and u.s. efforts to fight the disease. then the head of the u.s. southern command talks about organized crime and cocaine trafficking in central america. and later the u.s. senate returns for general speeches at 2 eastern followed later by a debate on a bill to repeal tax subsidies for large oil companies. go to c-span.org/can campaign2012 to see the latest on the presidential candidates and president obama on the campaign trail. other features include a video for candidates' views on major campaign issues and a social media link to read what people are saying about the presidential race. it's all about c-span.org/campaign2012, your resource for this year's presidential race. in march of 1979, c-span ban televising the u.s. house of representatives to households nationwide, and today our content of public affairs,

nonfiction books and american history is available on tv, radio and online. >> my personal appreciation that i owe a great debt to others reinforces my view that a certain humility should characterize the judicial role. judges and justices are servants of the law, not the other way around. judges are like umpires. umpires don't make the rules, they apply them. the role of an umpire and a judge is critical. they make sure everybody plays by the rules, but it is limited role. nobody ever went to a ball game to see the umpire. >> c-span, created by america's cable companies as a public service. now, remarks by dr. thomas frieden, director of the centers for disease control. he recently outlined the current status of the hiv/aids pandemic and u.s. efforts to fight the disease. he also commented on what he hopes will be accomplished at

this july's aids conference in washington d.c. the center for strategic and international studies hosted this hour and 15 minute event. [inaudible conversations] >> good afternoon. we're going to begin. welcome and thank you all for being with us. i'm steve morrison from csis. we're really thrilled today to be able to host dr. thomas frieden, director of the centers for disease control and prevention. he's been this that position since june of 2009. i want to offer a special thanks before moving into some very brief opening remarks. special thanks to susan mcclure from cdc along with don. >> liker and justin -- for all of their assistance and from staff here at csis. there's a lot of effort informed in this. suzanne brundage, carolyn shrout, julia nagel and alicia

kramer among others, seth gannon. we're bringing you together today to really look at, um, at hiv/aids and look at the accomplishments up to now, and that's a bit of a look backward and up to the present as to what's happened in this period in terms of the end demic and efforts -- epidemic and efforts to bring that under control and change the arc of that and to really focus both on where things stand today in the united states as well as globally and how -- and we'll hear more from dr. frieden -- how to impact the buzz and the excitement that we see today around the new science of prevention in the hiv/aids. and this really is a very remarkable period. it's remarkable that we would find ourselves in a situation when the secretary of state, hillary clinton, comes before a scientific audience here in the

united states in november of last year to talk about with a very public health-based address about an aids-free generation and when shortly thereafter the president of the united states on world aids day spoke in considerable detail on the high risk and difficult to region marginalized population of the united states and that unfinished business and the challenge that is there as well as the challenge of moving globally from four million to six million, a very ambitious goal of persons on u.s.-supported treatment in a fairly short period of time on existing budget levels. we're also going to be looking forward today particularly with respect to the aids 2012 international aids conference to be here in washington july 22-27th. dr. frieden will tell us a bit about that and what we might expect as coming out of that unique event that returns to

u.s. soil after a 22-year absence or hiatus which will be dramatic, a dramatic and very promising event. cdc brings a unique set of assets. we're all familiar with dr. frieden's exceptional leadership in public health, his role in leading the tb effort in new york city from '92-'96, his continuation in those efforts in india for a five-year period, thereafter returning to new york city where he led a remarkable period of innovation in new york city from 2002 to 2009 spanning anti-smoking efforts, controls in trans fats and greater disclosure around caloric and be other food content, electronic records and many other very distinguished accomplishments. we also know that cdc itself brings very special strengths in its evidence base, in its public

health lens and in the cross- fertilization we'll hear about today in terms of innovation and programmatic and training efforts here at home and abroad. it's really remarkable also looking back how much the hiv/aids epidemic itself has changed cdc. just ten years ago when we first started interacting closely with cdc, the international programs were really in their earliest stages, and it was really a small and exceptional component part of what cdc did at that time as an institution. now it's become very much embedded as part of the institutional dna of this organization, and i think we'll hear much of that reflected today. i want to draw your attention to the fact that next week, um, we will be convening here on march 28th in the middle of the day for an event. we've passed out a flier from

