**JOSEPH F. O'NEILL, MD,**

**DEPUTY COORDINATOR AND CHIEF MEDICAL OFFICER,**

**OFFICE OF THE GLOBAL AIDS COORDINATOR**

# 

# 

# THURSDAY, DECEMBER 18^th^, 2003

*Transcript by:*

*Federal News Service*

*Washington, D.C.*

ABNER MASON: (In progress) -- everyone to take their seats we will get
started. We have a pretty full agenda. Thank you.

My name is Abner Mason, and as chairman of the International Committee
for the Presidential Advisory Council on HIV and AIDS, I want to welcome
each of you to this townhall meeting on President Bush's Emergency Plan
for AIDS Relief.

I want to first introduce the other members of the International
Committee who are here, so starting from my far left, Jim Driscoll, and
Nate Nickerson, Cheryl-Ann Hall. And then from my far right, John
Galbraith, Edward Green, Karen Ivantic-Doucette. And to my immediate
right, Dr. Louis Sullivan.

On behalf of the entire council, I want to thank each of you for taking
the time to share your experience and your advice with us and through us
to Global AIDS Coordinator, Ambassador Randall Tobias and his team at
the State Department, which we're very fortunate is represented here
this afternoon by his two deputy coordinators: Ambassador and Deputy
Coordinator, John Lange, and Deputy Coordinator and Chief Medical
Officer, Dr. Joseph O'Neill. Thank you both for being here. And you'll
have an opportunity to hear from them shortly.

For those of you in the audience, your presence here in such large
numbers and from such a diverse cross-section of American society is yet
further proof of our nation's commitment to fighting HIV and providing
treatment and support to those infected and affected by this disease:
the greatest threat to human life in history.

I also want to acknowledge our international guests who are here for the
important perspective and contribution that you bring. We gather this
afternoon with a sense of optimism because in arts of the world hit
hardest by HIV, the leadership of President Bush, the bipartisan support
of the Congress, and the generosity of the American people has brought a
sense of hope to where there was once only despair. We owe it to those
in need to get the implementation of the president's plan right. Having
the benefit of your experience and advice will be helpful to that end,
and I commend Ambassador Tobias and his team for seeking your experience
and your advice and I want to thank each of you for being willing to
provide it.

With that, let me now introduce Dr. Louis Sullivan, the co-chair of the
entire Presidential Advisory Council for some remarks.

Dr. Sullivan.

DR. LOUIS SULLIVAN: Abner, thank you very much. Let me, indeed, join Mr.
Mason in welcoming all of you to this afternoon's hearing and thanking
you for coming and sharing your perspectives to assist us as we develop
recommendations for the president on his global AIDS program.

In addition to the members of the International Committee who are
assembled here at the table, we have other members of our Presidential
Commission on AIDS who have joined us who are in the audience and I
would like to introduce them and ask them to stand as I introduce them
so you'll know who they are.

Mrs. Anita Smith, would you please stand? Mr. Joe McIlhaney standing in
the rear. Ms. Rashida Jolley, I don't believe she has arrived yet. Mr.
Brent Minor. Ms. Sandra McDonald, would you please stand? And Mr. Don
Sneed. I'm sure he'll be joining us shortly.

I'd like to emphasize that as we proceed in this process the
Presidential Commission on AIDS and HIV is actively seeking additional
input on ways we can engage the public in the council's processes, and
we would also like to inform you of upcoming meetings of the council to
which the public is invited. Those dates are as follows: March 29^th^ --
30^th^, 2004; June 28^th^ -- 29^th^, 2004; and September 20 -- 21, 2004.
We welcome your input as all of us work together to improve the picture
that confronts all of us as humans with HIV and AIDS. Again, I thank all
of you for coming.

MR. MASON: It's now my pleasure to introduce for some comments, Deputy
Coordinator of the new office at the State Department, Dr. Joe O'Neill.

JOSEPH O'NEILL, MD: Thank you. I see that John and I have between 1:05
and 1:10, which means that I have two and a half minutes, and that's as
it should be because we're here to hear from you, not the other way
around.

So a couple of major points to make to you. First, thank you for being
here. You ought to look a this meeting as emblematic of Ambassador
Tobias and -- Tobias's and our office's desire to engage constructively
with nongovernmental sector and the community and interested parties,
not only in this particular task ahead of us today in developing a
strategy, but in the way that we manage and work to bring this program
to fruition in months and years ahead.

We approach this -- my view is that we need to approach this issue --
all of us need to approach this issue with a great deal of humility.
Global AIDS is a terrible problem. It's a complicated problem. Anybody
who thinks they have the answer is wrong. The answer's out there, but
it's going to come from a wide number of people and perspectives. It's
going to be a bumpy process on the way getting there. There's so much
passion and so much commitment on this issue, in this room, on this
committee, in this administration, and around the world, and we need
that commitment and we need that passion because that's the only way
we're going to get to where we need to go. But at the same time, with
that passion and commitment comes -- you know, a great deal of toing and
froing and struggling to find the right answer and a lot of
disagreement. I'm trying to strike a note here of humility and wanting
to work in a constructive way together as we move forward.

There's a huge number of tensions or paradoxes that we need to resolve
as we administer this program. We need to respond to an emergency, but
we need to do it in a thoughtful and deliberate and considered way, and
in a strategic way. We need to bring in new partners, and yet at the
same time we need to be able to work effectively with existing
organizations that are also doing good work. We need to bring in new
ideas and we need to find new ways of doing business. We need to program
a tremendous amount of resources. One out of every two dollars spent in
the world from the donor community on global HIV come out of the wallets
of U.S. taxpayers. We need to be accountable for those dollars. We need
to get two million people in treatment by the year 2008 in these
countries, and 10 million people given care and palliative care and
orphan care for children. We need to prevent seven million infections.
We need to do this with a very small staff. We need to do this in an
efficient way where resources end up in the hands of people who are
actually doing the work.

None of this is easy. We can't do it alone. We're developing our
strategic -- a strategic plan, which is -- I want to close by
emphasizing, this strategic plan, which is mandated by Congress and it's
due February 20^th^ to Congress, that will -- may even be due before we
have an appropriation. So I'm making the point here that this is a
piece, and only a piece, of a long-term strategic planning process that
is going -- that should last in any healthy organization, - last for the
duration of the time that we're working. Planning is an iterative
process. We need to bring new ideas in, new blood in, new -- and process
and continue to talk to you and talk to community as we move forward.

This plan that we're working on now is the beginning, not the end, of
that process. It's going to be an articulation of how we in the
administration are approaching the management of this program, what our
priorities are, and how we see ourselves moving forward, but I just want
to be clear that none of us ought to sort of think, okay, we're done
with that part and go home on February 20^th^. That's actually the
beginning. So I look forward to many more of this kind of interaction
with affected communities, with people who are involved and concerned.
And thank you for being here.

MR. MASON: And now we'll hear form Ambassador and Deputy Coordinator
John Lange.

AMB. JOHN E. LANGE: Thank you very much, and I'd like to second the
comments of Dr. O'Neill and say how delighted we are to be with you all
today and to be hearing your thoughts on our strategy.

As I talked to Ambassador Tobias back in July when he was first named by
the president for his intent to nominate Randall Tobias as the U.S.
Global AIDS Coordinator, this program has three goals: to reach the
individual, the individual, and the individual. Whether it's prevention,
care, or treatment, it will not have an impact unless in the end we
reach that individual, and their situations are different in countries
all over the world. This is a global program, but from my experience
working at our embassies in West Africa, East Africa, and Southern
Africa, you really see HIV/AIDS firsthand and realize how critical this
is as a pandemic that is tearing away fabric of societies and that must
be dealt with and with the strong political and -- political commitment
as well as resource commitment, the U.S. will be in the lead role on
this.

Much of the emphasis of discussions has been on the programmatic aspects
of this program, but I would like to bring in one other issue that I
hope we get input on, which is the -- what we call the diplomatic side
of things, because one can easily look at the programs for the 14 focus
countries or for the other 75 countries that the U.S. government has
HIV/AIDS programs in, but they're -- this is really the global problem,
and as Ambassador Tobias says, he wasn't nominated by President Bush to
be the 14 focus country AIDS coordinator, but to be the Global AIDS
Coordinator, so we're working and will be working with governments all
over the world on this. To give you an example, because some of you may
not have seen the media coverage of this -- it was overshadowed by some
other events -- on the 20^th^ of November, the prime minister of the
United Kingdom, Tony Blair, and President Bush spent one hour discussing
HIV/AIDS with five ministers of health from five African countries:
Ethiopia, Kenya, Nigeria, Zambia, and Uganda. This is -- my guess -- an
unprecedented event to have two leaders such as that spend that much
time on HIV/AIDS with some key African leaders who are dealing with
this. This is the kind of high-level attention that we expect to
continue given President Bush's commitment as well as the high-level
interest in other governments of the world, and that is also part of
what we look to as our strategy that we need to develop in the months to
come to try to gather interest from all over the world, both attention
to this issue and resources to be applied to the issue.

I look very much forward today to hearing your comments. Thank you.

MR. MASON: I'd like to thank Ambassador Lange and Dr. O'Neill for being
here. Dr. O'Neill has to leave, but before he goes, I just -- on behalf
of the whole council I want to thank you both for -- just to be -- an
incredible amount of hard work that you have been doing. We -- a lot of
people are depending on your success, and we want you to know that we
support you and we want to help you in any way we can, so thank you.

We are going to begin the public comment. I just wanted to remind you
that it's three minutes for each of you, which we're going to try to get
to everyone. We're going to start with the agenda as it's laid out, with
nongovernmental and community-based organizations. I want to remind you
to turn off your cell-phones and any other kinds of electronic devices
like that, that would cause a disturbance, and I'm going to call about
five people at a time so that we can keep things moving pretty quickly.
There is going to be a timekeeper who will have a sign to my right who
will remind you when you have one minute left, and then there's another
sign that will say stop, and in order for us to hear form everyone, I
hope that you will obey his commands over there. So with that, let's
start with Terje Anderson, Shari Ayers, Andre Banks, and Marty Bond.

Terje first, if -- then why don't we move to Shari Ayers, from Africa
Nation. Some people are going to get here late, and we'll allow them to
-- at the end of this section if they come in. Then is Andre Banks from
Africa Nation? Marty Bond from Africare?

Okay, then we'll hear from Clarence Hall. Thank you.

CLARENCE HALL: Good afternoon. My name is Clarence Hall, I'm the deputy
director of HIV/AIDS and heath at Africare, and I'd like to make the
following statement: on behalf of President Julius Coles and staff
members of Africare, I am very pleased to have this opportunity to share
the Africare HIV/AIDS experience and give support to the president's
Emergency Plan for AIDS Relief and the mission of this body.

Founded in 1970, Africare is the largest African-American owned
501(c)(3) nonprofit development organization in the U.S. We currently
have 150 development projects in 26 African countries, with 1,400
employees. Ninety-five percent are in Africa, and 93 percent are
African. Africare has provided over \$450 million in development
assistance to Africa over the last three decades. Africare's mission is
to improve the quality of life by assisting African families,
communities, and nations with a multisectoral community-based strategy
in three principal areas. They are HIV/AIDS health, agriculture, and
food security.

Africare's philosophy is to work -- to strengthen community-based
initiatives, scale up best practices, and provide assistance to make
these initiatives sustainable. Africare seeks to promote public-private
partnerships to build capacity and infrastructure to mitigate the
HIV/AIDS crisis. Africare has supported national efforts in Africa to
combat the AIDS epidemic since 1987. I would like to share with you just
one or two of our success stories that are in conjunction with the
president's -- that are very close to the president's initiatives and
his emphasis. The adolescent reproductive health program that we have in
Southern Africa reveal that Africa has been able to reach over two
million youth, the ages -- between the ages of 10 and 25 in Southern
Africa, and specifically in Malawi, South Africa, Zambia, and Zimbabwe
with reproductive health and HIV/AIDS prevention messages that have led
to significant behavior change among the target population. Based on
these results, Africare received a follow-on grant from the Bill and
Linda Gates Foundation to consolidate these accomplishments in the three
countries that I mentioned earlier.

A very good demonstration of our effort to scale up our HIV/AIDS
programs is the African -- is the Africare Disease management Foundation
and the Eastern Cape department of health's initiative in South Africa.
This five-year program will provide a wide spectrum of HIV/AISD
prevention, treatment, and support services to 30,000 people living with
AIDS, their families, and affected communities.

Africare is well-positioned to play a leading role in achieving this --
these objectives of the president's Emergency Plan for AIDS relief with
its 33 years of development experience in Africa, offices in 26
countries, its multisectoral community-based strategy, and highly
motivated and committed staff. We applaud the urgency with which the
administration has given this crisis, and we look forward to working
with you and our colleagues around the world to make HIV/AIDS a
historical event.

Thank you.

MR. MASON: Thank you. Next we'll hear from Sarah Boeski (sp) from Family
Health International, and after Sarah, Katherine Brandt, and then Galen
Carey.

GRETCHEN BACHMAN: Hi there. I'm Gretchen Bachman, filling in for Sarah
Boeski. I'm from Family Health International. FHI, as you probably know,
is a non for-profit (sic) organization. We've been working in developing
countries for close to two decades on HIV/AIDS prevention and care and
we've been generously funded by both U.S. taxpayers and from
foundations, and from the work that we've done we've learned some
valuable lessons about this pandemic. Not the panacea solution, but some
lessons. And I'm going to sum up these lessons learned in the four C's:
C for collaboration among all partners; C for community-led and owned; C
for comprehensive services; and finally, C for care centered on the
family. In our experience, whether it's been through the introduction of
anti-retroviral therapy or the establishment of community outreach
centers for orphans, these four C's are key. Here are a few examples of
how each has guided our approach.

C for collaboration among all partners and C for community-led and
owned. FHI does not run programs; we are a catalyst. Sometimes we are a
technical advisor, but our programs, or the programs that we support
with taxpayer money, are designed, run and owned by local partners. In
Rwanda, FHI did not introduce anti-retroviral therapy. We supported the
ministry of health and the Catholic mission clinics, home-based and
community care clinics, to introduce ART.

It is through this partnership that access to treatment is now widely
expanding in Rwanda throughout the wider network of clinical and
community-care services under the auspices of the diocese and the
government. In another example from Kenya: for the introduction of ART
we played a role in introducing home-based care volunteers from a
faith-based organization with local PLHA -- persons living with HIV/AIDS
support groups. Together, they designed treatment, education materials
for people living throughout Kenya. It is interesting that the funding
for this came from the U.S. government, from the Kenyan government, and
from a multinational corporation interested in supporting HIV/AIDS work.
Together, these dual partnerships, both international and at the local
level, we've ensured the people affected by AIDS throughout Kenya get
the information they need to participate in their own care, and these
informational materials are designed for them in their own language by
their own peers.

C for community owned and led is crucial for all programs. We know that,
but no more -- I think more so than anything in the support of orphans
and other vulnerable children. To give you an example, in Zambia FHI,
Care International and a local NGO called SCOPE (ph) have worked to
establish and strengthen community-level committees at the district and
subdistrict level. Serving on these community committees are farmers,
doctors, businesspeople, teachers, nurses -- I mean, everybody is sort
of pulled together in these voluntary committees and they do amazing
things. They set up community care committees, schools, farms --
anything that these children need. And when new resources come in, they
vote on whether or not those resources are going to be used and how
they're going to support their efforts. This is a long-term problem for
orphans; we need a long-term solution. We need to rely on communities.

Finally, since I'm out of time, just two quick more C's. Comprehensive
care. Just in a TB clinic in a high-prevalence country where people did
not know that you could be TB and HIV co-infected. We need to pull these
things together. Comprehensive means we both need the mission hospitals
and we need the government hospitals. No one can do it all.

Finally, family-centered care. Let us just remember that we cannot treat
just individuals. Mothers will share their drugs with their children if
they are both infected. Wives with their husbands, so that's my quick
lessons learned: comprehensive, family-centered care, community led and
owned, supported by a collaboration of all the partners you see before
you.

Thanks.

MR. MASON: Thank you. For people who have not signed up but want to give
public comment, you can sign up -- we will take walk-ins and as we have
time -- we will call on you, so you need to go out and sign up and
that's the way we'll handle that, for you and any other walk-ins.

MS. : Off mike.

MR. MASON: There's a special sheet out there if you want to give public
comment.

KATHERINE BRANDT: Good afternoon. My name is Katherine Brandt. On behalf
of the National Hospice and Palliative Care Organization, thank you for
sponsoring this townhall meeting and allowing us to contribute to the
president's Emergency Plan for AIDS Relief.

NHPCO applauds President Bush's commitment to helping address some of
the critical global needs resulting from the HIV/AIDS pandemic.

Fifteen percent of the funds allotted for the president's initiative is
intended to address palliative care needs in Southern Africa. As the
oldest and largest nonprofit organization dedicated to improving hospice
and palliative care in the United States, NHPCO has expertise in a
network of professionals well-equipped to offer insights and practical
knowledge regarding the delivery of hospice and palliative care and the
role they play on the continuum of care for patients and families.

So what do we mean by palliative care? The health resource
administration of the Department of Health and Human Services developed
an important definition that reads in part: "palliative care is patient
and family-centered care. It optimizes quality of life by active
anticipation, prevention, and treatment of suffering. Palliative care
addresses the physical, intellectual, emotional, social, and spiritual
needs." This relatively simple definition can begin to describe the
importance of palliative care services appropriately delivered to those
struggling with HIV and AIDS. Relief of pain and symptom control makes
other forms of care possible. We know this based on 30 years of care in
this nation where hospice and palliative care providers have been
helping patients and families live with life-limiting illness free of
pain and with dignity and compassion. We know this by the more than
885,000 Americans served by the nation's 3,200 hospice providers in
2002. We know this by the millions of terminally ill Americans who have
utilized the hospice Medicare benefit -- one of the most valuable
benefits provided by a compassionate government. And we know this by the
untold number of family members who are able to live beyond the loss of
their loved one through the support services bereavement care made
available to them.

In less developed countries where symptom control and end-of-life care
are not well-developed, there is much to learn from the model of care
that lies at the heart of hospices' interdisciplinary philosophy. NHPCO
has experience in working with other nations surrounding end-of-life
care. We've participated in conferences sponsored by the World Health
Organization and other organizations.

More importantly, NHPCO recently hosted a working summit in South Africa
that brought together more than 45 participants representing a dozen
countries in sub-Saharan Africa, England, and the U.S. This group is
working together to write a guide about providing palliative care
services to HIV and AIDS populations in Southern Africa.

Palliative care programs provide services which are client-centered and
structured around the cultural and social needs of patients and
families. These programs strive to bridge the gaps between communities
and institutions. By including palliative care services as an integral
component of the president's initiative, the care provided to those most
in need will be significantly improved. This includes patients, family
members, and other loved ones as well as the community at large.

President Bush has shown that the relief of human suffering is a noble
goal for a foreign policy. The president's initiative sets the goal of
providing two million persons with AIDS with palliative care in 14
countries. We encourage the International Subcommittee of the
Presidential Advisory Council on HIV and AIDS to take advantage of what
we in this nation understand about the delivery of compassionate,
quality, palliative care at the end of life and facilitate the sharing
of this valuable information between our nation and others.

Thank you.