that that continues this series of activities looking forward to aids 2012. my colleague, katherine bliss, is going to be publishing next week a study that she's been working on for two years now i, a historical analysis of the international aids conferences. an excellent piece of work. and she'll be joined by anthony fauci, president of the international aids society and international co-chair of the aids 2012 effort, david munar, president and ceo of the aids foundation of chicago, and diane havlier will moderate that discussion that will be looking at the history of the international aids conferences and what we can expect as we look forward. so we'll continue that conversation next week, and i hope you can all join us. that will be webcast live at midday, and we expect a strong turnout here as well. and i want to thank everyone who

is joining us online. we have 100 persons joining us online for this event today, and i want to welcome them. and we've, we're very fortunate, also, that c-span3 has chosen to come and be with us, we're very grateful for that. so, please, join me in welcoming our guest of honor, dr. thomas frieden. [applause] >> thanks very much, stephen. thanks to everyone at csis for really excellent, cutting-edge work that you've done in global health on a wide variety of issues. and also i want to thank all of the nongovernmental organizations and faith-based organizations and individual advocates who have helped us get to where we are today in hiv. we're all committed to making further progress, but i think we also can take a moment to look back and see how far we've come. i'm very honored to be here and delighted to share with you some reflections and some data on the

hiv epidemic and where it sits in global health, where it fits in policy and where it fits, also, in the u.s. health care system. it's possible, i think, to forget just how bad the hiv epidemic has been. hiv has already killed in this country as many people as died in if all wars since the civil war. hiv continues to be, but was a much worse blight on countries that were already struggling with basic health issues. and yet we have remarkable hope and progress to celebrate as well. when i think of that, i remember a woman i met in nigeria a couple of years ago who was carrying twins. and she said to me i'm hiv positive, but i'm on treatment, and i feel great.

and my twins are hiv negative. they're going to grow up without aids because of pepfar and because of the american people. so, please, go back and tell people how much we appreciate the support because it is our lives and the lives of our children. so we've come a long way, but i think in terms of our response be to the epidemic -- not the epidemiology, but our response to the epidemic -- 2012 is truly a tipping point. and i would point to three key trends in this area. first, that we're seeing increasing coverage and decreasing unit costs. so we're able to treat more people for the same amount of money. second, there is increasing recognition of global shared responsibility and accountability. that this is an issue that the world has to take responsibility

for not only the u.s., not only the countries in which the epidemic is hitting hardest, but countries throughout the world that can do more to address hiv. and third, new evidence that we can make a huge difference, that treatment is prevention. for so many years we had this fight treatment or prevention. now we know that treatment is prevention, andit's a critical part of combination prevention and effective prevention. we know that prevention of mother-to-child transmission and voluntary male medical circumcision can be scaled up and have population reach an impact. and we know that infection rates and deaths can be driven down. and this is crucially important, and i think informs and forms our response. i want to take a moment to describe to you the diverse work that cdc does all over the

world. we're fortunate to have fan task saf -- fantastic staff in atlanta and around the world. we have nearly 2,000 people working for cdc around the world, and we have another 10,000 people plus in atlanta who can backstop these individuals in any area where we need expertise. we recognize that there are huge challenges, and over the past year i've had the privilege of visiting with our staff and seeing some of the programs in a wide range of area. in haiti where we've been able to improve the ability of the government and of local institutions to respond to a cholera epidemic, we've prevented more than 9,000 deaths from cholera. much more needs to be done, and we're lacking in resources to improve water and sanitation the way that all of us would want to have happen, but we've made tremendous progress there. i just returned from knew career

ya -- nigeria where it's sobering to remember that there are an estimated 100 million cases of malaria each year and 300,000 deaths from malaria each year. where prevention of maternal-to-child transmission is not scaling up as rapidly as we'd like and where polio is continuing to be a major problem but with new commitment from the government of nigeria and the state governments of nigeria, and i'm optimistic that we'll see significant progress there. from kenya where we've seen terrific examples of scale-up. more than two-thirds of all tb patients in kenya are now being tested for hiv and, if found positive, being put on antiretroviral treatment. in just a couple of years, a very rapid scale-up accounting for about one out of six new starts of arvs in parts of that country. so showing that there can be

effective scale-up. in russia where we've worked on immunization issues and vaccination issues. in china where we've helped the country open up and look at things like influenza and become a global collaborating center where they're posting on the internet every single week the strains of flu that they're finding in laboratories that we helped them to develop with their own resources so that the whole world benefits from that information. in brazil where we've helped the country design a remarkable intervention that's going to try to scale up physical activity in an effort that i think is unparalleled in the world. they're going to spend their own money $700 million in coming years to see whether it's possible to get people moving on a mass basis. in vietnam where we've helped support development of public health infrastructure, studied and helped to reverse or tried to reverse or stop the spread of drug-resistant malaria.