MR. MASON: Thank you. Galen Carey and then Sonja Clay (sp) from Planned
Parenthood, and then Rachel Cohen from Doctors Without Borders.

GALEN CAREY: Good afternoon. I'm Galen Carey, the director of Policy and
former Africa director for World Relief. I'd like to start by commending
President Bush for his extraordinary leadership in announcing the
HIV/AIDS initiative, and to underline the fact that the progress we have
made so far in terms of funding is -- while very commendable, is not
enough, and I would like to encourage you as a commission to lend your
voices to seeking the -- at least the full \$3 billion in the next
budget cycle that had been promised for this initiative. I believe the
money is well needed -- needed, and can be well invested.

I'd like to briefly comment on the three areas that you asked us to talk
about. I won't read my comments, but I want to talk briefly about
program planning. World Relief has been involved in community
development work for 60 years, and probably the most common mistake that
we see made is that outside agencies come in with good ideas and good
intentions, but impose their ideas and their money on the local people,
and I think that's a -- there's a great danger, as Dr. O'Neill has said,
that because of the emergency -- the fact that lives are at stake --
that we will not take the time to have a well planned intervention in
each place. And it should look different in different places. So we very
much would like to encourage well-conceived and well thought-out
community planning processes, especially in the area of prevention. We
very much appreciate the focus on prevention through behavior change.
I'd like to emphasize that this is a long-term process -- something that
will take place in a sustainable way over years and not over months. And
so we need to be thinking with that in mind.

In the area of partnerships, World Relief has worked very effectively
with churches and local faith communities and we'd like to encourage the
initiative to look at how churches can be engaged -- and other faith
communities, in this process, but the caution is that we must not see
these local, indigenous institutions as merely vehicles for us to
accomplish our purposes, but rather see them as institutions in their
own right which need to be respected and need to be dealt with by
implementers who understand the unique identity of these faith
communities. We'd very much like to encourage that the president's
initiative be carried out to the extent that it involves faith
communities, by groups and implementers who understand the dynamics and
can work effectively and credibly with them.

Finally, in the area of the involvement of people living with HIV/AIDS
themselves, I'd just like to share one experience that we've had in our
work in Malawi where we've been able to work with churches to form
patients' fellowships. These are groups that work together that
encourage each other. As one woman said, "you know, I decided rather
than just waiting to die, I'm going to go out and help people who are
even worse off than me", and I believe that's the spirit we should
approach this in.

Thank you very much.

MR. MASON: Thank you. Sonja Clay from Planned Parenthood?

Rachel -- sorry. Welcome.

RACHEL COHEN: Thank you. My name is Rachel Cohen. I'm speaking today on
behalf of Doctors Without Borders -- Medecins sans Frontieres -- or MSF.
We're an international medical humanitarian organization with field
operations in 80 countries, and we're the recipient of the 1999 Nobel
Peace Prize.

Today I am speaking only about treatment. MSF is today providing
anti-retroviral treatment for approximately 10,000 patients and about 42
projects in 19 countries throughout Africa, Asia, Latin America, and
Eastern Europe. Clinical outcomes in our projects are excellent.
Patients' CD4 counts are increasing. They're gaining substantial amounts
of weight. They're suffering from fewer opportunistic infections.
Adherence rates exceed 90 percent. People are returning to work and
again becoming productive members of their families and their
communities. In short, treatment is really transforming the face of
AIDS.

While our ARV treatment programs have had a significant impact on the
individuals and the communities with whom we work, they are relatively
small scale and we have neither the capacity nor the mandate to provide
wide-scale access to treatment at the level that is required -- at the
level that is so urgently needed. That is in our mind the responsibility
of governments. We hope that the lessons we are learning -- that we
continue to learn about providing anti-retroviral treatment in
resource-poor settings are helpful in designing and implementing the
president's initiatives and we'd like to highlight at least three areas
to draw your attention to, keeping in mind that we've submitted fuller
testimony in written form.

I want to stress that there is no single formula, and as Dr. O'Neill
said, there is not going to be a magic bullet. If that's what people are
hoping for, they'll be disappointed. One of the most important lessons
that we have learned is that you must simplify, adapt, and decentralize
care and treatment -- treatment-monitoring protocols. MSF is in the
process of adapting our approach to AIDS treatment to better fit with
the real-life conditions faced in developing countries. Our medical
teams are using treatments with fewer pills. They're relying less on
sophisticated lab tests, taking better advantage of the skills and
resources that exist among health professionals in the countries where
we work, and decentralizing the point of care to the district and
community health-post level.

This is so that we can reach even the poorest and most vulnerable people
in the most remote settings, and it's not going -- it's so that
treatment is not limited to the wealthiest 3 percent.

One of the most important tools that we are using to simplify and adapt
treatment are fixed-dose combinations of anti-retrovirals. About 70
percent of our patients are taking their pills in the form of one pill
twice a day. These drugs are available for as little as \$140 per person
per year, and they are available only from generic manufacturers due to
patent barriers.

One other very important lesson is to involve the community. The
knowledge and meaningful participation of people living with HIV and
AIDS is key to the success of treatment. At our HIV clinics in Kialicha
(ph) in South Africa, MSF and grassroots treatment advocates have
fostered community-based education programs through carefully designed,
patient-centered adherence programs, people on ARVs and MSF programs
have the support of their peers and of trained counselors. This
community mobilization has already had a positive effect not only on
adherence, which is in this project about 95 percent, but has already
had a powerful effect on de-stigmatization, reducing discrimination, and
strengthening prevention efforts.

One other point is decreasing the price of medicines. The lower the
price of medicines, obviously, the larger the number of people that can
be treated.

I just want to make one final remark. During the past year there have
been several positive developments at the national and international
level related to expanding access to care and treatment. If the
president's initiative is to meet its stated objectives, it must be
designed to work in collaboration with existing mechanisms like the
global fund, the WHO three by five initiative, and so on, and with
comprehensive national AIDS plans. It must not undermine, duplicate, or
complicate these efforts. PEPFAR is just one part of the global U.S.
strategy and special efforts must be made to ensure that U.S. policies
in general do not contradict or undermine the ability of countries to
expand access to care and treatment.

When the U.S. talks of expanding access to treatment on the one hand and
then promotes trade policies that will restrict, for example, access to
generics on the other, they are in effect giving with one hand and
taking with the other. Nothing must get in the way of the goal of
providing universal access to treatment -- anti-retroviral treatment and
other forms of care and support for the millions of people throughout
the developing world who will die premature, avoidable deaths without
it.

Thank you.

MR. MASON: Thank you. Charles DeBose from Africare; Anna Evans from the
World Council of Credit Unions. Peggy -- come on up. I'm going to call
about five or six people. Could you just line up because I think it will
go faster if we do it that way so that we don't lose time with people
getting to the podium. Anna Evans, Peggy Harper, Ernest Hopkins from San
Francisco AIDS Foundation, and Jodi Jacobson from the Center for Health
and Gender Equality.

Thank you.

ANNA EVANS: My name is Anna Evans. I'm commenting on behalf of the World
Council of Credit Unions. The World Council of Credit Unions is the
international trade association and development agency for credit
unions. As a trade association, we represent 118 credit union members in
79 countries. As a development agency we provide technical assistance to
strengthen credit unions, primarily with USAID and World Bank funding.

I want to underscore the critical need for PEPFAR to support a
multisectoral response to the HIV/AIDS pandemic. First, I'd like to
discuss prevention. For meeting a challenge of preventing new
infections, it is essential and important to survey the landscape of
community-based organizations, not necessarily health service providers,
that have a large-scale outreach in rural areas and offer an existing
network, an infrastructure, through which messages of prevention and
referrals to health service providers can be delivered to vast numbers
of people. Credit unions and other member owned community organizations
already have the trust of their member clients. To set an example, in
Kenya, where credit unions serve 1.5 million members, adding value-added
services such as giving referrals to testing centers on savings deposit
slips or having an outside health expert offer prevention seminars at
already existing member education days offered quarterly could be a
lower-cost alternative than extending the operations of a program
dedicated exclusively to prevention -- extending that program to remote
communities where these community-based organizations already exist.

Second, regarding the goal of caring and supporting HIV-infected
individuals, I'd like to quote USAID's expanded response to HIV/AIDS
report to Congress from June, 2002: the report confirms that HIV/AIDS'
-- I quote -- "most immediate impact is financial" \-- loss of income
and increased medical expenditure, particularly when the ill family
member is the principal breadwinner. A healthcare-only response will not
yield optimal results for individuals that are infected as well as
affected by HIV/AIDS. AIDS has financial impacts that necessitate
households having access to financial services to cope with expenses
related to the pandemic.

In African credit unions that we've studied in Botswana, Zambia, South
Africa, and Kenya, we've seen members confronted with increased expenses
for medical and hospitalization bills, funerals, school fees for
additional dependents for orphans that they're being cared for. We have
to keep in mind that assuring adequate income in households so that they
can be food-secure and provide daily nutritional requirements for
HIV/AIDS-infected individuals is an essential component of HIV/AIDS care
and support.

Thank you.

PEGGY HARPER: Hi. I'm Peggy Harper from the Foundation for Hospices in
sub-Saharan Africa, and I'm coming kind of as a follow-up to Cathy's
words earlier about the National Hospice and Palliative Care
Organization, but I had some comments that I thought that would be
helpful to -- that -- of lessons that we've learned in our three years
in working with the hospice care programs in sub-Saharan Africa.

First, I want to stress that hospice and palliative care, as Cathy
indicated, is really a multi-disciplinary approach that is primarily
home-based care; that it's -- that it needs to be available to children
and adults. Primarily it's been -- adults have been accessing that care
to date and we need to include children. The community-based programs
might also include daycare where there could be clinical supervision,
and small inpatient units. There's much confusion in thinking that
hospices are buildings and I wanted to clarify that.

And that there is a scientific base to a hospice and palliative care,
and therefore this isn't just people who are holding hands with people
who are dying -- not that that's a bad thing to do, but it really is a
clinical base to that and therefore it really requires the community
caregivers who provide most of the care to have clinical supervision
that's appropriate to the country that they're in and how -- access to
clinical officers. That bereavement, hospice and palliative care has a
role in prevention, which is always kind of a surprise to folks, but
these are people who were -- are in the home and the trust -- have
gained the trust of the families and therefore can talk about really
what they're -- what the diagnosis is and what's going on and talk about
how it happened that this person was infected and how it can be
prevented in other family members. The role of bereavement is critical
in the early identification of orphans and their early planning for
orphan care.

I think one of the -- the experiences in Africa is that some of the
countries have hospice and palliative care and other countries are
begging for such care when they hear that not all of their people need
to die in pain. And so I ask you to be sure to think beyond the
country-by-country borders and really think about regional approaches so
that those countries that have people who are experiences in providing
hospice and palliative care can train other people in other African
countries, so a real model of Africans training Africans to provide the
care.

I think in addition the importance of not only including anti-retroviral
treatment, but also medications and drugs for hospice and palliative
care need to be included, such as morphine and other medications for
symptom management.

Thank you very much.

MR. MASON: Thank you. Why don't we have Gregory King -- go ahead -- you
can come up. I'm just calling other people. Gregory King from the
American Federation of Teachers. Hannah Klaus from Teen Star Program.
Kristin Langley (sp) from Plan USA, and Kya Lewis (sp) a former member
of the council.

JODI JACOBSON: Good Afternoon. Thank you, all of you, for inviting us to
give comment on the program strategy. My name is Jodi Jacobson and I'm
founder and executive director of the Center for Health and Gender
Equity, an international women's health policy and advocacy organization
focused on U.S. international assistance and policy vis-à-vis women's
rights and how -- We are deeply concerned that the overarching U.S.
global AIDS strategy now being developed by the global AIDS coordinator
including, but not limited to, the president's Emergency Plan adequately
address the specific vulnerability of women, girls, and other groups to
HIV.

I have submitted written comments and I just want to highlight some of
the points that I think are of greatest concern. As we're all now aware,
an overwhelming body of scientific, medical, and public health data now
irrefutably confirms the unique biological, social, cultural, and
economic vulnerability of women and girls to HIV/AIDS. In recognition of
this evidence, the United States' Leadership Against HIV/AIDS,
Tuberculosis, and Malaria Act of 2003 requires that the president and
the global coordinator develop specific strategies to, quote, "meet the
unique needs of women and girls including the empowerment of women in
interpersonal situations and young people and children including those
who are victims of the sex trade, rape, sexual abuse, assault, and
exploitation."

I am wanting to offer a few points that I think are critical as we move
forwards in the development of the strategy. In short, U.S. global
policy to achieve its own goals must, at a minimum, include the
following: support for comprehensive HIV prevention strategies that
promote scientifically proven, field-tested strategies and best
practices to meet the diverse and changing needs of women and young
girls throughout the developing world, keeping in mind that in many
countries, for example, child marriage or early adolescent marriage is
common. Many young girls are married, or 50 percent or more of young
girls are married by the time they are age 18, and the rate of new
infections is increasing among married women of reproductive age. For
these groups, and particularly women for whom their personal situation
requires that they are unable to control the frequency or timing of
sexual intercourse, abstinence only programs are not a viable option and
do not constitute a comprehensive or effective strategy.

The second point is that I wanted to underscore that we need to make
sure that we are supporting expanded access to integrated health
services. Ambassador Tobias and others have suggested that they will
ensure that development assistance and other components of development
strategies will be coordinated with the HIV.AIDS program. However, women
and adolescent girls need and rely upon a full complement of HIV, STD,
and reproductive health information and services, including family
planning information and services for sexually active individuals
wishing to avoid both infection and unintended pregnancy, as well as for
HIV positive women seeking to avoid pregnancy or to safely deliver.

I want to say that I am concerned that our development assistance for
international family planning funding is woefully inadequate and is not
being well coordinated with the goals of the overall HIV/AIDS agenda. We
need to be spending more in this area and we cannot see this area of
service apart from where women and girls get their information and how
they seek services.

Third, we need strategies to reduce gender violence, sexual coercion,
and harmful traditional practices and other barriers to women's health
and rights specifically because studies now show that between 50 -- 15
to 50 percent of women and girls have experienced some form of sexual
coercion or sexual abuse in their lifetimes throughout the developing
world. Other points are already allocated in my written testimony, but I
think if we were to pay attention to these basic needs and ensure that
women have access to equitable -- equitable access to treatment and
care, we would be going a long way to resolving the HIV epidemic.

Thank you.

MR. MASON: Thank you.

Fine.

DR. HANNAH KLAUS: I'm Dr. Hannah Klaus. I'm obstetrician gynecologist,
now working full time with the Natural Family Planning Center of
Washington, D.C., and the Teen Star program, which is an educational
program of sexuality for teens which has shown good results in
maintaining primary abstinence and the return to secondary abstinence by
half of previously sexually active adolescents in the U.S.

We are a health education NGO here, but work mostly with FBOs in
developing countries. I'll talk about our programs which are working
well. In Uganda, the coordinator also coordinates religious education
for the Catholic Bishops Conference in Kampala and their teacher
stipends come from the schools in which they work. We're now in seven
high schools and we have managed to get the kids to hang in with this.
They maintain abstinence. They chart -- the girls chart their cycles,
which validates their womanhood, increases their self-confidence. And
I'm sorry to disagree with the previous speaker -- it does work.

In Volovio (ph), the program is most developed in Zimbabwe, the
Christian healthcare services now receiving funding from Catholic relief
services with 26 teaching sites and 48 active teachers reaching 700
students by last summer with very positive feedback, but they have a
very slow approach to the program. They start with a two-hour awareness
meeting in the community picking out the leaders, then two weeks later
they come with a two and a half day introductory workshop, discuss
anatomy, physiology in the local language, indavala (ph) and shuna (ph),
and then also talk about parenting, child developing, and -- development
and counseling. And the last half day is then they have planning and
only five says a week -- dory, about a month later they give the full
teaching program and then go ahead.

So it has to be staged. People have to understand the need for the thing
and agree before you do anything else with it. In the course of the
training, the teachers learn the Billings ovulation method, which is a
natural family planning method which is the basis for fertility
awareness training. It enhances monogamy, et cetera. I see my time is
getting short. My full thing is on the web, but what I want to stress is
that you can't have a one-size fits all for everybody. There are many
people who will be very happy with abstinence until marriage and
fidelity within marriage. If you insist on making them offer things
which are against their philosophy, it's not going to work. And yet, the
best way to prevent HIV transmission is surely abstinence until marriage
and fidelity afterwards.

Thank you.

MR. MASON: Thank you.

ERNEST HOPKINS: Hello. Good afternoon. On behalf of the Pangea Global
AIDS Foundation, which is the global affiliate of the San Francisco AIDS
Foundation, I'd like to thank the Presidential Advisory Council for
having this meeting today, and certainly to commend the Bush
administration for the presidential Emergency AIDS Initiative and its
significant focus on treatment and medical care.

Saving the lives of people with -- of people living with AIDS through
treatment readiness and access is the focus of Pangea's work in the
developing world, and we strongly encourage the administration in its
efforts to quickly engage the actual doctors, nurses, health workers,
and HIV positive communities in each funded country in order to be
successful.

Our experience is that developing close working relationships with these
individuals is essential for success. We at Pangea were very pleased
that Secretary Thompson, Ambassador Tobias, and their teams were able to
visit two sites in Africa where Pangea is actively engaged: Kikiru (ph)
Health Center in Kigali, Rwanda, and the Makerere University's
Infectious Disease Institute in Kampala, Uganda.

The Kikiru Health Center demonstrates that health quality -- that
high-quality healthcare can be delivered in very basic primary care
settings. The comprehensive services provided at Kikiru include medical
care, treatment including ARVs, psychosocial support, and food. The
center is very modest, but the care is patient-focused and high-quality,
and Pangea commends the initiative's desire to build on the existing
infrastructures already in place in countries because we have found that
with modest investments significant good can be done.

The second site I mentioned, at Makerere University in Kampala, Uganda,
is a partnership with Pfizer Pharmaceuticals, the Academic Alliance for
AIDS Care and Prevention, and Pangea. Dr. Hank McKinnell, who is a
member of PACHA and Pfizer's support of this project will continue to
ensure the excellent training for generations of healthcare providers
will be available and high-quality HIV care and treatment will be
provided in the new infectious disease institute at -- the new -- the
Infectious Disease Institute facility now close to completion. There has
been careful attention to anchoring both the clinical and strong
administrative systems for durable, sustainable benefit to the broader
region.

One of the most important lessons that we have learned is that systems
of care designed in resource-poor settings must reach out and embrace
multiple levels of healthcare providers, particularly in light of human
resource constraints. When the proper support and mentorship is
provided, nurses and community health workers can deliver very high
quality care including monitoring of ARV therapy within existing
community-based systems of care. It is this careful attention to the
systems for consultation as questions arise, and mechanisms for referral
for patients' needs that allows the further evaluations for -- by a
physician to occur, and that is key to delivering services safely, even
in the most remote settings or the poorest -- the most resource poor
environments.

Finally, Pangea supports the rapid scale-up of treatment in the first
round of the R (ph) phase produced by the AIDS coordinator's office. We
hope that the country treatment plans to be developed by the 14 U.S.
ambassadors of the focus countries with the country representatives are
tightly integrated with and informed by each country's existing national
AIDS plan. Pangea looks forward to country treatment plans that are
consistent, complementary, and well integrated with each country's
overall national AIDS plan.

Thank you.

MR. MASON: Thank you. Let me ask Marsha Martin to come on up. Marsha
Martin from -- no you -- I'm just calling additional people. Marsha
Martin from AIDS Action; Pete McLain (sp) from Voice for Humanity; Jesse
Milan (sp) from the Cansella (ph) Group; and Jack Musaali from the
Family Research Council.

MR. : Good afternoon. I am speaking on behalf of Kristin Langley who is
on your -- from Plan USA, but I'm really speaking on behalf of the Hope
for Africa Children Initiative, which is a consortium made up of CARE,
Worldvision, Plan, Save the Children, The Society of Women and AIDS in
Africa, and NAPLAS (ph) which is the National Association of People
Living With AIDS in Africa, and we have been working together some three
years now. We are community-based. We are holistic. We are African run.
What I want to comment -- I initially was hesitant to come up at all
given the strategic level of these panels' discussion, but I heard
someone very early on -- it was either you, Dr. Mason, or Dr. Sullivan
saying getting things smart -- and I want to talk about an operational
implication as you go forward.

The first round of procurement under the president's emergency program
came out a few weeks ago, and what it tended to do is go just opposite
of an approach which we think would make the greatest sense. The
greatest sense is for organizations like FHI mentioned earlier on, to
work together, to work as a unified group, to subordinate our individual
self-interest as organizations for a greater good. But the procurement
documentation that came out did not facilitate working together; it
facilitated fragmentation, and because the size of each individual
procurement was so small and the enormity of the issue is so large, that
each organization on its own to compete with each other rather than to
unify together, so I just urge you as you are developing not only your
strategies, but your operational tactics, to facilitate organizations
that come together to put their individual self-interests behind. There
will be many consortiums. It won't be just one. There will be many
consortiums. There will be individual organizations that have such a
unique niche that they will rightfully want to go on their own and it
will make sense, but for the most part of you want effectiveness of
impact and you want efficiency in terms of the use of your dollar, you
don't want to set up 20, 30, 40, 50 separate parallel structures with
all the different overhead and administrative costs associated with it,
and that's what you did on your first procurement.

I'm trying to say this as constructively as possible because we all want
the president's initiative to work and work well.

Thank you.

(Applause.)

MR. MASON: Thank you. Thank you.

KYA LEWIS: Hi. Good afternoon and good to see everyone. I'm Kya Lewis,
senior policy analyst at the National Family Planning and Reproductive
Health Association and a former member of the PACHA. I will save some
time today by being extremely brief with my comments, but the National
Family Planning -- NFPRHA -- is an organization that represents state
health departments, community health centers, and clinics across the
country that provide public -- publicly funded reproductive health
services for low-income people.

And from our experience with our clinics, we know that comprehensive
messaging in education and prevention as well as comprehensive
integrated care for family planning, STD, and HIVC services work best
and that's what we strive to do here domestically. We were concerned
about the mandate within the president's initiative that one-third of
all prevention funding should go to abstinence until marriage programs,
and I just wanted to urge the council to do a few things and think about
asking the president to do a couple of things, especially in
consideration of the rates of HIV and AIDS we see in women and girls in
African and other nations.

First of all, I would urge the council to encourage the global AIDS
office and the global AIDS coordinator to make sure that programs --
prevention programs are duly coordinated on the ground, that
evidence-based prevention methods are used, and that organizations that
have been doing prevention work and good HIV work over the years are
able to access funds, collaborate with organizations that can do that
work with them, and help to solve the problem on the ground.

I would also urge the council to ask the administration to focus on the
development of vaginal microbicides to prevent the sexual transmission
of HIV, to expand access to integrated services, reproductive health
services, and HIV services on the ground. With that, I would say good
luck, Godspeed, take care.

MR. MASON: Thank you.

JOSEPH DAVIS: Good afternoon. My name is Joseph Davis and I'm with the
American Federation of Teachers. I'm substituting for Gregory King, who
had agreed to speak this afternoon, but unfortunately he could not make
it.

I would like to share the AFT experience with you and talk about some of
the work that we are doing internationally and domestically on the -- in
dealing with the problem of HIV/AIDS.

As I am sure all of you now, or most of you know, the American
Federation of Teachers is a teacher organization -- primarily a teacher
organization, but we also represent healthcare workers, public sector
employees, non-teaching school personnel. The AFT has 1.3 million
members across the country, mostly in major urban areas: Baltimore,
Chicago, New York, Los Angeles, New Orleans, Dade County in Florida, and
in many other locations. We are a political organization and we are
involved in the HIV/AIDS effort in two ways. One is through a domestic
campaign. We are educating our members throughout the country on the
importance of the HIV/AIDS work that needs to be done in Africa. We're
trying to build a constituency to support the president's initiative and
to support your work and try to encourage Congress to provide more
funding for the incredibly important work that you are doing.

The AFT over the years has had a very active international affairs
program. That's not our primary responsibility. Our primary
responsibility is to represent our members, but our -- the focus of our
international affairs program is to help develop and support
independent, democratic trade unions across the world. We have programs
in about 60 countries. We have many programs in Africa, and most
recently our president made a commitment to focus -- to make HIV/AIDS a
high priority. In our programs, we are working with teachers and teacher
organizations. We have programs in about five countries now. In those
five countries, the organizations that we work with represent over one
million teachers.

In the 14 countries targeted by the president's program, there are well
over two million teachers, and as you know, and as the minister of
education in South Africa says to us over and over again, there's no
vaccine for HIV/AIDS -- or the only vaccine we have for HIV/AIDS is
education. Teachers are central. Teachers are at the epicenter of the
problem. They are the people who meet every day with orphans, deal with
sick children, deal with children who are traumatized by the problem of
HIV/AIDS or the effects of AIDS in their families and their communities
and so on. Teachers themselves have a high rate of HIV infection and
they're dying in large numbers. Over 1,000 teachers die every year in
South Africa for example.

Teachers are also very active in the HIV/AIDS education \-- HIV/AIDS
program. They are working to support orphans; they're working to support
colleagues who are sick. The teacher organizations have a good
infrastructure -- an excellent infrastructure. Their representation at
the national level, at the provincial level, the district level, and
they have representatives in every single school, and in -- (audio
break, tape change) -- in your strategy paper, and also keep in mind the
importance of teachers, the work they can do inn reaching out to the
community, their importance in the community, but also teacher
organizations that can help facilitate your work because they have an
existing infrastructure and commitment to good leadership.

Thank you.

MR. MASON: Thank you.

PETE MCLAIN: Good afternoon. My name is Pete McLain. I'm with Voice for
Humanity, a relatively new organization that's working on serving as a
catalyst for behavioral change through information and education and
communication and interventions primarily with oral communicating
cultures and that's the point I want to talk on for three minutes.

The over half of Africans that are oral communicators; that is, they
take -- they may -- they're either illiterate or they may be literate,
but they primarily taking information visually, orally. In other words,
they don't rely on their books or their computers or their handwritten
notes or newspapers for information. They rely on what they've stored in
their heads or what they get from known and trusted people that they
have around them that are repositories of information. So to have---to
get information into people's heads, it needs to be in a format that
oral communicators can understand, internalize, that will hopefully lead
towards behavioral change, so that's stories, that's dramas, it's
proverbs, it may be songs, music, that kind of thing. And it's pretty
obvious that it's easier to remember a story than it is an outline of
eleven points.

We don't memorize outlines of 11 points as literates, we write it down
and then that's where we store it. We're not storing that in our heads;
but if you're an oral communicator, you're storing that in your head.
Or, if you don't do that, then you have people around you that you know
and trust that you go to for your information, so when it comes to
prevention and awareness, AIDS information, how do you get that across
to oral communicators so that they understand it, they retain it, and
that they change their behaviors as a result of it? So that's what we're
concerned about.

The best way to do that is through person to person, but how -- we don't
have enough time to do a person-to-person kind of intervention. There's
also a problem with person to person because the information can break
down over time as you go from one person to the next person to the next
person. It breaks down. We've all done that game of telling a story in
secret and you go around the room and by the time it comes back to you,
it's changed. So what we've been working on is a low-tech -- I mean
low-cost technology that can provide a consistent message, but in an
oral form, so if you think of an MP3 player, we have developed an MP3
player for about a tenth of the cost -- it's about \$25 -- and we can --
we're compressing speech up to 125 times, that's part of the reason why
we're getting the cost down, so we can put up to 80 hours worth of
content on this device, but we built it with a speaker so that you can
play it in a small group setting so people can sit around and listen to
it, stop it, and have a discussion about it. Interact with it. Maybe
it's -- there's a drama they reenact. Then you can rewind it and play it
again. It's that kind of learning experience that we think is going to
lead to more likely resulting in behavioral change.

Just for my last 10 seconds here I thought I would just demonstrate how
this sounds.

(Begin recorded segment.)

"Talking about HIV/AIDS prevention messages from Uganda. Walking in the
dark without light to guide you is dangerous. You could easily end up in
trouble. Living your life without HIV counseling and testing is like
walking in the dark: it is a threat to your life and the lives of loved
ones."

(End recorded segment.)

So you get the idea. Thank you.

(Applause.)

MR. MASON: Thank you.

Let me ask Julie Neff from Concerned Women for America. Lucille Perez
from the National Medical Association. Cesar Portillo from the AIDS
Healthcare Foundation, and Patrick Robinson from the Association of
Nurses in AIDS Care to be ready to speak.

JACK MUSAALI: Thank you. My name is Jack Musaali here today from the
Family Research Council. As a fellow with a Witherspoon fellowship, I am
here to share my experience growing up in Uganda, a country that has
been ravaged by HIV/AIDS and has experienced dramatic success in
reduction of HIV infections than any other country.

I was born and raised in Uganda and came of age just as the HIV plague
was spreading across the nation. During the -- when I was nine years
old, my teacher came to class one day and said, today we are going to
start a new topic. She said she had to teach us about slim (ph). Slim is
a local colloquialism about AIDS. That's descriptive of extreme weight
loss of a patient after they have gone to full blown AIDS. Ms. Nakami
(ph) -- that's not her real name -- proceeded to teach us about HIV,
about the virus, about the methods of prevention, and she said there is
no known cure for AIDS, so if you get it, you will die. Sobering words
for a nine-year old, but I would not know the significance of what she
was trying to tell us until much later.

Unknown to us, Ms. Nakami was dying of AIDS. She still looked healthy
and full of life, but on the outside she was surely dying, and before
our eyes, as her symptoms of full-blown AIDS became more evident, she
was transformed form a beautiful young lady to a haggard skeleton.

During the months and years that followed, a feeling of desperation
gripped the country. Reports of people dying from AIDS were too many to
count, but too real to ignore. Mothers and fathers, sons and daughters,
rich and poor, old and young, no one -- not even my teacher -- was
immune.

A national campaign to educate the young people began in earnest. Each
year, the primary school and secondary schools would hold a musical
drama competition presenting the message: AIDS kills. There is no known
cure for it. It is transmitted mainly through sexual contact, and
abstinence is the best choice.

By the time I was 16, I had attended more funerals for AIDS patients
than I could count on my hand. Nearly everyone in my school knew a close
relative or a friend that had died form AIDS. In 1997, my uncle and then
later his wife both died of AIDS, leaving behind six orphans who had to
be taken care of by my family. Last year, one of my best friends, an
orphan herself, was the last auntie that was taking care of her and her
little sister. She now has to raise the rest of her siblings in what is
called a child-led household. She cannot complete her education and must
grow up and begin to look after her siblings, including a little boy who
is HIV positive.

This year as I was leaving to come to the U.S., a close family friend
passed away leaving behind a devastated wife, a 10-year old, and a
six-year old. There is not one family in Uganda that I know that has not
lost at least one relative to HIV/AIDS. My father in his struggle to
find a way to teach my brothers and I about sex took us to an annual
conference organized by the Uganda Youth Forum and the first lady of
Uganda. The conference that year was aptly titled "Not Everyone Is Doing
It." In her opening remarks, the first lady of Uganda, Mrs. Musevini
(ph) stressed the importance of abstinence as the only viable and
preferred method of staying clear of the deadly plague of HIV/AIDS. I
attended the annual conference from 1993 to 2000 and during this time I
signed the true love waits commitment card, which says believing that
true love waits, I make a commitment to God, myself, my family, and my
country, my friends, and my future mate to be sexually pure until the
day that I give myself to my marriage partner.

Uganda's response to the devastating AIDS epidemic in a
resource-constrained setting has been acclaimed as a global model. The
focus on Uganda resulted in a 1995 announcement of the declining HIV
sero prevailing threats. As we plan for policy interventions in this
congressionally mandated five-year strategy -- I know my time is up now
-- to combat this HIV/AIDS, I would like to reiterate that Abstinence
and behavior change are possible. If the policies we make do not place
significant emphasis on abstinence, they will not be effective in
combating this epidemic. I want to testify that behavior change is maybe
is still a difficult way, but it is possible and it should be the
preferred way of -- because it trains the mind to be disciplined and it
establishes important qualities of self-control, restraint, and respect
for the other person's life.

Leaders should not be timid to support abstinence because, as I can
attest, the young people do listen and will abstain.

Thank you very much.

MR. MASON: Thank you. (Applause.)

DR. PATRICK ROBINSON: Good afternoon. I am Dr. Patrick Robinson. I am
the president of the Association of Nurses in AIDS Care, known as ANAC.
The association is a member organization representing over 2,500 nurses
across the United States. I am here today on behalf of the association
to urge this International Committee of the Presidential Advisory
Council on HIV/AIDS to recommend to the president that nurses be
included in all levels of planning, development, and implementation of
the president's Emergency Plan for AIDS Relief.

ANAC also urges the council to request of Ambassador Tobias that he
recommend to the leadership of the specific countries receiving
assistance through EPAR that nurses be included in the planning,
development, and implementation of the funding for HIV/AIDS relief.
Additionally, that nurses be utilized to educate, train, and empower
other nurses and community health workers to provide the care essential
to the attainment of the goals of EPAR.

The network model as outlined in the plan is familiar to nurses who work
and collaborate across healthcare delivery systems. Nurses are skilled
in addressing multiple priorities not only of the systems of care, but
also the priority needs of patients and their families. Nurses from the
United States and the specific countries must be included in the
planning and development of the implementation plan of EPAR and in four
domains as outlined. Ensuring that nurses are involved increases the
potential of success for EPAR. The foundation of quality healthcare in
this country is having highly skilled nurses in all levels of the
healthcare delivery. Multiple studies have identified nurses as the
critical component of care. When there is inadequate care -- nursing
care, morbidity and mortality rise. In resource-challenged countries,
nurses also are the primary providers of care. Physicians are frequently
in short supply, and nurses perform numerous interventions that are
usually done by physicians in this country. Additionally, nurses are the
primary link to communities and are not only knowledgeable about the
needs of the community members, but are trusted by community leadership.

Nursing input is not sought, and non-nurses are deciding what care needs
to be provided. If nurses were included in all levels of planning and
implementation, more efficient and appropriate programs would be
implemented. Worldwide, nurses have been significantly involved in
providing the majority of HIV/AIDS care. Their experience and expertise
would richly enhance the program planning and implementation processes.

Recently, the World Health Organization announced a need for 100,000
trained providers to implement their plan to have three million people
enrolled in anti-retroviral treatment by the year 2005. Nurses
undoubtedly will be the majority of these providers. The worldwide
plague continues to spread rapidly; we must respond rapidly. Providing
anti-retroviral treatment and care will certainly slow the progression
of HIV disease, allowing parents to live and raise their children;
allowing governments to stabilize political, economic, educational, and
social structures; and to prevent the total destruction of some of the
more severely HIV impacted societies. Nurses are ready, able, and
committed to participate in this endeavor.

Thank you for providing me this opportunity to speak on behalf of
nurses.

MR. MASON: Thank you.

JULIE NEFF: Good afternoon. I come bearing good news. You guys only have
30 minutes till your next break, so that's a good thing I guess. My
name's Julie Neff. I'm with Concerned Women for America, and I'd like to
thank you for giving us this opportunity today.

Concerned Women for America is a nonprofit women's public policy
organization that works both domestically and internationally on vital
social and health issues that affect women, men, and their families.
Time is short, so I'll be general.

Concerned Women for America and its over 500,000 members stand with the
president in his commitment to rescue a continent from destruction by
committing U.S. funds to combat AIDS in Africa. The U.S. has an
excellent opportunity to combat this pandemic in Africa by learning form
the errors we've experienced in our own domestic policies. Therefore,
there are three priorities we must exercise in order to achieve a
healthy success in preventing the spread of AIDS in Africa. First, we
need to provide access to lifesaving drug cocktails for every person who
is infected with HIV/AIDS so they can continue to lead their best life
possible. Second, we must meet the essential needs of orphans, widows,
and others bereft of means of support who are ravaged by this disease.
Those essential needs should include basic healthcare services, clean
water and good nutrition, and adequate housing. Third, we must also use
what works to prevent this disease, and in those prevention activities,
we should focus on behavior change as our strategy, eradicating unsafe
sex practices such as prostitution, rape, multi-partnering, and
fornication. Further, the proper role of condoms in a sensible
prevention strategy should be used as a tool to prevent those infected
from infecting others.

Compassion demands that we fund what we know will save lives, and based
on this premise I respectfully resubmit these comments.

Thank you very much.

MR. MASON: Thank you.

MARSHA MARTIN: Good afternoon. I'm Marsha Martin, executive director of
AIDS Action, and I would just like to say thank you for this opportunity
to address the subcommittee and also thank you to you, Chairman Mason,
for the opportunity to travel with you this summer to Southern Africa,
and your colleague, Jim Driscoll.

I would like to share with you some of the observations that AIDS Action
as a result of that trip have discussed with our board of directors and
would like to share with you what we think we observed that would really
help to solidify an effective response given the president's initiative.
The opportunity to visit South Africa, Botswana, and Uganda was a unique
one for AIDS Action. As many of you know, we are a domestic AIDS service
organization. We represent health departments, community-based clinics,
AIDS service organizations. We represent individuals and organizations
that cover the span of the epidemic from care and treatment to
prevention and services. And to be able to see the epidemic outside the
country was very important for us and for our membership.

To then be able to be in a position to comment and to provide support
where we could in response to the president's initiative. And I would
like to just say that this is a unique opportunity to build on an
effective response, and effective models that we have seen developed
over the years. In South Africa, we saw a serious commitment of the
corporate structure and the corporate sector. One of the things that we
talked a lot about in the United States in building an effective
response was leadership form the private sector, from the corporate
sector, from the business community and we saw in South Africa very
serious commitments and examples of collaborative programs that have
come from the private sector in response to the epidemic when the
government was not doing its part, so we want to say that we endorse the
role of the corporate sector. We saw large businesses engaged in direct
services, engaged in enhancing access to services, and in providing
direct care and treatment. Effective models.

We then visited Botswana where we were able to see the role that
government has played. There have been some concerns that have been
raised about what role can government play -- government directly. And
we saw in Botswana where the national AIDS coordinating council of the
government was engaged in coordinating care in partnership with the
private sector as well as with the community, so while we put a lot of
focus on the private sector and the corporate sector and we sometimes
talk about what government can and cannot do, in Botswana we saw
leadership from the very top engaged and knowing and knowledgeable about
what was going on, what part they had to play, and how they had a
responsibility to come together and coordinate and convene.