seeing their progress and help them in areas like motorcycle helmets where they've seen a dramatic reduction in injuries. and influenza where they remain at high risk. in india where we've been able to work with the world health organization and the government of india to make remarkable progress on polio. india now has gone 14 months without a case of polio, and that's with excellent monitoring, a result of enormous social activism, enormous focus and accountability and a billion dollar investment by the government of india for polio eradication. but hiv remains the leading global cause of, the leading global challenge in terms of infectious diseases. and before i get that, i'll just give you a sense of the scope of our activities. we have global disease detection activities around the world, we have immunization assignees

helping to insure that countries have effective immunization policies and programs. we have influenza assignees tracking the spread of flu so that we can have an early warning system to know what's happening and prepare for what could be a terrible pandemic. we have malaria assignees working with the president's malaria initiative providing technical assistance with ministries of health and with governments and programs to insure that the programs have high impact and are documented. our field epidemiology training programs have turned out more than 2,500 highly-trained epidemiologists in recent years, about 80% of whom stay in their host countries doing important work to document the spread of disease, design programs, implement programs and then see whether those programs are working. and we work with the department of defense in strategic areas.

and, of course, with the global aids program and pepfar. we're seeing, now, signs of progress. hiv remains the biggest infectious disease challenge of the world. there have been 65 million hiv infections and 30 million deaths since this epidemic started. in 2010 alone there were 2.7 million deaths -- sorry, 2.7 million new infections and 1.8 million deaths. so the number of people infected continues to grow from 34 million and up. but the graph you see here shows about a 20% reduction in hiv incidents and a slightly larger reduction, about 27% reduction, in incidents in sub-saharan africa. to achieve this, partnerships are absolutely essential, and

learning lessons from around the world and applying them wherever they can be applied is crucially important. hiv-related mortality is also declining. and one of the things that bill has taught us is that public health is at its best when we see and help others see the faces and the lives behind the numbers. these numbers are coming down, but they're still shockingly high. at the peak of the aids epidemic in africa, hiv accounted for two-thirds of all adult deaths. can you imagine what that would be like in our own village, our own community? there were communities in which the only business that was increasing were the funeral business. there were communities in which the hope that there could be

progress was dissipating. the number of health care workers who could care for patients with hiv was declining because of hiv thinning their own ranks. and the possibility for progress seemed remote. we now have the ability to make big change and significant progress. the u.s. government has called for an aids-free generation meaning that virtually no child will be born with hiv infection, that adults living with hiv don't progress to aids, that there is a rapid decline in hiv incidents, that combination prevention can turn the tide on the hiv epidemic just as combination anti-retroviral treatment can turn the tide on infection in an individual. anti-retroviral treatment as

prevention, prevention of mother-to-child transmission, voluntary male medical circumcision and correct and consistent condom use. what we're seeing in this call for an aids-free generation is the translation of evidence into policy and policy into action. we're hoping for more progress toward an hiv vaccine, but we don't have to wait. president obama has said on world aids day we will beat this disease. that's an ambitious but achievable goal and challenge to all of us. what we've seen is a goal to reduce mother-to-child transmission by 90% but not only to meet the goals of pepfar and in hiv, but to meet the goals of pepfar in strengthening systems, for example, reducing maternal

mortality from hiv by at least half and ambitious goals, three numbers that we need to keep front and center in everything we do. six million on treatment, 1.5 million women treated to prevent mother-to-child transmission and 4.7 million voluntary male medical circumcisions. those three numbers are enormously ambitious. we have 21 months to achieve them, and i'm confident that working together we can. at home we have for the first time a national hiv/aids strategy for this country with a focus on reducing new infections, increasing access to care and improving health outcomes for people living with hiv, reducing hiv-related disparities and health inequalities and achieving a more coordinated response to the hiv epidemic. and let's not mistake, we have