And then we saw in Uganda a very interesting program that showed us that
we can provide anti-retroviral treatment in rural areas, clean and safe
water, medical services and support, with training of family members and
community members in providing care. It seems that there have been times
in the past where folks have felt that this is not possible and doable,
and in these communities this is what we saw in partnership with
community. This is very important to keep in mind that we cannot do this
delivery of services without the community, so we believe that a blended
leadership model that recognizes all three components is the most
effective way to go.

And finally, we will leave you with the words of the ambassador to South
Africa. When he greeted us, he said it is time. It is time. It is past
time. We must do it now and we cannot wait. The ambassadorial group that
is working in response to this epidemic is exceptional. Many are career
civil servants who have been in Foreign Service for a long time. They
know the countries in which they work and they are prepared to do their
job, so we have the type of blended leadership that we know we need to
see.

And on a last note, because we are a domestic agency, we've heard a lot
of talk about three and five for the global response. We're going to
talk about two and four for the domestic response. We'd like to see \$2
billion in the '04 budget.

Thank you very much. (Applause.)

MR. MASON: Thank you. I want to just call a few more people up: Susan
Roylance from United Families International, Sharon Rudy from Population
Leadership Program, Asia Russell from the Action Group, and Natasha
Sakolsky from NASTAD.

CESAR PORTILLO: Good afternoon. Cesar Portillo, chief of Public Affairs
with the AIDS Healthcare Foundation. Thank you for the opportunity to
speak.

In August of 2001, we launched an anti-retroviral clinic in Durban,
South Africa with our local NGO partner, the Network of AIDS Communities
in South Africa, or NETCOM. The following year, we launched an ART
clinic in the Masaka district of Uganda in a collaborative called Uganda
Cares, a partnership with the health ministry of Uganda. And last month
we opened a second clinic in that partnership and have an agreement to
bring with the ministry up to 10,000 people into anti-retroviral
treatment.

In January of this year, we received an invitation from the Episcopal
diocese of Honduras to add an ART program to an existing OI clinic in
San Pedro Sula (ph). Three months later we launched an ART program with
them and we've just signed a memorandum of understanding with the
ministry of health to launch two additional clinics.

My comments below, in response to the questions posed in this hearing,
are a compilation of input from staff at the local level. In South
Africa we responded to the invitation from our local NGO partner,
NETCOM. This partnership has been essential in outreach to the community
since local communities best understand how to address cultural issues
and to help patients negotiate these issues in deciding to initiative
ART. This is very important in maintaining adherence. This has been
especially important in initiating community-based ART program while the
government remained publicly ambivalent about ART.

In Uganda, our staff emphasized that partners, partners, partners makes
successful in-country programs possible. Each clinic site has started
only after community consultation and mobilization. Criteria for
admission was based on WHO and national standards, but decisions on who
to admit for treatment must ultimately be a local decision by Ugandans
for Ugandans. Local staff and partners conduct needs assessments, which
ensure that persons living with HIV and AIDS shape and form the
structure of our treatment programs.

And finally, in Honduras the strength of our partner NGO infrastructure
has been essential to our success. Our NGO partner, the Episcopal
Diocese of Honduras, has a network of local clinics throughout the
country. Their experience in hiring and managing medical staff and
maintaining medical programs in resource-constrained settings allow us
to add quality improvement in their existing HIV program and to layer an
ART component on top of their existing program. This combination has
allowed us to focus on technical and financial support rather than
reinventing the wheel. Together, we're perfecting the ART wheel.

In conclusion, I wanted to echo the statements made by a previous
speaker about the recent RFA on treatment. I applaud the administration
for moving so quickly to get this funding out to providers, but instead
of creating a process by which any willing and qualified provider can
tap resources to expand access, an arbitrary threshold of three years
experience in three countries is required to apply. Why not two? Why not
four?

I would urge that this and other RFAs instead reward innovation and
initiative first, to ensure that those in need quickly get access to the
best care that we can create.

Thank you.

MR. MASON: Thank you.

LUCILLE PEREZ: Hi. Good afternoon. I am Lucy Perez, past president of
the National Medical Association and I thank you for this opportunity to
be here and to share with you. For those of you who do not know, Dr.
Sullivan, the National Medical Association is the largest and oldest
national organization, representing over 37,000 African-American
physicians and millions of multi-ethnic patients in the United States
and in the Caribbean. Through its membership, professional development,
community health education, advocacy, research efforts, and federal and
private sector corporations, the National Medical Association is
committed to improving the health status and outcome of
African-Americans, people of color, and disadvantaged and underserved
people throughout the United States.

While throughout its history the National Medical Association has
focused primarily on health issues related to African-Americans and the
medically underserved, its principal goals and initiatives and
philosophy encompasses all sectors of the population. For over 100
years, the National Medical Association has become firmly established in
a leadership role in medicine and serves as a catalyst for parity in
medicine.

HIV disease is a preventable virulent disease that poses one of the most
significant challenges to the global public health and it is for that
reason that the National Medical Association is so grateful for this
opportunity to come before you. We have learned a lot and personally I
have had the opportunity not only to see the epidemic from the
standpoint of a government worker and going on a very exciting
opportunity for prevention about four years ago, but also had the
opportunity to serve as a physician on a medical mission trip to Kenya
in which, for me, I had the opportunity to see what I had to do and
where HIV disease, though was part of the differential, was low down on
the (low ?).

The National Medical Association has had the opportunity to make a
difference where there has not been parity in medicine; where we know
that it is important to look at the respect and collaboration of the
population in which we are dealing with; where we come with a helping
hand, but a hand that is culturally sensitive and culturally
appropriate, one in which advocation for diversity is woven into
compassion. It is important that the planning strategies, the
implementation strategies that you have asked for our input on are done
in that manner.

It is imperative that not only the United States, but the world, be
sensitive to the womb of civilization and to go into it not as if it is
something different, but it is the mere essence of what and who we are.
Spirituality is a component of what we do and what we must bring with us
when we bring our medicines.

You asked what are the vital aspects of effective partnerships for which
the National Medical Association is strengthened and poised to assist in
this very comprehensive, though delayed, but very important quest to
make a difference, and some of those strengths that we feel are very,
very important are strengthening collaborations, medical associations,
faith-based organizations, community-based organizations, World Health
Organization, Pan-health Medical Association, all of these together
working to make a difference.

You asked how -- how we were able to effectively in the past bring
people together. We were able to take science-based information, take
that information, make it culturally sensitive and appropriate, and
apply it.

So I thank you for this opportunity. We are grateful for the leadership
working to make this initiative move forward. The depth and breadth of
our response you have in writing, and I thank you.

MR. MASON: Thank you.

NATASHA SAKOLSKY: Good afternoon and thank you for this opportunity to
comment and also to learn from everyone here in the room today. My name
is Natasha Sakolsky and I am the director of the Global AIDS technical
assistance program at NASTAD. NASTAD is the National Alliance of State
and Territorial AIDS Directors here in the U.S.

NASTAD has been funded by the CDC global AIDS program since October of
2000 to provide peer-based technical assistance to national AIDS control
programs and national AIDS committees around the world as they plan,
implement, and evaluate HIV prevention and care strategies for their
countries.

NASTAD applauds the release of a recent joint agency RFP as a part of
PEPFAR that focuses on the development of a twinning center, twinning
partnerships, and a voluntary healthcare corps. Over the past three
years, NASTAD has witnessed firsthand the value of twinning partnerships
and peer-to-peer support as we facilitated the transfer and adaptation
of lessons learned from state AIDS directors and their programs in the
U.S., particularly in the areas of community planning, particularly the
involvement of those infected and affected at the local level in that
planning; the design and implementation of data systems, including
national HIV surveillance systems and the development of epidemiologic
profiles that promote the use of data for decision-making; and national
strategy development for scaling up the acquisition and distribution of
anti-retrovirals particularly in Caribbean countries.

Human capacity building and strengthening of public-sector programs in
Nigeria, Ethiopia, Botswana, Brazil, and the Caribbean has benefited
greatly form the trust and familiarity that comes with true peer
exchange. When real live AIDS program directors and AIDS program staff
from one country exchange experiences, frustrations, challenges, and
successes with their colleagues from another, this leads itself to
success. This human capacity building is vital for scale-up, for
innovation, and for sustainability.

A primary lesson learned has been that this relationship has been
mutually beneficial and has enabled public health department staff in
the -- from the U.S. working abroad to bring lessons learned home to
their states. For example, a technical assistance provider from
Minnesota working in Nigeria returned to her health department with the
idea to disaggregate their HIV surveillance data to determine if the
increase in HIV infection among blacks in her state were primarily among
African-Americans, African born populations, or both. As it turns out,
the rise in HIV among those born in Africa was what contributed to the
increase in rates she had seen previously and there was actually a
decline in rates among African-Americans. This significantly, then,
changed their outreach and prevention strategies in the state of
Minnesota.

Another example is the technical assistance provider bringing health
education materials home form her travels in Ethiopia. Materials that
were used in indigenous communities there that she intends to use here
in the states with Ethiopian communities at home.

These are two examples. There are many more. Specifically when you look
at issues around the air bridge from New York State, Florida, to the
Caribbean, the examples are endless, as I'm sure many of you know.

The ANSTAD global program experience has proved that a foundation for
effective partnerships is created when colleagues are able to actively
come together and learn from one another by sharing tangible lived
experiences, both past and present, in the global fight against
HIV/AIDS. In addition, we have learned that global AIDS work not only
benefits the countries and the people with whom we work, but has a
direct benefit in enhancing the U.S. response to the HIV epidemic
domestically we well.

What have been the challenges? Our health department staff need
permission to travel from their department heads, their secretaries of
health, and their governors. In light of state budget cuts, this has
become increasingly difficult in recent months. Greater advocacy for the
role of U.S. state health department employees as volunteers and as
technical assistance providers would be a great asset in all the work we
do.

Thank you very much.

MR. MASON: Thank you.

ROBERT WEISSMAN: Hello. My name is Robert Weissman. I'm with Health GAP.
I'm here in place of Asia Russell. Health GAP is a U.S. organization
founded by AIDS activists and public health experts in 1998 to campaign
for access to affordable treatment in resource-poor settings and the
resources necessary to sustain such access.

The PEPFAR's objectives were clearly defined in the president's 2003
State of the Union address. Health GAP believes that these important
clinical objectives will not be achieved without significant changes in
U.S. policy regarding: first, global AIDS funding; second, collaboration
with other entities engaged in HIV treatment scale-up efforts; third,
intellectual property rights; and fourth, the involvement of communities
fighting AIDS in poor countries.

First, on funding, the commitment by the Bush administration to increase
AIDS funding by approximately \$10 billion to \$15 billion total over
five years is an important first step, but it's far from enough. The
U.S. fair share of global AIDS spending estimated by UN AIDS at 17 -- at
\$15 billion annually by 2007 is much more than has already been
promised. In particular, we feel that much more U.S. funding should be
devoted to programs that, unlike the PEPFAR, are already operational,
accountable, and showing results, such as the Global Fund to Fight AIDS,
Tuberculosis, and Malaria.

As a new bilateral bureaucracy, there will be some time lag before the
PEPFAR can be expanded -- can expand its capacity to spend money on
programs needed to save lives. The Global Fund is already operational,
but it needs adequate funding. We urge the Bush administration to commit
to a level of spending that represents our fair share of the fight
against global AIDS: a cumulative total of \$30 billion between 2004 and
2008.

Second, collaboration and complementarity. We believe the achievement of
the PEPFAR's clinical goals depends on the success of the Global Fund as
well as the WHO's three-by-five initiative. The current crisis and
resource scarcity means that PEPFAR must prevent wasteful duplication of
efforts and must cultivate substantial relationships with the Global
Fund as well as the three-by-five emergency field teams. This
relationship must involve regular significant contact and collaboration
between program coordinators as well as operations staff.

Third, prioritizing access to medicines in U.S. trade policy. Generic
competition has dramatically brought down the price of ARVs over the
last several years down to now \$140 per person per year. We're pleased
that the U.S. government supports the procurement of generic medicines
for use inn implementing PEPFAR. However, we're dismayed that the U.S.
continues to push trade policies that undermine exactly those
objectives. Only yesterday, the USTR completed negotiations of the CAFTA
agreement that includes provisions which, if implemented, will undermine
the ability of countries in Central America to procure generic
medicines. Similar proposals are being sought in the Southern African
region.

We call on the administration to halt its pursuit of standards for
intellectual property protection that exceed the already high standards
set up by the WTO in order to increase generic competition, decrease the
cost of medicines, and assure sustainable supplies of lower cost drugs.

Fourth, support procurement of generic fixed-dose combinations of
anti-retrovirals. The WHO is moving forward on this front. It is really
vital -- based on all experience in the field -- in making treatment
affordable, accessible, and easy. But through trade policy and now we
think through questionable clinical justification, the U.S. is
questioning the viability of prequalified FDCs, medicines that are only
available as the result of generics.

We are calling on the Bush administration to permit procurement of
generic FDCs with PEPFAR money and to support the efforts by the WHO for
prequalification of quality generic FDCs in order to maximize treatment
coverage, simplify treatment regimens, and improve compliance.

Finally, community mobilization and people living with HIV/AIDS. The
involvement of people living with HIV/AIDS and HIV treatment scale-up
efforts are central to clinical success. Community mobilization is
necessary to overcome stigma, develop and implement local principles of
equity and community access to ARVs, and to prepare communities for the
uptake of ARVs and related interventions. However, PEPFAR is placing a
cap of 7 percent on funding for community mobilization efforts. That cap
should be removed immediately, and we urge the administration to
prioritize the involvement of people living with HIV/AIDS in all
planning on the PEPFAR program and to include people with HIV/AIDS and
enable them to select their own representatives among stakeholders who
coordinate with the U.S. State Department officials in the PEPFAR
implementation.

Thank you.

(Applause.)

MR. MASON: Thank you. Kate Schecter from the American International
Health Alliance, Chris Torgeson from Doctors Without Borders, Dr. Elaine
Wolfson, Global Alliance for Women's Health. If you're here, you can
come up. Gregory Carter, Washington AIDS International Foundation, and
Louisa Pacheco, Tidewater AIDS Crisis Taskforce. And that completes our
NGO community-based organizations section.

DR. ELAINE WOLFSON: Thank you very much for this opportunity. My name is
Dr. Elaine Wolfson from the Global Alliance for Women's Health. We are
an advocacy and educational organization that's 10 years old. We've been
working internationally at the United Nations, at the World Health
Organization, and in various countries inn Africa. We have also been
developing service programs of palliative care in Burkina Faso with
which we work with 14 ambulatory care centers in distributing palliatory
care -- palliative care, sorry.

We are concerned about the thrust of the program and the context in
which we are discussing it. HIV/AIDS is a virus. It's a medical issue.
And over two million people are dying each year in sub-Sahara Africa.
While we have no -- we take no issue with most of the comments made
today, there is a question of urgency that I think should be addressed,
certainly if we place it next to other epidemics that we have seen in
the world and how we respond. In order to get to two million people to
be treated with ARVs in the next two years, it would require that 3,000
people ready for anti-retrovirals be -- have access to treatment each
day and that be aggregated through the years, perhaps my math is wrong.
It might even be larger than that. And if we were to take the WHO
program -- three-by-five -- we would have to exceed 3,000 people a day.

Clearly, the structures must be addressed and plans must be made to
mobilize treatment. We know prevention is important. We know that in the
endgame that will be one of the issues that must be addressed very, very
seriously. But if we look a the trajectory of the epidemic, we also know
that in the past 10 years in sub-Sahara Africa the epidemiology
indicates the epidemic has more than doubled and that we have an
opportunity to certainly cut down the deaths, reduce the orphans, reduce
the widows, increase the working power of the various people who will
die in the next year or who have in two years if we address the
treatment problem seriously.

To that end, we have been meeting with diplomats at the United Nations,
at the World Health Assembly, at the Economic Commission for Africa.
We've held five meetings in the past year. We've had more than 60
countries send delegates, and we have partnered with 11 African
countries. Recently, we've been invited to address this issue with
African-based NGOs at the African Development Forum in Ethiopia in
March, and we look forward to working with you so that we can reach out
and work with the Development Forum and the Gender Center in Ethiopia so
that we can multiply the demand dimension for treatment. They do seem
interested. They have reached out to us, and we would like your support
so we can reach out to them.

Thank you.

MR. MASON: Thank you.

DR. LOUISA PACHECO: Good afternoon to all of you. My name is Dr. Louisa
Pacheco. I am the president of the National Organization for the
Advancement of Hispanics and I also work with the Tidewater AIDS Crisis
Taskforce.

We have been working with the Hispanic community for more than 17 years.
We are dealing with the HIV/AIDS issue. We have been in collaboration
with Central American and South America. One of the things that we had
been finding out through the years is prevention really works, and when
we're talking about collaboration, we talking about partnership. We're
talking about working together. We have been seeing that not all the
races they are the same, and as Hispanics we also -- we do a lot of
multicultural and multisensitivity and when we put programs together,
you've got to think about not everybody is the same. Not everybody go
with the same culture. Not everybody have the same belief and we have
been -- every time we get to a country that we have been able to put
programs together, basically our program is going towards prevention and
education. Our programs go towards, you know, approaching medical staff
and requesting them, please, to help these people. That things has been
working very good. I mean, that is collaboration. It's not bringing the
agenda, your own agenda and your own interests. We don't have enough
funds. We don't use no funds, we just use volunteer people all around,
even when we go in the countries we use volunteer people.

And one thing that I really want to -- for all of you is to think about
it, is that here in our backyard we have people that they are dying, all
right? I mean, don't forget about those that there have been -- that
they are in here and they're going to be in here. I have been a doctor
for 20 years already dealing with this illness, and I decide just not
only to be in here -- United States -- but to go out of here. And I
would say, though, please don't forget about the prevention and
educational funds.

Thank you.

MR. MASON: Thank you. We're going to take a break at 3:15 as the
schedule -- it's about 3:00 now? So we're going to -- we're going to
make a little headway into the next group, so let me call George
Bellmany (sp) from Love For All People International, a faith-based
group; Ann Claxton from World Vision; Father Michael Czerny from the
African Jesuit AIDS Network.

GREGORY CARTER: Good afternoon ladies and gentlemen and distinguished
guests. My name is Gregory Carter. I serve as the co-director of the
Washington AIDS International Foundation. Please target the youth.

As I stand before you today, my heart is filled with excitement and
inspiration. I give thanks to God that there are people concerned about
HIV, such as you and those in this room. I believe that a new day of
hope is dawning for all of humanity. Of the more than six billion people
that are living in the world today, no one has clear knowledge about the
origin of humankind or HIV/AIDS. The origin of these viruses are
mysterious and also unclear, but because of the human origin and also
our historical process, then the elimination of this virus is also
unclear and mysterious. This also carries over into our personal,
political, racial, and cultural spheres as well.

Who has a permanent solution? Historically at times we pursue goodness
and altruism and at other times evil intentions and selfishness.
HIV/AIDS appears in this age as the equal opportunity offender. This
virus can either unite us all or kill us all. It has that kind of modern
day impact, as you are all aware. It is one of the most lethal
equalizers that we'll ever know. It equalizes us in suffering and pain
and also, ultimately, in death.