significant challenges in this country. 1.2 million people are living with hiv approximately, one in five, 200,000 people don't know that they have hiv. another 450,000 or so know they have hiv, but they're not on effective treatment. we're seeing an increase in the hiv incidents among young men who have sex with men in african-american communities. we see that more than be 60% of new infections occur among men who have sex with men. and when we look at that key concept of accountability, only 28% of all americans living with hiv have their viral loads pressed. that means that they're own health is at risk and their partner's are at risk. so we have a long way to go. but we also know that significant progress can be made. san francisco be, for example,

has scaled up treatment as prevention, and they're seeing significant reductions in incidents of hiv. and at cdc we're taking a new approach to our prevention work. we're saying let's make sure in this country for our prevention dollars that we're sending our resources to the places that need it most for the programs that work the best for the populations at highest risk. that means we will shift our funding. and determine our funding based on the number of people living with hiv and support innovation in health departments and communities and insure that three-quarters of all resources we send out go for four key activities; scaling up testing and linkage to care, comprehensive prevention with positives, condom distribution and initiatives to promote prevention and accountability

especially monitoring viral load and helping health care workers insure that we're controlling it. we won't be able to effectively manage the epidemic and help people be healthy unless we systematically track these numbers. in this country we have seen progress. eleven million more americans know their status than knew it before. three-quarters of those at high risk have been tested. we've seen 90 president decrease -- 90% decreases in mother-to-child transmission, among drug users and in blood-borne transmission, 90% or more. those same levels of effectiveness, 90%, can be seen globally. and what we hope to know in the next few years is whether scaling up treatment as prevention can reach that kind of impact on sexual transmission of hiv. not only is this saving lives,

but it can save money as well. we know from a broad variety of public health initiatives that we can drive down health care costs. immunizations save $3 for every $1 we spend for the health care system alone and $10 for society. a single patient living with hiv has a lifetime cost in this country of about $400,000. if we can drive down new infections and reduce the number of people who become infected in the future, we can truly bend the cost curve for caring for hiv. effective prevention interventions are increasingly understood. we know that pmtct can be highly effective and reduce transmission down to 2-4%, but we're at less than 50% coverage globally. this is all on the global scale. we know that treatment as prevention has been documented to reduce transmission by 96%.

this is remarkable evidence of progress. we now know that if you're on treatment, not only will you live longer and healthier, but you'll be 96% less likely to spread hiv to others. that's a game changer in our understanding of how the epidemic works and how to treat the epidemic, how to manage the epidemic, how to control it and prevent it. but even with a modest level of cd4 count, we're still at only 47% coverage. male circumcision is at least 60% effective in reducing female-to-male transmission of hiv. our coverage is less than 5% globally. but we have seen that it can be scaled up. kenya, for example, has scaled up remarkably and done nearly 400,000 voluntary medical male circumcisions, and they will

have an enormous benefit from that effort in fewer transmissions, fewer illnesses, more productivity in future years. the hiv vaccine, we're still a long way from where we need to be, but we need to continue to work on it because it would be, without a doubt, an enormous contribution. microbe side we're looking at and trying to see how we can incorporate this and identify its effectiveness in programs and preexposure prophylactics, something we need to continue to try to understand better. this is the data from uganda on the effect biveness of circumcision. as time went on, it didn't go down, it actually went up in terms of the level of e educate ifive -- effectiveness. 73% effectiveness over a longer time period, so there's tremendous progress by scaling up these interventions. what we're able to do is increase our partnering to insure that every cat is si

increases -- efficacy increases, cost decrease and sustainability increases. we've seen systems established, and when the systems are established, the unit costs fall dramatically. drug costs have fallen, but there have also been economies of scale. we've transferred services to local partners, and now cdc is providing most of our services through local partners, ministries of health and others. we've helped to expand team-based care, and team-based care is a very, very important initiative. a very important tool that we could learn more from in this country as well. making sure that every member of the health care team is used to their fullest potential will allow us to do better care for lower cost and insure that we have people in the health care system who are working in ways that can support commitments. communities. we're also seeing south africa

and other countries take on a greater proportion of the financial burden of treatment, and that needs to continue. this is a global, shared responsibility. the u.s. has done an enormous amount and is committed to continuing to do an enormous amount and more going forward, but other countries -- countries that are affected by the epidemic as well as other low, middle income countries and donor countries -- also need to do more. this slide shows a model of different scenarios of what may happen in swaziland as we scale up different interventions. and on the y axis you see the number of new infections per 100 person years. the current model based on the best available modeling that we have is that there are about two and a half for every 100 person years.

and if we do nothing, that will increase. if we expand medical circumcision, that will fall. if we don't do either, it will increase. but if we look at expanding both treatment and circumcision, we can see substantial reductions from 2.5 to 1.5. and if we treat at lower levels of cd4, we can see those levels going down all the way below one per 100 person years. we think it's possible to drive down incidents of hiv with combination prevention. ..

what we do in this country to support public health and what we do globally to support health. we provide technical guidance, technical assistance, as well as direct funding. we have technical experts in more than 75 countries working on hiv and a variety of other issues. we have very close partnerships with ministers of health and local organizations. we work in country to build capacity. applied epidemiology is critically important. helping countries look at and act on their own information. i told you about earlier have populated ministries of health

as well as nongovernmental organizations committed to our progress in countries throughout the world. replace that and we bed them so they can help them set of systems, monitoring systems, implementation systems and ensure that the systems can continue for many years to come. we also use a large number of host country national staff who skills we rely on and are able to interact effectively with local organizations. we have cooperative agreements with 63 ministries of health, developed carefully over many years with careful safeguards and technical assistance so we can gradually and steadily improve the capacity of countries to detect and respond to hiv, and other health threats. we've established or helped to establish african society for laboratory medicines, to approve accreditation of labs so that there are labs throughout africa

now that provides reliable results for clinicians for hospitals and others. we improve laboratory networks and quality. and improved health security by helping to build institutions like cdc, which can work at set knows for health and as the leading edge of response to epidemics to health threats. there are countries throughout the world are building programs like cdc, most recently india has created its own cdc in countries like africa are doing the same. health security reminds us that we are all connected by the air we breathe, the water we drink and the food we eat. and the risk anywhere is really potentially a risk everywhere. the spread of drug resistance is something that takes only days or weeks to spread from one country to another, and can be very costly. we are all looking forward to the international aids conference in july in this city.

i think he'll be an exciting time. it's a welcome return to the u.s., and i know that many in the audience work hard to revert the travel ban on hiv. cdc was proud to play key role in that policy change. and we are delighted to welcome back the aids conference, after a long pause. and what a world of difference, two decades, makes. i trained as an infectious disease physician in the mid '80s. my training experience was seared by caring for hundreds of people dying of aids, for whom i could do virtually nothing. when i left the u.s. to go to india for five years in october of 1996, it was just at the point when combination

antiretroviral treatment was coming into widespread acceptance. i had two friends who were dying from aids, and i figured i would never see them again. both of them are working full-time today. so two decades makes an enormous difference. i think we can expect process at the international aids conference, and we also need to recognize that if it were not for the advocacy in hiv, we would not be where we are today. not just in hiv but in many other diseases. the hiv advocate community i think showed the way for people suffering from a wide variety of health conditions, to demand better treatment, to demand faster results, to demand access to the latest information. and we celebrate the progress, we celebrate the ability to

respond to the needs of the community with an entire partnership of commitment. we have the national hiv/aids strategy in u.s., and the rolling out of the strategy, despite an enormous fiscal pressure the u.s. government was under, we increased our spending on hiv/aids in each budget year. we celebrate a commitment to an aids free generation. we'll be looking at scale-up effective treatment. we were looking forward to the reauthorization of the path for program am and will be focusing on the translation of science to policy and policy to action. will be looking looking at new technology, at microbicide, we'll be looking at new ways to be a circumcision that are bloodless, simple and scalable. we'll be looking at pre-exposure and the impact of treatment on

both incidents and death rates. i think there are very exciting possibilities. we know that treatment works as prevention between one individual and another. we are going to focus now on treatment as prevention on a population basis and document the impact of that, and optimize it so we can do it as effectively as possible. we are also looking at the impact of transport and hiv programs on systems, not only does pepfar achieve its target, not what has he done that with steadily declining costs but it's done that at the same time we have been able to strengthen systems, health care systems, public health systems, delivery systems, community efforts to improve health. and that's something to be celebrated and built on moving forward. combination prevention is

something that would have been virtually unimaginable 10 years ago. no one entity can do this alone. but i think working together we can achieve a society in which infant infections are rare, progression from hiv to aids is rare, hiv treatment is effective and accountable, helping people to live long, productive, healthy lives. and the incidence of hiv is falling rapidly. that's the world that we all need to continue fighting for. so thank you all for the work that you do all the time to make that a reality. thank you very much. [applause] >> thank you. thank you very much.