Ladies and gentlemen, this is not the sort of equalization of democracy
or fairness that my ancestors cried out for. How about yours? In one
sense, this virus epitomizes our global problem. What do I mean by this
statement? The answer is simple. We have not completed the basic
utilitarianism or the Golden Rule toward each other. We have not been
helpful and respectful nearly enough toward each other. Further, we
violate sexual contact with each other -- proper, healthy, sexual
contact. Ninety-nine percent of the HIV/AIDS is preventable by what we
think and what we do.

Therein lies the possible cure. We must take what is often called sexual
responsibility for ourselves. I applaud your efforts and encourage you
all to continue on your journey for universal education; also, my
colleagues here who talk about education and prevention. The other 1
percent is contracted through the birth process, contaminated objects,
or other blood transmission items. Ladies and gentlemen, we have the
cure right here. We have to teach uniqueness, beauty, the values, the
potentials, and the importance of every single human being. Further, we
have to embrace the value of abstinence for some and the importance of
monogamy for others.

Many are already infected and suffering and have died. More still will
be victimized while we grapple with technicalities and political
correctness. We must care and supply toward the needy. They and we are
in a war of viral terrorism. Nevertheless, prevention directed toward
the youth should be our greatest concern. Care for those infected,
education, and mobilization of the houses of worship is paramount.
Investment form the private business sector is a key component and a
united global strategy is essential.

I submit that the Ugandan ABC model is the most effective, national,
preventative method to date, which combats the scourge plaguing humanity
head by head. Please target the youth.

With closer examination of this application, many will see that it has
been successful. Lives are saved and people from various groups and
perspectives unite together to defeat the virus. I am excited and
inspired by this effort. I believe that we here in America have the
ability to create a similar united movement.

Ladies and gentlemen, I will do my part. The Washington AIDS
International Foundation will do its share of the work. Our work is to
stimulate the national and the rational consciousness of all people; to
encourage our fellow world citizens to make intelligent choices, both
sexual and otherwise; to disseminate truthful information, be it
scientific or empirical; to introduce the concept of sexual discipline;
to tear down the walls of cultural barriers and liberate many
disadvantaged people, especially in the minority community in America
and to encourage them to pursue their dreams and goals. This is our
slice of the pie.

The Washington AIDS International Foundation -- WAIF -- symbolizes an
orphan. We are all orphans in some capacity or fashion. Nevertheless,
when orphans pull together they create a family. Combining their talents
together, they create a community. Uniting these communities together,
they create a nation. This nation or movement can effect change in the
world. Ultimately, this global change will benefit us all.

Thank you very much for your kind attendance.

MR. MASON: Thank you.

GEORGE BELLMANY: Good evening. My name is George Bellmany and thanks for
the opportunity to share. I'm the president of Love For All People
International Ministries. I'm also on the board of a local AIDS ministry
here in the U.S. that has an outreach to 500 people, and I'm also a
volunteer AIDS counselor. I also co-founded a ministry in Nairobi,
Kenya. Started a rehabilitation center, and 90 percent of the funds for
this ministry I supported -- come from my personal funds. That's why I
caught the Greyhound bus up here from Altamont Springs, Florida -- 17
hours. And I don't recommend that. (Laughter.) And you're all laughing,
but I've got to go back tonight. (Laughter.)

Anyway, I would like to address one of the answers that I think that
we're supposed to be addressing \-- one of the questions, and that is
what are some of the valid aspects of effective partnerships? And with
only three minutes I'll be very short.

From my experience, or our experience, I think it's imperative -- and
when you're talking about partnerships, a partnership is no stronger
than the weakest partner, and we feel that as a ministry that we want to
be a strong partner and we -- again, we think it's imperative that those
that we're working with and those that -- and that's from the head to
the grassroots person -- that they must have love, respect, and
compassion for the person that they're working with. And let me give you
an example as a counselor, and I don't want to say I'm all that and a
bag of potato chips, okay? But one of the gentlemen that I counsel, and
he has been off drugs for medication for two years, his viral load is
zero and his T-cell is up past 400. And I'm not saying it's because of
me, but I do believe it's because of that relationship, and we
understand what it takes for a person to live longer -- you know, and we
don't want to go through that, but we have to. I think it's imperative.
Our seeing people with the wrong attitude, even though we're getting
paid, it was a job and -- I don't want to go there. Okay.

Also, there must be acceptance and affirmation. In Kenya, there are 42
different tribes, and all the tribes are not the same. If there's anyone
here from Kenya, maybe they can amen that. All right. We need to be
culturally sensitive; we also have to have some cultural knowledge about
what's going on. Okay? Now I've been -- I've lived in the bush. All
right? I've also been to all the major slums in Nairobi, and we're just
talking about Nairobi, okay? And we're not picking on Nairobi because in
the U.S. here we also have some issues and there are some pockets that
you can't get into because people are insensitive.

And I'm going to close by saying thank you, God bless you, enjoy your
Christmas, and we need some money. (Laughter.)

(Applause.)

MR. MASON: Thank you.

ANN CLAXTON: Thank you very much for this invitation to provide some
comments. I'm Ann Claxton from World Vision and World Vision -- just to
brief introduction for some who might not be aware -- World Vision is an
international Christian relief and development organization with about
50 years of experience working now in about 90 countries around the
world and we partner directly at the community level with churches,
community-based organizations, other faith-based organizations, and
directly with community leaders and their families.

World Vision's been working in HIV/AIDS programming since about 1988 in
Africa and Southeast Asia and Eastern Europe, and in the nine PEPFAR
focus countries where World Vision is also active, we are currently
reaching about 3.6 million households and support more than 700,000
orphans and vulnerable children through community-based support -- care
and support programs.

World Vision applauds the presidential initiative. It's a visionary and
compassionate one, and we would like to just make a few contributions;
hopefully to contribute to the efficiency and effectiveness of the
programs. The PEPFAR goals of two million receiving treatment, seven
million infections prevented, and 10 million receiving care are all
excellent, ambitious, and worthy goals. And I think that they are
achievable through the NGO institutional partners and community-based
partners that are already experienced and working on the ground.
However, what's going to be needed, I think reflecting some of the
earlier statements that were made, are some more flexible funding
mechanisms. Some of the ones that we've seen coming out so far, we --
basically repeat a pattern of rather burdensome and rigid procurement
roles, and they need to be modified if we're going to reach the scale
that we need to achieve.

Second, all of these goals are equally important and are mutually
reinforcing and -- so we don't want to get too excited by the great
opportunities of the new technology and the anti-retroviral treatments
that are available that can save millions of lives and forget about the
families and the --especially the children who are especially burdened
and impacted by the disease as they watch their parents die and are left
behind as orphans. So prevention, orphan care, palliative care, and
treatment are all equally important, but we sometimes are hearing more
emphasis on the treatment side of things and we want to urge that we
remember the families and especially the orphans, because these are all
mutually reinforcing goals and the children who are left behind are the
ones who will be the infected adults of the next generation.

A third point is that integrated programs are the most effective, and
we've heard this from a few people, so I'll be brief, but through many
years of child survival and other types of preventive healthcare
programs that are running at the community level we have learned that
communities can be linked with the formal healthcare system to expand it
to the millions of people who are outside of the catchment areas of
these very, very limited healthcare infrastructures, and so the types of
community partners who are mobilizing churches and community
organizations, who are training community healthcare workers to spread
prevention messages, to go into families and care for orphans and care
for those who are ill with HIV/AIDS, these are the same volunteers and
community organizations that are starting the voluntary counseling and
testing centers out in the remote, rural areas and who are able to refer
patients for anti-retroviral treatment and for prevention of
mother-to-child transmission. Short-course treatment. So it's very
important to integrate the community care with the facilities, with the
laboratories, and the voluntary counseling and testing systems that are
being set up.

Finally, just in terms of partners, which was the question that you
asked, the faith-based organizations, the churches and the mosques in
the communities have the moral credibility and moral authority -- the
ear of the community. They have the mandate to reach out with
compassionate care. They are sustainable and they're everywhere, so they
are excellent partners. They often lack accountability -- good strong
accountability systems and experience with large grants, and so we need
to partner with them through intermediary organizations and I would
urge, as we heard before, intermediary organizations who have the trust
and credibility of faith-based organizations and share their values and
their cultural and religious world views. But together, they can be
very, very effective partners with the government in achieving the
secular objectives of prevention, care, and treatment.

And one of the things that World Vision is doing with -- to involve
people who are living with AIDS is to mobilize support groups for clergy
who are living with AIDS in Africa, and it's a very, very sensitive
subject for them. It's very difficult for them to find the support that
they need because of the stigma surrounding it, and yet they are a
wonderful role model and a very powerful voice for mobilizing other
faith-leaders and their congregations and so World Vision has partnered
with faith-leaders to start a group especially for African religious
leaders that are living and directly affected by HIV/AIDS called
Anorella (ph). And we think that that's going to be a really powerful
force in reducing stigma and helping to mobilize faith-leaders and their
congregations.

Thank you.

MR. MASON: Thank you.

MICHAEL CZERNY: My name is Father Michael Czerny. I am the coordinator
of the African Jesuit AIDS Network, and I thank the Advisory Council for
this opportunity.

In 2002, the Jesuit Conference for Africa, facing the aggravating
crisis, decided to fortify the earlier efforts that we had already been
making and set up this continent-wide network called AJAN, or the
African Jesuit AIDS Network. We're about 1,400 Jesuit priests and
brothers serving in about 27 countries in Africa, and I think the most
significant fact -- the most significant starting point is that we are
all personally deeply affected, and we recognize that HIV/AIDS is not
just a problem out there, it is our problem.

HIV/AIDS is forcing everyone in the church and in society to -- (audio
break, tape change) -- and then to develop appropriate responses. We're
trying to pull these responses together into a African-wide network
which will enhance the response in the individual countries and that
will encourage new forms of accompaniment, care, prevention, resource --
(inaudible) -- this.

HIV/AIDS in Africa cannot be treated only from a medical point of view.
Social ills of poverty and malnutrition, prevalent throughout Africa,
set the stage for opportunistic diseases such as malaria and
tuberculosis to attack people rendered infinitely more vulnerable by
HIV. Anti-retrovirals do little good if HIV positive people lack clean
water or a good diet. Just as telling young people to be careful and
responsible is practically futile when they see absolutely no future for
themselves. In their message on world AIDS day, the bishops of Africa
stated their concern that our already fragile economies should be
further weakened with much of the trained labor force lost to HIV and
AIDS. Poverty, they said, facilitates the transmission of HIV, makes
adequate treatment unaffordable, accelerates death from HIV related
illness, and multiplies the social cost of the epidemic.

The U.S. administration's \$15 billion emergency plan is certainly to be
applauded and it will certainly contribute to arresting the rapid spread
of HIV and AIDS. It is estimated, however, that anti-retrovirals
represent only about 10 percent of the cost of an adequate response to
HIV and AIDS. In other words, for every dollar worth of ARVs, another
nine dollars is needed for basic health, clean water and sanitation,
housing, nourishing food, education, and social services. So I'd like to
urge that the just proportion be maintained. One part American, nine
parts African. One part ARV, nine parts human development. It is
essential that the administration also fund and support these
supplementary nine units even if this stretches America's capacities and
resources.

Finally, America really needs to listen to Africans rather than impose
notions of health and welfare that may be appropriate for this setting,
but remain alien to the African reality.

Thank you very much. (Applause.)

MR. MASON: Thank you. Why don't we take a break now? You'll be first up
when we come back. And just so we're ready when we come back, Matt
Hanley, Catholic Relief Services; Raymond Martin, Christian Connection
for International Health; Rabia Mathai from Catholic Medical Mission
Board; and Reverend Charles Jurogay (ph) from World Hope Ministries. So
we'll take a 10-minute break. Try to stay on schedule. We're a little
behind, but not too bad. We're about -- probably about 20 minutes
behind.

MR. : Yeah. One suggestion: I really crack down on those --

MR. MASON: Okay.

MR. : Really, because you're going to run out of time and --

MR. MASON: Okay.

MR. : And the people who come at the end --

MR. MASON: They're not going to have time.

MR. : Yeah.

MR. MASON: So what I'll do is I'll say we've got to -- (audio break).

MR. MASON: -- and Rabia Mathai from Catholic Medical Mission Board. Are
any of them in the room? And -- okay. I think we --

MR. : Why don't we go ahead -- (off mike).

MR. MASON: Can I ask someone in the back to close the door and that way
we'll keep the conversation in the hall from interrupting us. Okay.
You're next. I'm -- there was a fellow who was here, but we'll take him
when he comes backing the room, so if you want to come on up.

MR. : Even without the full panel, huh?

MR. MASON: Let's see. I think every --

MR. : Be nice for Ted to be here. I believe that would be nice.

MR. MASON: Well, okay. I hear you. If we can get -- I think Josephine is
going to go out and grab our members.

Just, yeah, could you get Ted Green? Because I -- just so that -- I just
want to share that the committee is going to take all of the public
comment -- there's a transcriber -- we will get it transcribed. We're
going to take the transcript of the public comment in addition to the
written comment and try to put it into -- do a summary and try to
capture the themes that we have been hearing and that are a part of your
written testimony and then we will provide that to Ambassador Tobias and
Ambassador Lange and Dr. O'Neill and their team, so just so you know,
you're -- both your oral comments and your written comments will be sort
of gathered together, consolidated in a form, and then passed to
Ambassador Tobias and his team for them to incorporate into their
thinking, so again we want to thank you for doing this and thank you for
your patience.

Yes?

MR. : Okay. Thank you very much.

MR. MASON: Sure.

MR. : Thanks for --

MATT HANLEY: My name is Matt Hanley. I'm a technical advisor with
Catholic Relief Services, which is the official relief and development
agency for the U.S. Conference of Catholic Bishops. We're most pleased
and welcome the increasing recognition on the role that faith-based
organizations play in responding to HIV/AIDS around the world in both
care and prevention. The Catholic Church is the single largest provider
of care to people living with AIDS around the world, and also provides
approximately -- or up to 60 percent of all healthcare in many
sub-Saharan African nations.

The church also has an extensive network of schools, presenting an ideal
infrastructure through which to introduce value based HIV/AIDS
preventive education and life-skills education. The dioceses structure
itself, with its network of parishes, youth groups, and women's groups,
and other community mechanisms, also represents a powerful local
resource that has remained largely untapped and underutilized.

Recently, SECAM, or the Symposium of Episcopal Conferences for Africa
and Madagascar, also called on every African bishop to place HIV/AIDS on
their personal agenda, which will further open up the doors to all the
pastoral, administrative, human and health resources of every dioceses
within Africa. CRS works a lot with the local church, but other
faith-based groups, other community-based groups, ministries of health
and governments, in its response to HIV/AIDS primarily consists of
home-based care, palliative care, orphan support, and prevention.

CRS believes in a holistic response to HIV/AIDS -- believe that's
necessary, especially as there's no panacea at the present time for our
response to HIV/AIDS. And CRS further recognizes the tension and
dilemmas inherent in making difficult decisions regarding the allocation
of limited resources to a crisis of such magnitude. However,
accumulating and well-documented evidence suggests that prevention, and
specifically primary behavior change, needs to be urgently prioritized
even more than it presently is. We're all well aware of the encouraging
examples of successful locally owned and developed prevention campaigns
that have achieved real changes in sexual behavior and subsequent
declines in HIV prevalence.

As a result of Uganda's success, which was eloquently addressed earlier
by Jack, Uganda is faced with treating and caring for approximately 5
percent of its population today as opposed to 20 to 30 percent of its
population if those changes in behavior had not occurred. Outside of
Uganda, there's also evidence. For instance, a rigorous UN AIDS
multi-country study concluded that the only two behavioral determinants
associated with the decline in HIV/AIDS prevalence are a reduction in
the number of sexual partners and a delayed onset of sexual debut --
essentially, our abstinence and fidelity messages. And I think this is a
critical point in our discussions on policy and strategy that you've
graciously invited us to today. In fact, it's -- I just think we all
need to keep that in mind, is where risk-avoidance -- and what I mean by
risk-avoidance is abstaining or being mutually faithful. When those
risk-avoidance behaviors have not occurred, we have not seen declines in
the epidemic even with infusions of resources, counseling, and
sophisticated -- other sophisticated technical interventions, as
important as they are. So that is really a critical piece for all of us
to keep in mind, both short-term and long-term.

There are other implications for that. Many are aware of the new variant
famine in Southern Africa, which is attributed in large part to the
onset of HIV/AIDS. The onset of the famine is attributed to HIV/AIDS,
which has killed many of the laborers themselves, so that just is
another very compelling reason why we really need to prioritize primary
behavior change. So -- and Catholics and other faith-based groups are
well-positioned to continue promoting those risk avoidant -- risk
avoiding types of behavior which are essential to achieving the impact
that we all need to see.

So if we are to use wisely the administration's generous allocation of
resources, and are serious about achieving a maximum possible impact, we
must decrease the overall toll HIV/AIDS exacts on communities and
countries by reducing its persistent transmission.

I would also in closing --

MR. MASON: We're going to have to stick to --

(Cross talk.)

MR. HENLEY: Okay, thank you.

MR. : Please, we have a lot of people here. We don't want to be fair to
those who have yet to testify by using up all of the time, so if you'd
please respect the time constraints.

MR. HENLEY: Thank you very much.

MR. MASON: Thank you.

RAYMOND MARTIN: My name is Ray Martin. I'm the director of Christian
Connections for International Health. CCIH is a membership association
of individuals and 40 organizations promoting international health and
wholeness from a Christian perspective through field-oriented
information sharing, networking, research, and partnership building. Our
network relates to nearly 2,000 organizations and individuals in 100
countries.

I would like to make two points. First, priorities in the implementation
of the president's plan should be determined by public health and social
science evidence of what has worked. CCIH interaction with
church-related people throughout Africa and elsewhere convinces us that
they recognize that defeating AIDS is largely a challenge of changing
behaviors. Even though many political leaders and traditional public
health organizations may be more comfortable with strategies focusing on
medical solutions, we must learn from success stories such as Uganda and
Senegal which emphasized mobilizing faith-based organizations and other
institutions to reduce high-risk sexual behaviors.

As we scale-up to implement whatever we are able to do medically and
financially to treat HIV-infected individuals, let us be careful not to
be distracted from the paramount importance of preventing new
infections. To extinguish or dampen the raging fires of the global AIDS
pandemic, we must aim our fire extinguisher at the base of the flames.
Churches and other religious institutions need to be empowered to
scale-up their capacity to promote delay of sexual debut and reduction
of sexual partners as well as any other effective means of prevention
that they are comfortable with.

My second point has to do with moving from rhetoric to reality in
engaging with faith-based organizations. When you look beyond the
rhetoric, the actual level of resources allocated to faith-based
organizations by major donors is still very small. One example: only 4
percent of Global Fund grants go to FBOs, even though in many countries
a quarter to a half of medical and social services are run by FBOs. This
suggests an inefficiency in deployment of resources that should be
corrected as we move to implementation of the president's Emergency
Plan.

Thank you.

(Applause.)

MR. MASON: Thank you. Why don't we -- come on up: Reverend Jurogay from
World Hope Ministries, Jacob Fein from American Jewish World Service,
Alan Saunders from the Interreligious and International Federation for
World Peace.