that was really powerful presentation. let's talk for a few minutes and then we'll open to our audience for their comments. let's talk a little bit about budget, because obviously that's a rate unknown at the moment, and many of the really most difficult decisions are being postponed until the end of our year and into the next cycle. and a vision that's been laid out, which is very powerful, does imply that they will be an ability to certainly sustain and scale of resources looking forward. it also rests on the cost that you outlined, and many of those costs advantages have been captured the last period, and the modeling exercises that have gone forward have steered us towards redirecting those dollars towards the most effective use of them. but we're still going to need to address a very, very difficult

budgetary environment. and perhaps you can see more about that. much of what you laid out here is, in fact, the essence of the case, but looking be on that in a very polarized manner, look at context, and one in which some really hard decisions are made as the country around our budgets. what is your thighs? >> three points to make about this. first, we are not done decreasing unit cost. we think there's still very ability and we can still drive down unit cost by transferring services to local entities, by increasing accountability, but achieving economies of scale, by using optimization. so i don't think we are done with reducing unit costs. i'm confident that within the budget envelope that we think we'll see over the next few years we will be able to reach the target of 6 million, target of 1.5 million, pregnant women

and target of 4.5 knowing. the challenge will be as much problematic as fiscal. the second point i would make is that we need to see more country skin in the game. we need to see more country commitment to pay. no one wants to see hard earned hiv or other assistance dollars used to basically supplant existing government investment in health. and secretary clinton has been very forceful and forthcoming on that issue, and i'm confident that an increasing number of countries, not all, but an increasing number of countries will increase their domestic commitment. they already have and more will. we're also seeing more commitment from other countries, and i think we'll see more responsiveness from many of the multilateral organizations in ensuring that there's effective accountability and use of funds. the third point i would make is

that i'm encouraged by the bipartisan, bicameral administration and congress, medical community and advocates. there's a commitment to global health and a commitment to hiv, and that's something that a strong. i think it can't -- we have to ensure that we make optimum use of all of the funds entrusted to us, but i am impressed by what it strong commitment is to global health generally, and hiv specifically. >> thank you. what we are hearing now in talking to different interests on the hill and elsewhere who are puzzling over the budgetary realities, those who are sympathetic and part of this coalition, but nonetheless we thinking, what we're hearing is yes, indeed, there have to be more skin in the game from some of the country. we're hoping that the multilateral institutions that

have been very fragile and brittle themselves, that they will return and be stronger. but there's also an increased discussion around how do you present to an american public what the endgame, the endgame may be the wrong term. that implies an exit. but a vision looking out for, five years, or 10 years, that tells a narrative to the american people that it's different than what a few years ago seen in the emergency phase seemed like somewhat open-ended and ill-defined area looking for. can you say something about that? >> i think there are several trends that are going to affect that. the models suggest that within just a few years of scaling up treatment, we can truly bend the

cost curve and reduce expenditures down the road. there's going to be a need for more, but the option is, do you let people buy or do you scale-up treatment? we decided as a world where not going to do the first, we're going to do the second. the date is clear. the quicker we do that, the more people, the lower the financial burden will be in the medium term, not even the long-term. so we have a major impact that we can make an interesting now to drive down costs going forward. but i think we need to see increased commitment from countries, both host countries as was other donor countries, and i think it's also important that we seek pepfar as a platform for other critically important health interventions, whether it is maternal mortality reduction our laboratory strengthening, or reducing health disparities, or establishing a health workforce.

we need to, on the one hand, always keep that accountability for outcome. we have got those three numbers to focus on. but also use that, use all the precious resources that we have to build systems that will be more resilient and more able to address a wide variety of health threats. >> let's talk for just a moment a little more about what lies ahead in the aids conference, age 2012. this is coming after a 22 year gap which is an interesting proposition. well, what with the opinion and climate be like, and will this eight night a renewed interest in enthusiasm or will this be, captive to some of our other more polarized and politically charged debates that may attach themselves to this and it might

tensions rather than bring about greater unity and renewal of interest. and when you think back historically to the relationship that the trend has had at these conferences, it's often sometimes contested and combative. in the last conference, there was quite a turbulent event. between then and now there's been periods in which the u.s. government has found themselves at different points in bangkok and other places, in a fairly confrontational position. and so there's a little bit of anxiety about what will happen. and i very much enjoyed the fact that you position it is in saying we must acknowledge and celebrate the dimension of social mobilization. in driving forward our own. perhaps you could say a bit more about how you think about getting the best outcome,