RABIA MATHAI: Thank you for this opportunity. I'm Dr. Rabia Mathai
representing the CMMB, the Catholic Medical Mission Board, a faith-based
leader and a catalyst. We call it a best-kept secret engaged in
exclusively in the international healthcare since 1928. My organization
has 75 years of global experience having worked with 350 faith---based
partners in over 100 countries. Our experience spans providing medicines
and medical supplies; building capacities of in-country, front-line,
primary healthcare workers through training programs; and most
importantly, providing long-term and short-term U.S. medical and public
health professionals training in over 100 countries including our
HIV/AIDS programs.

CMMB's two major HIV/AIDS initiatives from which I am going to draw
lessons learned are: Choose to Care, a community-based HIV/AIDS
intervention for prevention, care, and support with Southern African
bishops conference and the Bristol-Myers Squibb Foundation with 144
projects on the ground in its fourth year in five countries: South
Africa, Botswana, Namibia, Lesotho, and Swaziland.

A second initiative is called Born to Live. It's a global initiative for
prevention of mother-to-child transmission for HIV/AIDS in South Africa,
Haiti, Zambia, Nigeria, to name a few, and going to scale in Kenya with
60 faith-based sites.

The lessons learned that I'd like to share with you are: first lesson is
that we have learned that in partnering with umbrella, in-country,
faith-based organizations, it helps and facilitates a lot in rapid
scale-up through the healthcare, parish, and educational networks.
Second lesson is -- that we have learned is that since up to 50 percent
of the healthcare in the focused 14 countries is provided by FBOs, our
catalytic role in building their capacity has helped us in carving a
space for the FBOs on the main table with the government for HIV/AIDS
national policy and strategy issues. Much more help is needed with this
from a group like yours.

Our PMTC sites now have a critical mass of HIV-positive women needing
and ready for chronic ARV treatment. This will contribute towards gender
equity, for strengthening household units at the community level, for
health treatment. In both programs, we have many, many HIV-positive
people, especially women and youth. They have found a new sense of hope
and they have support networks. They are not afraid of revealing their
status and have become community advocates.

Lastly, two important points that we have learned. HIV/AIDS programs
cannot be vertical programs, but have to be integrated into the existing
maternal and child health and other multisectoral programs. Our HIV/AIDS
work in Asia and Pacific, in China, India, and Papua New Guinea informs
us that if we do not begin focusing and addressing that region in these
early stages, it will mimic the current pandemic and -- or even dwarf it
in comparison.

Thank you very much.

MR. MASON: Thank you.

CHARLES JUROGAY: Good afternoon. My name is Reverend Charles Jurogay and
I'm representative on a project called Aid of World Hope Ministries, a
ministry that works with HIV/AIDS orphans down in Kenya and Tanzania.
And the most basic thing that I see the need -- the most pressing need
we have -- is the need for the pastors and other faith-based
organization leaders, because they lack training. So training is one of
the handicaps that we face in combating the HIV/AIDS.

The next thing we truly need is kind of support from other networks in
order to have proper strategies in order to combat the AIDS. And then
the next thing -- I'm sorry, I would like to keep it very briefly just
to pressing needs -- is support. We lack support because we don't have
adequate funding. Support for the orphans.

And the next thing is the training for the caregivers. And as you know,
the caregivers are -- where they come from probably is not so many
people would like to be affiliated with the people who have AIDS, so
technically training is basically needed in order to accept people
living with AIDS among the community they are from because what kills
the most is to be rejected.

Also, the other thing is about the other organization -- the government
and other sectoral organizations -- if we could strengthen to train this
pastors and other social and community leaders in order to deal with the
stigma of AIDS, this will probably reduce the pain and other -- and
actually other affiliated suffering with the disease.

Nutrition is one of the most, most necessary things, but as you know,
once the kids get infected and they don't have proper -- proper feeding,
the treatment will actually do nothing, so without proper nutrition even
if you give -- even if we get the AIDS vaccine right now and we don't
have food, still it won't work. So in accordance with the treatment,
nutrition is also very necessary.

Actually, funding for all these other organizations would be very good
if we get adequate funding with a faith-based organizations because what
it comes to be is that governments try to fund other sectoral
organizations -- secular organizations and -- like me; I'm a project
coordinator of some 20 churches with 500 apiece. If all these people are
now trained and taught about the effects of HIV/AIDS, this will be a
tremendous groove on stopping the AIDS.

And thank you for listening to my needs with the African accent.

MR. MASON: Thank you.

MR. JUROGAY: Truly appreciate it. Thank you.

(Applause.)

MR. MASON: Thank you.

JACOB FEIN: Good afternoon. My name is Jacob Fein. I work for the
American Jewish World Service, which is a not-for-profit organization
founded to help alleviate poverty, hunger, and disease among the peoples
of the world regardless of race, religion, or nationality. Though we
draw our inspiration from Jewish tradition, most of our project partners
work in communities and countries where there are no Jewish communities.

The American Jewish World Service funds the work of our partners, which
are local NGOs and community-based organizations offering a full range
of help to individuals and communities coping with the effects of the
HIV/AIDS pandemic. Our funding and technical support is always driven by
the needs of these communities as they articulate them.

In our experience, the most successful projects link development and
advocacy efforts, demonstrate the ability to manage funding, promote
community leadership and local participation, empower the
disenfranchised, are both replicable and sustainable, and have a high
rate of social return.

This year, the American Jewish World Service supported 47 projects in 21
countries. And particularly, we have worked to develop relationships
with groups that integrate comprehensive community-based prevention,
home-based orphan care, support for people living with HIV and AIDS, and
advocacy -- specifically, efforts to enhance treatment access and
preparedness.

Through our work, we have come to the following conclusions that we hope
will offer some help in developing and implementing the president's
Emergency Plan for AIDS relief. Sustained and multi-year hands-on
support is necessary for success. Community and home-based programs for
orphan care must be prioritized. Orphanages only increase stigma.
Organizations are capable of reporting responsibly on the usage of funds
and the success of programs. Complex reporting requirements for
programmatic and financial oversight only hinder results. There is a
generation of experts in community-based prevention and care programs
and existing pilot programs to offer ARVs. While delegates at the recent
ECASA (ph) conference were talking about how to create home-based
palliative care programs, our project partners were meeting and telling
each other how to sustain and expand the programs they already run.

We will not succeed in turning back the tide of this pandemic without
learning from the lessons of these community leaders through peer
education and I think that's by far the most important point that I
could possibly make is that the expertise is there. We need to make sure
that we share that expertise through peer education and that outside
experts are most useful when they're brought in specifically for their
knowledge of country-wide scale-up, but not for actual implementation on
the ground.

So thank you very much for an opportunity to share our thoughts with
you.

(Applause.)

MR. MASON: Thank you. Alan Saunders from the Interreligous and
International Federation for World Peace, Carl Stecker (ph), Catholic
Charities Relief, Daniel Tolan (ph), Global Health Services Ministries.
Okay, then Troy Lewis (sp), Baptist Mission of Zambia and Laura van
Vuuren, World Relief, both of whom were here. If not, then we'll move on
to -- okay.

DR. DANIEL TOLAN: Dr. Daniel Tolan from Global Health Services.

The AIDS epidemic can be beaten. I've heard some say because of AIDS
that it is too late for Africa, but based on my almost 20 years
experience in Africa as a missionary doctor, I want to state
unequivocally that this epidemic -- this scourge -- can be beaten. The
question is how.

The AIDS epidemic can be beaten by the right people. A Masai man, an
educated man, a research assistant, a man with AIDS and overwhelming TB,
I invited him to speak about living with AIDS to a hospital chaplain
training program -- to 12 students from East and Southern Africa. He was
scheduled for two hours. He left after three days of incredible impact
in those students' lives. The best people to teach are those already
infected.

The AIDS epidemic can be beaten by the right message. It is not a matter
of information or encouraging certain behaviors, it is a matter of
changing world views and beliefs which decide behavior. I will never
forget an old Masai man telling me the men -- the way we men have valued
our women is the problem. That is why we have forced them to have sex
with people in our own age group, and if we change how we see women --
how we see women, we will begin to treat them differently.

The AIDS epidemic can be beaten by the right partnership and the right
leadership. Today I represent 14,000 members of the Christian Medical
and Dental Associations. Five hundred of our member physicians and
nurses are giving their lives to a career in another culture outside the
U.S. -- outside the U.S.A. I also speak for thousands of international
members, especially in Africa, who are caring in their own culture.
These people are experienced in dealing with issues of worldview and
belief systems. They know the language and the culture, and they realize
that the agenda must be set by the community people themselves if we are
going to beat this disease. These physicians and others have the
influence that only long-term presence within a community can bring.

I've heard Dr. O'Neill speak about the importance of the church and
mosque in Africa in this disease, and the leadership that the church
must take. It is these physicians and healthcare workers who are often
looked to by the church for leadership in issues like AIDS. We must
bridge to this community of medical leaders and national churches to
give them the best chance to beat this disease.

The right people, the right message, the right partnerships. The AIDS
epidemic can be beaten. A young Masai boy died in my arms of
overwhelming infection from a simple wound by a stick. 1984, a mission
hospital, 300 inpatients, one surgeon, one physician, and myself -- a
scared fourth-year medical student. I held his lifeless body in my arms
and I cried. I gave mouth to mouth resuscitation. In retrospect, the
clinical picture likely was AIDS. The boy's face has never left my mind.
When I feel like quitting in the fight -- and I have felt that -- I see
his face. We have an opportunity to help breathe life into the suffering
of Africa and elsewhere. Let's breathe, work, partner, and hope
together.

I know -- just as a note of thank you from the children of Africa, I
know that President Bush has taken a strong stance that can only be
supported by those close to him, and I'm sure Mrs. Bush is standing
solidly with him in this, and as a thank you to President Bush, to
Ambassador Tobias, Dr. Joe O'Neill, Mr. Abner Mason, comes this thank
you from the children of Africa: a Masia shuka (ph), a blanket work by
the warriors of Africa. Wrap up in it at Camp David, take it to a
picnic, to -- in a car to ballgames, but always fight like a warrior.

Thank you.

(Applause.)

MR. MASON: I thank you very much. That's very kind. Thank you.

MR. : By the way, Mrs. Bush gets first dibs.

MR. MASON: Thank you. (Laughter.) Thank you.

TROY LEWIS: Good afternoon. My name is Troy Lewis. I'm with the Baptist
Mission of Zambia and we live and work in Zambia dealing with this
HIV/AIDS problem and I serve in that capacity there as program developer
for that group.

We also work side-by-side with a number of other African brothers and
sisters bringing together as far as other faiths and other
denominations, particularly the expanded church response in Zambia,
which I serve as an officer for, where we work bringing umbrella bodies
together of Christians of all denominations and forging a Christian -- a
united Christian response to HIV/AIDS and the PACANET -- the pan-African
Christian AIDS Network, which I serve on as well doing the same thing at
a continental level.

In addition to trying to work at a systems level dealing with these
issues, I'm doing work -- doing much work -- or we're doing much work on
the ground. And part of my hope here and in these few points that I want
to share is to try to be a voice for those that are in the rural areas
and the villages that don't have a voice and aren't here today. And some
of this echoes some of what has been shared already.

In representing faith-based, I also want to thank you for the
acknowledgement that this administration and that we're seeing from the
UN and others with regards to recognizing faith-based organizations
which are in every village, in every urban compound. And right now, with
these efforts and with this help we're creating synergy bringing
together the faith-based, working with other sectors and institutions.

The four points I just want to touch on briefly as far as about them, I
hope that these resources can be used for -- in fact I believe that it
is imperative. One is, in Africa, there some of the infrastructures that
we take for granted here in the U.S. do not exist, and one of the things
that happens repeatedly is that initiatives and (helps ?) they come and
they reach the city capitals, but they fail to make it out to the rural
areas and the villages. And so if we think about it as that -- we think
about Africa has some major arteries, what is needed is that money needs
to be dedicated towards building capillaries to get the resources -- to
get the resources, knowledge, and monies out to those areas, out to
those villages. And faith-based institutions form a connect -- form a --
places a presence to be able to form this connectivity from the capitals
down to every rural area and village.

The other, we need to be careful in strategic and the use of these
monies. And for example, what I mean about how is it that we do staffing
strategically, but not to some of the extremes that I've seen. Working
in Zambia with the Global Fund and the World Bank, for example, they
said that these monies cannot be used for staff. Well, some of the
things that we're trying to do in Africa has not existed before,
particularly some of these connectivity issues and if we need quality
people working in some of these areas, we're going to have to pay them
and some monies have to be devoted strategically to staffing.

But on the other hand, we have to be careful about setting dangerous
precedents. For example, where an NGO comes in and doing a
community-based school and they end up paying all their staff people.
Well, we have churches and others doing these -- that have been doing
these for years, but in terms of with volunteers. Well, this NGO can
serve this one particular area, but what happens that it sets a
precedent for those that are working with volunteers and it destroys 500
other initiatives for this one that is started.

The third one is about representation, as was shared before, about
listening to the voices that are on the ground and just as we have
representation from persons living with HIV/AIDS and representation for
women, it's imperative -- particularly I wanted to encourage the
Presidential Advisory Council that we have the voice of people from
Africa. Not just those that can afford their own plane fare over here,
but those that are from the rural areas and working in the villages. And
also representing -- a need for representing these voices that I think
is underrepresented is that there are -- is that while everyone --
people are talking about advocates for ARVs, they're an incredible need
and what I'm seeing people dying from are opportunistic infections.

I just have this one picture here of the lady that we're working with,
Mrs. Peery (ph). And what happened to her -- one of the sadder cases I
went to going to her home and she's laying there on a pallet in the
corner as we so often see -- in the corner of her little hut in her
little home. And what happens is that she\'s only been able to lay in
two positions because she has bedsores all over her body, and what they
were saying is that -- and what happened whole churches want to get
involved in doing home-based care, but they don't even have antiseptic.
They don't have pain medicines. They don't have anything to be able to
give this lady here. And so, yes, while we pay attention to ARVs, if we
can do something to help people to survive from opportunistic infection
to opportunistic infection until the ARVs reach those communities.

Thank you very much.

(Applause.)

MR. MASON: Thank you.

LAURA VAN VUUREN: Hello. My name's Laura van Vuuren and I serve on World
Relief's HIV/AIDS technical team. I'm really the only member that's not
living at the epicenter -- in sub-Saharan Africa at the epicenter of the
pandemic.

World Relief first addressed AIDS in 1992 in Swaziland and Malawi where
I was actually a country director, and it was prompted by just a
chilling awareness that something both colossal and terrible was
happening in these communities where we were working to alleviate
poverty, empower women, and help children live beyond their fifth
birthday. We've continued since then with very limited resources and we,
though, are thankful for that because it's made us more resourceful and
more careful about what will make a difference, but we do rejoice at
this new allocation and -- but at the same time we worry that if we
don't leave our egos and self-interests at the door, we could focus on
trying to make a big impression and doing things too fast at the expense
of these very carefully planned and implemented programs when resources
were very scarce.

We -- regarding partnerships -- you asked us to speak about that -- we
partner with the church and we've learned that to construct a solid
community-based program takes time. For it to be sustainable we have to
listen, we have to ask questions, we have to work with local leadership
and respect them before we set any strategy or proceed with the plan. I
think a key challenge for us is that we have to channel support to the
community-level players who are already responding to HIV/AIDS with
their own resources.

World Relief has worked steadily to equip and build local congregations
to plan and implement and monitor their own programs. Our goal is really
to fuel a grassroots movement that gains momentum over time and will
continue long after we're gone. Effective partnerships are based really
on mutual respect and building on natural competencies and allowing each
player to do what it does best. For example, we accept that ARVT is
necessary to prevent parent-to-child transmission of AIDS, but for the
treatment to reach its full potential we need to build -- to be holistic
about out approach. And -- oh dear. And we have to break down stigma and
fear and create an enabling environment, and the church does that very
well. So we don't teach them to give verapine (ph); we teach them to
counsel and break down stigma and fear.

I'd like to also talk about program integration and multisectoral
collaboration. From the start, World Relief has tried to integrate both
prevention, care, and counseling, and economic strengthening with the
common foundation of family, church, and community. But we've also
worked hard to integrate AIDS into our micro-enterprise development
program, into our maternal child health program, and our youth programs
because we feel we'll have greater impact and more efficient use of our
resources.

We've also tried to encourage collaboration within our sectors. I'm very
privileged to be the facilitator of a working group on HIV/AIDS for the
micro-enterprise development practitioner peer learning group, and one
of our projects right now is to come up with some alternatives for the
groups that HIV/AIDS NGOs are struggling with -- to have some safe and
sound practices that they can use, so we are encouraging this
cross-sectoral dialogue as well.

Thank you very much.

MR. MASON: Thank you. We're going to move to the next group. Jennifer
Cooke from CSIS, Cynthia Davis from Charles Drew University of Medicine,
Andy Fisher, Population Council, and Gus Gill from Charles Drew
University. You folks could come up.

JENNIFER COOKE: Hi. I'm Jennifer Cooke. I'm dreading that orange sign.
(Laughter.) I'm Jennifer Cooke with the CSIS Africa program, the Africa
program of the Center for Strategic and International Studies. I work
with Steve Morrison who directs the CSIS task force on HIV/AIDS, an
initiative that's bipartisan, chaired by Bill Frist and Senator Russ
Feingold and funded by the Gates Foundation. We're very grateful to Dr.
Sullivan for his frequent input and leadership as a member of the task
force.

The task force also brings to Washington front-line leaders in the fight
against HIV/AIDS to ensure that their perspectives are incorporated into
U.S. policy thinking. Last month, we held a conference on Botswana and
Botswana's strategy to fight HIV/AIDS. President Festus Mogae led a
senior delegation of nongovernmental and governmental experts. The
purpose of the conference was to profile for a U.S. audience Botswana's
achievements in fighting HIV/AIDS, the enduring challenges that it
faces, and how these might inform U.S. policy efforts, particularly the
president's initiative.

Botswana's experience with HIV/AIDS is a conundrum, and I think for that
reason it's a fascinating case study. It enjoys democratic governance, a
well run economy, very strong leadership on HIV/AIDS, but what the
conference highlighted for us was that despite these factors, the
enduring challenges of gender, stigma, and human capacity persist.

The Botswana case highlights that if women are not empowered legally,
culturally, economically -- there's the sign -- to negotiate the terms
of sex, prevention efforts will fail. Similarly, if messages of
abstinence, condom use, and fidelity do not reach men, prevention
efforts will fail. And finally, if appropriately trained personnel, from
doctors to community leaders to community care providers, are not
available, it will be difficult to bring to scale any programs no matter
how well designed.

Despite these challenges, Botswana has taken bold steps through a number
of public-private partnerships to fight the disease. Among these, the
ACHAP, a partnership with Merck company, Gates Foundation, that's
strengthening capacity institutionally and at the grassroots supporting
an effort to provide anti-retrovirals through the public sector.

A number of other promising partnerships that are really building
enduring capacity and I think importantly are helping encourage
additional new partnerships within Botswana and across the region.
Botswana may not be -- the model may not be replicable in all its
details elsewhere in Africa, but I think this idea of building on
comparative strengths of the corporate, the public sector, and most
importantly harnessing the energies of the people most affected is
something that can be replicated elsewhere in Africa and worldwide.

Thank you.

MR. MASON: Thank you.

CYNTHIA DAVIS: Good afternoon. My name is Cynthia Davis and I'm an
assistant professor in the department of family medicine at Charles Drew
University of Medicine and Science. I have developed health education
and prevention programs for the last 20 years on a local and national
level targeting high-risk populations, but since 1995 I have been
directly involved in several international projects focusing on advocacy
and the provision of direct services targeting at-risk populations in
sub-Saharan Africa.

In 2000, after attending the international AIDS conference in Durban,
South Africa, I decided to try to visit as many sub-Saharan African
countries on my way home to learn directly from people who are working
in the field what their experiences were. I traveled throughout South
Africa, Zimbabwe, Uganda, Nigeria, and Senegal and some of the lessons
learned -- that I learned from people who were doing the work at the
grassroots level included the implementation of broad-based community
mobilization efforts including all sectors of the public and private
sectors; involvement of persons living with HIV and AIDS and are
impacted by HIV and AIDS in all aspects of planning, implementation, and
evaluation of proposed projects; the enhancement of educational support
and mentoring programs whose goals are to empower women so as to improve
the standard of living for girls and women who are being severely
impacted by the pandemic due to their low socio-economic status as well
as cultural practices which discriminate against women; transparency at
all levels of program planning, implementation, and evaluation;
protection of human subjects when research projects are being developed
and implemented; and the development of social marketing campaigns that
speak to the needs of people and the realities of their lives whereby
messages are not sugar-coated but reflect the stark realities of
HIV/AIDS' impact on families, communities, and societies at large.

The vital aspects of effective partnerships that were shared with me
include: ongoing, open communication whereby there is a level playing
field and all parties share equally in decision-making and
problem-solving; involvement of trained professionals and laypersons who
have a passion for their work, have experience in working with the
populations targeted for intervention, who are respected and trusted by
the community, and are knowledgeable of the cultural norms, beliefs, and
attitudes of the individuals and communities being targeted for
interventions; and most importantly, strategic planning that clearly
delineates a development of financial mechanisms to sustain the
collaborative in order to ensure its long-term viability.

Since I have less than a minute, again I want to thank you for giving me
the opportunity to come and share with you some of my -- the work that
I've done on an individual basis. Thank you.

(Applause.)

MR. MASON: Thank you. Dr. Kathleen Kurtz with the International Center
for Research on Women, and Cherreka Montgomery from the same
institution, and Charles Dugu (sp) from the McCormack Graduate School of
Policy Studies.

JOHANNES VAN DAM: Good afternoon. My name is Johannes van Dam. I am
deputy director of the Horizons program of the Population Council. I'm
speaking on behalf of Dr. Andrew Fisher.

Thank you for the opportunity to comment on the president's Emergency
Plan for AIDS Relief. In the next few minutes I will make a case for
allocating a relatively small percentage of the total budget available
to operations research as an essential programmatic activity to ensure
that money spent is indeed well spent.

The history of HIV/AIDS programs resembles that of many other public
health and development programs. Large numbers of successful pilot
programs offer promise, but few examples of large-scale, nationwide
implementation deliver on that promise. Attempts to implement what we
know to be successful in one location often fail when those programs are
introduced in other cultural settings or in settings with a different
resource-base.

Operations research offers the means to turn this around. It does this
by diagnosing and evaluating the potential and problems of programs and
interventions and by comparing one service delivery option with another
in terms of impact, cost effectiveness, quality, and client
acceptability.

Let me give you just two examples of how applied operations research has
made a difference in program planning and implementation. In the United
States, mother-to-child transmission is almost nonexistent, but every
day in the developing world 2,000 babies and newborn infants are
infected with HIV. Short course Anti-retroviral therapy is now available
in many developing countries to help prevent mother-to-child
transmission, but where such programs exist, few women have taken
advantage of them. Operations research conducted in Zambia and Kenya
documented acceptability, operational barriers, cost, and the impact of
pilot MTCT programs. Materials developed for operations research were
adopted in the scale-up process in those countries and include needs
assessment materials and training curriculum.

Second, the HIV.AIDS epidemic is leaving in its wake a huge number of
orphans, overwhelming existing support systems. Operations research was
used to test and develop an approach to improve the chances of
successful survival and social integration of orphans in Uganda. The
program involves families early, before parents die, in planning for
their children's future. Because of operations research, will writing,
memory books, succession planning, and identification of guardians now
are accepted as a best practice in many programs.

We encourage the president's Emergency Plan for AIDS Relief to allocate
funds under the plan for operations research to ensure that United
States leadership in the campaign against HIV/AIDS results in optimal
use of available resources, and we modestly suggest that of the funds
allocated to programs, 2 to 3 percent be allocated specifically to
operations research.

Thank you.

MR. MASON: Thank you.

CHERREKA MONTGOMERY: Hi. Good afternoon. My name is Cherreka Montgomery
and I'm the policy advocate with the International Center for Research
on Women. ICRW, or the International Center for Research on Women, was
founded in 1976 to really conduct research on women's economic and
health status, particularly in developing countries.

I would like to share with you today some of our important research that
we've conducted regarding cross-generational sex and its impact in
increasing adolescent girls' vulnerability to HIV infection in
sub-Saharan Africa.

What is cross-generational sex? We define it as when an adult man has a
sexual relationship with a female partner age 15 to 19, and this
relationship leaves the young women powerless to negotiate safer sex.
And we find that this is a large contributor to the spread of HIV/AIDS
in sub-Saharan Africa. For example, among girls age 15 to 19 in Uganda,
the risk of HIV infection doubles for those with male partners 10 or
more years older. And in Zimbabwe the risk increases for each age of --
for each year of age difference. So what we know is that as the age
difference increases, the power imbalance also increases, making girls
more vulnerable to HIV infection.

Why should we care about this? Well, the UN estimates that adolescent
girls have the fastest growing rate of HIV infection. We know that girls
are up to six times more likely to be infected with HIV/AIDS than boys.

What's driving this phenomenon of cross-generational sex in sub-Saharan
Africa? We know that, for example, in sub-Saharan Africa many older men
seek relationships -- these sexual relationships for pleasure and that
because they have this perceived notion that sex with young girls
enhances their prestige and that such girls are free of HIV infection.
On the other hand, adolescent girls' sexual behavior is motivated mainly
by the desire for gifts or for money to increase their social status.
Both older men and girls accept this as a social norm.

So we also find that marriage does not protect against HIV transmission,
particularly for girls and young women. Our research shows that many
married men engage in sexual relations with multiple partners. Sometimes
they are already infected with HIV when they enter marriage. The other
key point is that power imbalances play a particularly strong role in
increasing the infection among young women. The threat of violence and
coercion within these sexual relationships further increases girls'
vulnerability to HIV infection. We have studies that show that men tend
to control the conditions of sexual intercourse, including condom and
contraceptive use and the use of violence. And that we know that without
condoms for protection during sexual intercourse, girls who have sex
with these older men are at extremely high risk of HIV infection.
Lacking adequate and accurate reproductive health information, many
girls do not even perceive that they are at risk of HIV infection,
making them even less prone to protect themselves in sexual
relationships with older men.

Quickly, I want to just leave you some points, but we do want to be
engaged in further dialogue with you and Ambassador Tobias, and I'll sum
them up as this: we need to create an enabling environment by working
with youth, parents, and teachers, and traditional authorities, and
other key stakeholders to make young people smart about the reproductive
health decisions and avoid sexual -- risky sexual behavior including
cross-generational sex. We need to develop comprehensive education
programs that teach women and girls, and information and skills about
HIV infection, including reproductive health.

The other thing I want to mention is we've got to create peer networks
to support and encourage safe sexual behavior, but I also want to leave
you that men must be equally involved and that we've got to support
efforts and encourage men to be more responsible in their sexual
behavior including being faithful and also using condoms.

Thank you.

(Applause.)

MR. MASON: Thank you. We're going to try to -- we're running behind
about 20 minutes. We've got to stick to the three-minute -- okay.

GUS GILL: My name is Gus Gill. I'm from Drew University of Medicine and
Science and I'm head of our international health institute. I didn't
plan to talk today; I just came here to learn and I've learned a lot.
I'm speaking on behalf of Dr. Eric Bing, who just got in from Angola
last night so he wasn't able to make it today, and you'll receive his
written statement later.

We have a unique program that was funded by the Department of Defense,
and this program was to train the military in Angola about HIV
prevention and as a consequence of that we have the soldiers putting
down their weapons and fighting another kind of war in the local
communities.

Dr. Bing and members of our faculty have learned Portuguese as a sign of
respect for the country that they are dealing in. We've brought Angolans
here and they've taken courses at UC San Diego and UCLA as well as Drew.

My personal feelings are God has given America everything. We have
everything. It's much more important rather than just being mighty, we
can be great. And being great means you've been given a lot, it's our
responsibility to give a lot. And I wanted to tell Dr. Louis Sullivan --
because I want to personally thank President Bush for putting emphasis
on this dredge to humanity.

Our program was on on PBS, or one of those channels. I'm getting senile
now in my old age. But he had Bill Frist -- whatever his name is --
speak on that program about what we're doing in Angola. We have programs
throughout the world, but that's just one.

Thank you.

MR. MASON: Thank you.

I'm Audrey O'Donnell (sp), McCormack Graduate School of Policy Studies,
University of Massachusetts, Boston. We are a land-grant university. We
have a mandate to work in the community.

I'm going to talk about a mechanism that we have developed to deliver
services and programs to individuals in the rural areas of Africa. The
McCormack Graduate School in Mass, Boston, and its African partners have
established university-based community resource centers, or CRCs, in
Senegal and Kenya by building the infrastructure to combine ICT access
and delivery of health services in programs with more traditional,
local, economic and social development mechanisms.

In the 48 countries of sub-Saharan Africa, there are approximately 131
universities. Kenya has five public universities with about 16 campuses.
Senegal has two. All are underutilized and undervalued as agents for
development. University-based community resource centers have great
potential for development and delivery of health services because the
universities are able to provide good organizational and operational
support and they are a link to learning opportunities, a bridge to the
community, and have a revenue basis.

Accessing technology for the CRCs has been central to the development
and sustainability of our initiatives in Africa. This could not have
been accomplished without the CRCs receiving their IT access from the
university whether it be through a landline or wireless. Even as our CRC
in Senegal was under construction, impact was already being felt. The
proximity of our site in rural northern Senegal a short distance from
the Mauritanian border to national and international traffic reaped a
good deal of attention from other regional initiatives including NGOs
and donor agencies seeking to link up with our CRC to combine services
and programs and to develop a databank, or indeed to replicate it
elsewhere.

Before McCormack's project began at Egerton University in Kenya there
was no organized plan to work with the community, usually ad hoc without
any sustainability. Since our partnership began a little more than 14
months ago, and a framework was developed for Egerton to work with the
community surrounding the university, community tensions and conflicts
that existed between the university and the community have subsided. The
(varsity ?) management and the community leaders have seized the
opportunity to promote and enhance a university community nexus. The
university management sees it as an opportunity to not only educate the
community, but to address their most challenging problems together,
including HIV/AIDS and drug abuse issues in the rural Nekora (ph)
region.

There are about 340,000 inhabitants and 20,000 out-of-school and at-risk
youth in that community surrounding Egerton University. The tools,
infrastructure, and technology for the empowerment of the rural poor in
the LDC's are possible. The challenge, however, continues.

MR. MASON: Thank you. And Peg Willingham, from the International AIDS
Vaccine Initiative, and Lea Acord from Marquette.

CHARLES DUMO: Good afternoon. My name is Charles Dumo, and I'm a Kenyan
Ph.D. student at U. Mass, Boston, and I'm also their program director
for Kenyan programs at the John W. McCormack Graduate School of Policy
Studies. The McCormack school at the U. Mass, Boston, in alliance with
the office of the Kenya's first lady and Egerton University in Kenya has
developed a university-based, community resource center, or what I'm
calling a CRC, initiative that's addressing in a comprehensive and
multifaceted manner the high levels of HIV/AIDS in communities
surrounding the university in Akuru (ph), western Kenya.

CRCs enable the partners to address HIV/AIDS through a diverse array of
programs that are aimed at prevention and mitigation of the disease. For
the infected, programs include peer mentoring and counseling on behavior
change, and for the infected programs include provision of ARVs through
the Kenyan government-monitored VZT (ph) centers; guidance and
counseling attention to orphans, which is a much overlooked segment of
our Kenyan population; and provision of nutritional supplements and
other income generating projects.

Because a diverse array of programs are housed in the CRCs, including
the government-monitored VZT centers, the stigma of those who visit
testing centers is reduced. An individual could be visiting other
programs in the CRC and not necessarily the HIV testing.

Eighty percent of Kenya's population lives in the rural areas. Most
health services and programs do not reach them. Using CRCs based at or
near universities, most of which are located in the interior of the
country, enables services and program to reach these populations. It is
also possible to tailor the programs to a specific community, reflecting
its language, circumstances, and culture.

Egerton University has donated land where the CRC is housed and provides
experts to work at the CRC in services such as IT access. With these
resources emanating from the university and its income-generating
activities, the CRC is able to sustain itself.

In conclusion, university-based community resource centers have distinct
advantages whereby they are able to comprehensively mitigate and prevent
the spread of HIV/AIDS. Kenya's -- our Kenyan president has also asked
for the Egerton project to be used as a prototype for a countrywide
initiative.

I'd like to thank you and thank the president and everybody who is
working on HIV/AIDS. Thank you.

MR. MASON: Thank you. Why don't we also -- Konji Sebati from Pfizer,
William Shild (ph) from Pfizer, Rolf Campbell from Land o' Lakes, and
William Courtney from Computer Sciences Corp get ready.

PEG WILLINGHAM: Thank you. Ladies and gentlemen, I appreciate this
opportunity to discuss today what is needed to accelerate finding a
vaccine to prevent HIV and AIDS. My name is Peg Willingham and I'm here
today to represent the International AIDS Vaccine Initiative -- IAVI. My
written testimony tells you who we are and what we do, but today I'd
like to focus on what we hope you will do.

The president's Emergency Plan for AIDS Relief is an unprecedented step
in the expansion of prevention and access to treatment and care for
AIDS. As the administration moves forward to implement your strategic
plan, we hope you will also incorporate actions necessary to accelerate
the search for a vaccine to prevent AIDS. That will be the true endgame
in the struggle to eradicate AIDS.

With new HIV infections occurring at a rate of five million per year, an
AIDS vaccine is more urgently needed than ever. A vaccine that shields
people from HIV infection before it strikes, complemented by education
and treatment, is our best hope to end this terrible epidemic. An AIDS
vaccine is within reach, but only if the world mobilizes a concerted
effort to push promising candidates from the lab into clinical trials
and takes the necessary steps to ensure global access to a vaccine once
it becomes available.

The United States is leading the world in providing treatment to people
who desperately need it. We hope the United States will also now make
finding an AIDS vaccine a top priority and commit to significantly
increasing funding for AIDS vaccine research as well as overall AIDS
research in general.

The U.S. government has provided an array of incentives to marshal the
biotech and pharmaceutical companies' expertise to meet the threat of
bioterror. Certainly none of us wants to get anthrax or smallpox,
especially those of us living in Washington, DC -- we worry about that.
But similar incentives are needed to encourage research and industry
involvement for an AISD vaccine and other preventive technologies like
microbicides.

The United States should also commit to ensuring that an AIDS vaccine is
available globally by creating legally binding precommitments or
contracts to purchase an AISD vaccine for international use. Important
synergies can also be found between PEPFAR programs and AIDS vaccines
clinical trials. Communities who are participating in research that has
a potential to benefit the entire world should get first in line and
receive priority in the provision of comprehensive AIDS services,
including anti-retroviral therapy.

The administration should include scale-up of AIDS services associated
with clinical trials as an objective of your strategic plan. The plan
should also lay the groundwork for eventual delivery of vaccines through
existing PEPFAR programs and channels, and the U.S. should also seek
coordination between AIDS vaccine trials and the Global Fund.

The United States has the power to achieve the greatest hope of our
time: a world without AIDS. We look forward to working with you and the
other groups represented here to achieve that vision. Thank you.

MR. MASON: Thank you.

LEA ACORD: Good afternoon. My name is Lea Acord, and I am dean of the
College of Nursing at Marquette University in Milwaukee, Wisconsin.
Thank you for this opportunity.

In September, 2002, two nurse faculty members, one, Karen -- (audio
break, tape change) -- we'd like to share with you.

The global nursing shortage is affecting the healthcare infrastructure
in Africa. There are not enough well-educated nurses to serve the
populations in Africa, especially in light of this very serious
epidemic. Secondly, there is a perception that the nurses in Africa are
leaving for jobs in other countries. Unfortunately, the way the African
countries seem to be addressing these issues is to lower the standards
for nursing education. For example, Zambia plans to increase the number
of, quote, "enrolled nurses." These are nurses educated in six to 12
months post-secondary school.

Nigeria is in the process of reducing their nursing education standards,
believing that doing so will mean that their nurses are less likely to
be recruited to other countries. These solutions are unconscionable
given the complexities of the healthcare systems, the gravity of the
healthcare issue Africa faces, and the dependence on nurses as frontline
caregivers. In fact, a recent large-scale study in the United States
confirmed the need for better, not less, educated nurses. Furthermore,
educating nurses at a lower level has major implications for the nurses
themselves. With little training and no protection from injury, nurses
increase their own risk of infection on the job, and death if untreated
after occupational exposure.

In Kenya, two to three nurses are dying of AIDS monthly according to
Elizabeth Oyer (ph) from the Ministry of Health. This statistic could be
turned around if nurses were well-educated and knew how to better
protect themselves and others and had the resources to do so.

Let me conclude by telling you that Jesuit -- that Marquette as a Jesuit
institution is committed to service and supports the college of nursing
in our efforts to enhance the quality of healthcare to persons with HIV
and AIDS, and we're working with other Jesuit institutions. We would
also like to take advantage of government opportunities, but we're often
finding that the timeline is very short to respond to your RFAs, and if
you want comprehensive responses we respectfully request that the format
be less cumbersome and the timeline be longer.

Thank you.

MR. MASON: Thank you.

ROLF CAMPBELL: Good afternoon. I'm Rolf Campbell. I'm with Land O' Lakes
International Development.

Good nutrition is an essential treatment for people with HIV/AIDS.
There's a proven role for nutrition in effective drug therapy and
palliative care for people with HIV/AIDS. In the successful care and the
growth of orphans, nutrition holds a central position. During each phase
of HIV/AIDS there are stresses on the body that have crucial
implications for the quality of nutrition needed and the body's capacity
to ingest, absorb, and utilize nutrients effectively. As HIV infection
progresses into AIDS disease, hypermetabolic responses, malabsorption of
nutrients in the gut, diarrhea, and anorexia all contribute to severe
challenges to intake and maintenance of adequate nutrition, protein,
energy, and micronutrients.

Quoting Mr. Paul Harvey from his 2003 HIV/AIDS literature review: "In
the early stages of HIV infection, adequate nutrition can help to slow
the progression to AIDS, and diets rich in protein, energy, and
micronutrients are likely to help build immune resistance to
opportunistic infections." This has led to calls for food relief rations
to be revised to reflect the needs of people living with HIV/AIDS. Good
nutrition can change their life, reduces the cost of medical care,
reduces complications and hospitalizations, shortens the duration of
hospital stays, improves effectiveness and tolerance to medications and
treatments, increases productivity and independence, and increases the
ability to remain at home.

Quoting Dr. Heinrich Friess (sp) of the United Nations Subcommittee on
Nutrition: "The potential for micronutrient deficiencies to act as
co-factors in HIV transmission and progression is most obvious in poor
populations with adequate dietary -- inadequate dietary intake and high
infectious disease burden."

There are four factors showing how good nutrition must be considered an
essential treatment for people in Africa with HIV/AIDS. One, good
nutrition is essential to meet physiological needs of people with H --
with AIDS disease, including their hunger and metabolic responses to
drug therapies. Two, the nutrition status of a large percentage of
HIV-positive Africans including orphans, African children, is already
depleted. They are not starting off well and if they're fortunate enough
to receive diagnosis and formal medical care, they're starting at a
position where they're already depleted. Their nutrition intake is
inadequate. Number three, access to nutritionally dense affordable
supplemental foods is crucial to maintaining health. An essential input
to drug treatments for effective recovery from debilitating HIV/AIDS
conditions. And lastly, private African and U.S. food industry, in
alliance with NGOs and institutions, are in a position to deliver
nutritionally dense foods to people with HIV/AIDS disease and to
orphans. And I've included three concrete examples in my written remarks
of Kenyan -- or, not of Kenyan -- of African businesses engaged in
exactly that.

Thank you.

MR. MASON: Thank you. As Konji's coming up, can we have Renee Fiorentino
from Synergy Project, Gary Hinnenger (ph) from Becton Dickinson, and
David Oxley from OraSure get ready.

KONJI SEBATI: Thank you. Good afternoon. I'm Konji Sebati, Pfizer's
medical director for global HIV/AIDS philanthropic programs. I will talk
about our flagship program, the Diflukan Partnership Program, which is a
donational diflucan and antifungal medicine for the treatment of
AIDS-associated opportunistic infections. The medicine is donated free
of charge with no limit to cost and time to all developing countries
with a prevalence rate of 1 percent and above.

The program also provides training for healthcare workers on the
treatment of opportunistic infections. It is now operational in 21
countries and we have learned a lot of lessons. The ones that stand out
and have continued to inform us as we expand the program worldwide are
the following. For a successful program, it is important that the
beneficiaries be governments, people living with AIDS, nongovernmental
organizations, or CBOs. They should have shared decision-making, shared
responsibilities as well as accountability. It is not for the donor to
dictate what needs to be done and how it will be done.

Second, it is important to understand the local context, beliefs, and
just how things are done in a country. Even though some may look and
feel odd to Westerners, it is important to understand how people do
things. Ensure that programs are integrated in already existing and
successful programs. Identify what works well in the country, what has
been working well, improve on those that are not working well, and adapt
-- do not reinvent the wheel.

Building capacity is absolutely important and transferring skills is
imperative. The days of signing checks or sending a cargo load of
medicines or sending Western experts for short periods of time are over.
It is important to build local capacity, improve infrastructure, and
ensure sustainability. All these lessons learned, if addressed early and
appropriately, make for good partnerships.

Thank you.

(Applause.)

MR. MASON: Thank you.

MICHAEL SHELL: Good afternoon, Mr. Chairman, Mr. Ambassador, ladies, and
gentlemen. I am Michael Shell, not from Pfizer, but a professor of
medicine from the University of Virginia and the immediate past
president of the Infectious Diseases Society of America, or IDSA. Today
I represent the Academic Alliance for AIDS Care and Prevention in Africa
as one of its founding members.

The Academic Alliance is a unique private-public partnership between
prominent academicians from North America and Africa; the pharmaceutical
industry; the IDSA; the AIDS Support Organization ORTASA (ph), the
largest NGO in Africa; and many other partners which we have listed in
our written testimony. That was launched in June 2001.

Our core mission is very direct: to enhance the care and prevention of
HIV and AIDS in Africa through training and research. You have before
you our written testimony which lists the founding members of the
Academic Alliance as well as some of our initiatives and accomplishments
to date. Within the timeframe available, I'd like to highlight only two
of these: clinical care and capacity-building.

Malago (ph) hospital is a national hospital of Uganda and a major
teaching facility of the Makerere University Faculty of Medicine. When
the Academic Alliance was formed, the AIDS clinic was operational only
one day per week. We have now renovated space and have expanded the
clinic to five days per week with more than 500 patient visits per week
and now care for a cohort of over 3,000 HIV-infected patients.
Currently, over 600 of these receive anti-retroviral therapy.

A major new initiative, the Infectious Disease Institute of the Academic
Alliance is under construction. This facility, comprising approximately
25,000 square feet, will open in March of next year. It is the first
large-scale facility to be constructed on the grounds of Makarere
University in over 30 years. The clinical facility resources are listed
in our written testimony, but this facility also will house the finest
state of the art laboratory and training center in sub-Saharan Africa.
The IDI will support care of at least 10,000 patients annually with
HIV/AIDS, and with support as many as 7,500 could be on the
anti-retroviral therapy by the end of 2005 if resources for drugs and
laboratory tests become available. In addition, infrastructure and the
delivery of excellent care and prevention services, building capacity
for the future is vital to combating the AIDS epidemic in sub-Saharan
Africa.

We have developed a curriculum for the education of African physicians
in the state of the art HIV/AIDS care. Selection committees for trainees
as well as trainers are multinational and there are more than 20 to 25
applicants for every position that can be filled.

The AIDS training program is facilitated by trainers selected by the
membership of the IDSA, but 50 percent or more of the training is
already done by Ugandan physicians. The training program started in
April, 2002, and since then we have trained more than 150 physicians
from 13 sub-Saharan African countries and have completed this intensive
one-month course. The trainees are now training others throughout the
continent.

We developed the first AIDS treatment information center to provide
up-to-date, essential, clinical information to physicians in real time,
as well as a newsletter to stay in touch with our trainees and monitor
the success of the training program and improve patient outcome.

Expansion of the training program to other countries as well as the
nurses and clinical officers will be initiated next summer. Time does
not permit the discussion of our operational research, clinical
community outreach, or prevention activities; nevertheless, the Academic
Alliance has achieved a great deal in the last two and a half years and
wishes to partner with you and facilitate our mutual and shared mission.

I'd like to commend you on your commitment to this important, complex
problem and we look forward to working with you in the future. Thank you
very much.

MR. MASON: Thank you.

RENEE FIORENTINO: Good afternoon. My name is Renee Fiorentino. I'm a
monitoring and evaluations specialist with the Synergy Project. The
Synergy Project is a contract held by Social and Scientific Systems and
we provide support to the Office of HIV/AIDS within USAID.

My message today is about partner coordination and strengthening of
information systems. In response to the Presidential Advisory Council's
request for lessons learned regarding planning, implementation, and
outcome measurement strategies that have worked best, I would like to
share some of the synergies work in the area of implementation
monitoring.

As part of a framework referred to as APDIME, which stands for
assessment, planning, design, implementation, monitoring, and
evaluation, Synergy has devoted significant resources to improving and
building consensus around standards for implementation monitoring.
Logistically, Synergy has achieved this through our mandate to serve as
secretariat for the Implementation Working Group, the collection of
50-plus agencies and organizations implementing HIV/AIDS program with
USAID funds.

Substantively, our work in implementation monitoring has included the
establishment and promotion through a participatory consultative process
of a categorization system for HIV/AIDS programs and a set of core
program output indicators organized according to the category structure.
Implementation of this category and output data collection system
through an HMIS called the HIV/AIDS programmatic database, has allowed
us to look at coverage and effectiveness of HIV/AIDS programs. Coverage
and effectiveness being the questions that inevitably arise from outcome
analysis. And the system has allowed us to look at these things across
USAID's portfolio.

Looking at program-level data in this aggregate, standardized way has
not typically been done in the past, but coordination of implementation
agencies and donors, including the multilateral agencies, around this
approach has already increased capacity for broad-level planning with --
which with strengthened communication and bi-directional
information-sharing systems in place could lead to the improved local
planning and eventually leading to improved outcomes.

In our work, remaining challenges include the development of improved
tools for decentralized data collection and tools to facilitate the
interaction of diverse management information systems, but our
experience tell us that in this era of increased resources and increased
need for coordination collecting and looking at program-level data in
this standardized way is incredibly useful.

Thank you.

MR. MASON: Thank you. And while you're coming up, can we have Beth Shehy
(sp) from Land O'Lakes, if she's here; Mike Trainum from Shell Book
Publications System; Chris Wright from John Snow; and Paul Meyer from
Voxiva.

GARY HENNIGER: My name is Gary Henniger. Got all this time waiting and
now I can't get it out. Isn't that great? (Laughter.)

My name is Gary Henniger. I am the director of Product Development for
Syringe Reuse Prevention Devices at BD -- Becton Dickinson. I'm here on
behalf of my company to discuss our experiences in helping to prevent
the spread of HIV/AIDS in Africa and the developing world.

For those of you who do not know BD, we are a medical technology company
that serves healthcare institutions, life-science researchers, clinical
laboratories, industry, and the general public throughout the world. We
manufacture and sell a broad range of medical supplies, devices,
laboratory equipment, and diagnostic products.

One of the questions that we are often asked regarding HIV/AIDS is, what
are the issues driving HIV/AIDS problem in Africa? While the role of
unsafe sex in the spread of HIV/AIDS is well documented, international
health studies indicate that the reuse of medical devices in Africa and
developing world is also a contributing factor to the spread of HIV/AIDS
and other blood-borne diseases. The World Health Organization and
Centers for Disease Control have reported as many as 40 percent of all
injections in the developing world are administered with reused,
unsterile medical devices. In the year 2000 alone, WHO estimates
indicate that 500,000 new HIV infections, two million hepatitis-C
infections, and 21 million hepatitis-B infections resulted from the
reuse of injection devices.

Other recent studies argue that a third or more of all new HIV
infections in the developing world might have been caused by injection
device reuse. The data from the WHO also indicates that unsafe medical
practice, including device reuse, is among the causes of preventable
HIV/AIDS spread in the developing world. Many concerned parties,
including BD, have been dedicated to addressing this issue for many
years. Even though a vast majority of injection devices utilized and
reused in the developing world are not manufactured by our company, our
commitment to this issue has (manifest results ?) in many ways. We have
developed low-cost technologies specifically designed to prevent reuse,
collaborated with international agencies in the development of
appropriate safe injection policies, and made substantial philanthropic
commitments to support of international vaccine efforts utilizing safe
injection technology for deadly diseases such as tetanus and measles.

As a result of leadership of international agencies such -- and
organizations such as WHO, UNICEF, GAVI (ph), USAID, American Red Cross
among others, and the work of all manufacturers of safe injection
devices it is estimated that 75 percent of childhood immunizations in
Africa today are administered with syringes and needles that physically
lock after a single use.

But efforts to prevent the spread of HIV/AIDS in Africa and the
developing world cannot stop with immunization efforts because
immunization accounts for only 10 percent. There are many more important
priority -- there are many important priority areas -- I'm going to
respect the time.

Thank you very much.

MR. MASON: Thank you. Thank you.

Yes? And then Paul.

CHRIS WRIGHT: Thank you. My name is Chris Wright. I'm with John Snow
Incorporated.

An investment in health logistics, improvements will improve program
impact, is cost effective, and saves lives. John Snow incorporated has
been working in health logistics for the last 15 -- 18 years. We have a
phrase called no product, no program. IF you have no ARVs, you have no
ARTs. Public health and international assistance programs --
organizations cannot successfully address the HIV/AIDS pandemic unless
the right products for preventing and treatment of the disease are
delivered in the right quantities, in the right condition, to the right
place, at the right time, and for the right cost.

This is the role of health logistics; a role often underemphasized and
underfunded in the planning of public health initiatives in the
developing world. For programs to function efficiently, and one day
independently, HIV/AIDS assistance programs must be balanced between
directly providing commodities and services and reinforcing the
infrastructure.

Logistic systems must be strengthened if they are to manage
appropriately and avoid wasting the coming surge of HIV/AIDS commodities
promised by multiple new funding mechanisms and initiatives, not least
of which is the president's initiative. A comprehensive HIV/AIDS program
requires more than 1020 distinct products to be managed effectively,
including anti-retroviral drugs, HIV tests and laboratory reagents,
medicines for treating essentially -- sexually transmitted infections
and opportunistic infections, condoms, contraceptives, and consumable
laboratory and medical supplies.

But many existing distribution systems, particularly in Africa, are
unable to provide even the most essential medicines to hospitals,
clinics, and other service delivery points with any consistency or
reliability. Stronger logistic systems will save lives. Securing a
dependable and regular supply of HIV/AIDS commodities to service
delivery points is especially critical to the success of ARV treatment
programs because any interruption in those supplies will endanger the
lives of the patients and -- due to the risk of drug resistance --
jeopardize the treatment program itself.

Do we wait for distribution systems to be set up on the scale of UPS in
Timbuktu? No. But we want to make sure that the near-term solutions are
also transferable -- transferable and evolve into long-term solutions.

I'll stop there, but please remember: no product, no program.

MR. MASON: Thank you.

Yes?

MIKE TRAINUM: Thanks for listening to us today. I'm Mike Trainum, CEO of
Shell Book Publishing Systems. In the 1980s, my family and I lived and
worked among the Klo-whai-wasai (ph) people of Papua, New Guinea. We
helped as much as possible with community development, literacy, and the
diffusion of life-crucial information.

One summer when many babies were dying from diarrhea in the mountains
all around us, a nurse traveled up from the nearest government station
to explain to others that they must use rehydration fluid to save their
babies. Her exhortation was in the local trade language -- pidgin -- and
she explained very clearly, at least to us, how to make life-saving
rehydration fluid by adding sugar and salt to boiled water. After she
left, though, we overheard some of the local women laughing and talking
about how stupid she was. Of course, because everyone knew that you
withheld fluids from someone with diarrhea. After all, like begets like,
doesn't it? Why would you give more water to someone who obviously had
too much already? After more investigation, we worked with the local
people to develop a small booklet based on a cultural analogy that had
emerged from communities -- the discussion and validation -- cultural
validation of the crucial concepts involved, and I want to emphasize,
not translation. Community process, cultural validation, community
ownership, oral, written -- it's important.

This shell book -- shells are a traditional unit of value in that -- the
mountains of Papau, New Guinea -- compared a severe diarrhea victim's
limp skin with the leaves of a common plant the Klo-whai-wasai would
irrigate when it grew limp from drought. It worked. Many babies were
saved and that shell book has since been localized by communities in
several hundred Papua, New Guinea languages.

The lesson I've learned is that people rarely, if ever, act on
information that they cannot understand and have no way of validating in
terms of their own language and cultural perspective. Until new
life-crucial information is understood, validated, and accepted by local
communities, it will miss the mark more than -- often than not.

The implications for PEPFAR success are: there are 400 million people in
PEPFAR countries. These people speak 1,082 languages; over two-thirds
live in rural areas and are the least likely to have functional fluency
in the national or regional languages most commonly used for HIV/AIDS
information. That's 250 million of the target -- over two-thirds of the
target population don't -- will not have a clue that PEPFAR occurred.
Now, this sounds daunting but our -- over the process -- over the last
14 years we've developed this resource in local communities. It's not
rocket science, but it's got to be done properly. And in Papua, New
Guinea, now, 435 languages use -- the communities are used, and for
grades one, two, and three curriculum, and then they transition into the
national language. This can be done and you need our help. Read our
paper.

MR. MASON: Thank you very much. And our last speaker, Paul Meyer from
Voxiva.

PAUL MEYER: Mr. Chairman, thank you. All protocols observed. My name is
Paul Meyer. I'm the CEO of Voxiva, an information technology company
that builds technology applications for public health in developing
countries.

I want to just share a couple lessons that we've learned in deploying
systems in a lot of countries. I'm actually glad to have spoken after
john Snow, who really focused, I think, on the logistical challenges of
this undertaking, which is really tremendous. This is an enormous
undertaking this initiative is driving and I think that unless
information technology is really leveraged effectively to find out where
the problem is, to manage resources, to track distribution, it's almost
inevitable that it will fail.

I want to just repaint a mental image for the committee of information
flows in developing countries, and I've now seen this in country after
country after country. There's a ministry of health in a country and
then there's the sort of constellation of programs -- the WHO, CDC, and
NGOs, and donors, and so forth -- and in each country then there are
programs. There's the HIV/AIDS program, the TB program, the PCT program
-- the PMTC program, polio, malaria, and so forth. They all have their
own information flows and right now in most of the developing world
those information flows are paper-based.

What does that mean for the doctor in the field? It means the doctor in
the field has a form to fill out for the TB program, a form to fill out
for the polio program, for the malaria program, and it's absolutely
paralyzing for that health worker in the field. The thing that terrifies
me, and this I'm speaking as a technologist, because all those programs
have their own budgets, their own -- different people at the top of
them, different donors that impose their own requirements in terms of
M&E and others, that each of those programs get technologied over
separately. So I have a nightmare vision that some poor doctor or poor
health worker in a village in Africa or Latin America or India will end
up having a Palm Pilot from the TB program, a laptop from the HIV/AIDS
program, 36 different passwords, and will be paralyzed by technology.

I think that obviously given the resources, that the president's
initiative is directing towards HIV/AIDS there's an incredible
opportunity to actually deploy appropriate technology systems to really
manage the critical information flows that are absolutely necessary to
tackle this huge challenge. If done right, the possibilities are
beautiful. One could put systems in place starting with HIV/AIDS that
are architected and designed in such a way that they can then be
extended to do TB and malaria and polio. And at the end of this
initiative, one will actually leave strengthened infrastructure in place
and public health systems that actually work and manage it effectively.

One -- so, again, two just points I'd like to leave in your minds. One,
just classic problem is this stovepiping is purpose-built systems that
don't work across programs. The second one that I want to dwell on is
actually this tendency on the part of donors' initiatives to put
monitoring and evaluation systems in place -- to basically extract
information from people in the field. The potential of information
technology if done appropriately is to actually introduce technology
into the operational flow of programs, tracking things like
distribution, new cases, and so forth. If you do it the right way, M&E
is just a byproduct of a well-flowing information flow and the whole
system will be strengthened more effectively.

Thank you.

MR. MASON: Thank you.

I want to just before we close ask Ambassador Lange if he has some
closing comments.

AMB. LANGE: Just a very brief comment to thank everyone for coming. I
found this to be very, very helpful input and we will be giving a full
report to Ambassador Randall Tobias and hope to be working with you all
in the future.

Thank you.

MR. MASON: I want to thank you, Ambassador Lange. Thank you for staying.
I want to thank all of you and -- for coming. I think Reverend Bellamy
may get the award. Seventeen hours each way on Greyhound -- but all of
you -- I want to thank all of you. We really appreciate this. And I want
to thank the committee members as well for taking time, and I want to
thank the staff of PACHA: Josephine Robinson, Elizabeth Onjoro, Dana
Ceasar, and all the staff. They put this together under a very tight
timeframe. It's been wonderful.

Your oral comments and your written comments will be on the PACHA
website by February 1^st^ of next year, and that's
[www.pacha.gov](http://www.pacha.gov/). Thank you and we look forward to
working with you in the future.

(Applause.)

MR. MASON: Not too bad. We're five minutes late. That\'s not too bad.

MR. : Thank you very much.

MR. MASON: Absolutely. Thank you. Thank you. Look forward to working
with you.

(END)