getting the best set of messages to an american public. trying to get public to understand what the opportunities are. we have an opportunity as we move towards and through the conference to connect with americans in a very different way. >> there are areas within the hiv response and the response of the hiv epidemic that are controversial now and will remain controversial. but i think the u.s. has a great deal to be proud of. pepfar is the largest global health program ever undertaken by in the country for any disease. and in this administration we have built upon that success, and in this administration we have done more nationally. there are certainly, there's certainly plenty of unfinished business and all of us are benefited when we focus on

unfinished business. honestly, objectively, and say we're going to do whatever we can with whatever resource envelope we can achieve to stabilize and stop the epidemic. i think, what i hope is that we can focus on where the areas where we need to do more. there are, i think there's an 80/20 rule here. we agree about 80% of what to do, but we may spend 80% of our time arguing about the other 20%. and i think one of the things that we need to do is figure out ways, use the conference as a catalyst to move further in those areas where we know we need to make more progress, and there is widespread consensus. i think also a generation of americans have grown up not realizing what a terrible scourge aids is. a generation of men who have sex with men but a generation of gay

men have grown up not seeing their friends die from the epidemic, thankfully, thank goodness. but, but that means we are seeing an increase in sexual risk behavior. we're seeing very high levels of risk behavior across a wide varieties of demographics groups among men who have sex with men. so one of the things that it can do is increase awareness of how bad hiv is as it remains an incurable disease. wonderful as treatment is it remains an interval disease. so one thing we can hope is that for a general understanding, it emphasizes that this deal is, and for general understanding it could emphasize that this is a bipartisan commitment to stop a terrible epidemic. >> i want to ask, i want to invite our audience members to offer comments and questions. we have microphones in the back. what we will do is take three or four at a time and come back to dr. frieden. so with a couple of hands up and

in the back, and up front to. please be patient. we will do a couple of cycles. yes, please stand up and identify yourself. >> ray martin from kristin connections for international health. thank you very much. it's great to hear, considering what we face not too many years ago, all this talk about combination prevention and the potential, all the tools that we can bring. i have a question about combination prevention. the for priority components that you mention in your slide were arv treatment has prevention, pmtct, voluntary male circumcision, and correct and consistent use of condoms. different times i've heard eric goosby, the global aids coordinator, talk about the importance of behavior change as a component of combination prevention.

and i presume by that he meant the various aspects of sexual behavior. so i'm wondering whether there's a difference, a different perspective of priorities between office of the global aids coordinator and cdc, or why behavior change didn't appear on your list of priority components of combination prevention? >> thank you. in the rear. >> hi. donna barry from partners in health. so, its world tv week, and i did miss the beginning of your talks or apologize if you mentioned it. but clear where not going to address some of the mortality levels without addressing and building a better tb trade the program as was prevention. and i see a lot of tb friends in the obvious so i imagine will have a few questions for you. if you could please be to the a little bit. we are incredibly disappointed with the administrations key be

funny but and cdc has played a huge role in the international role, especially treatment et cetera, so we would love to hear more about that. >> thank you. up front here. >> thanks. karl. thank you for all you're doing, and she mentioned how in the united states you are focusing the money and the programs on the communities most impacted. just want to say thank you for that. my question is the affordable care act, and it's in the news lately. and how is that going to impact hiv prevention in the united states? >> shall we take one more? back here. >> thank you. my name is david, from the partnership supply chain management. i want to thank you very much for a clear and encouraging presentation.

i wanted to come back to your comments on the unique cost of care. we've been very involved in driving down the unique cost of a number of the commodities, particularly the drugs. and an area we worked very closely with your folks in the field, and successfully, is in the laboratory area. we found it much harder to drive down unique cost of equipment, reagents, diagnostic test in that area. work is being done on harmonization and standardization that reduces the overall cost, but i wonder if you had any thoughts about whether you feel there is scope for economy in the cost of that, commodities themselves in laboratory work, and how one would said about driving those costs down? thank you. >> i think these are all

wonderful question, and all critically important issues. in terms of behavior change, this is and remains and will remain an important part of response to the epidemic. delay of sexual debut has been documented in a number of countries and is a very important epidemiologic role, and we would see those programs continuing. similarly efforts to reduce the number of partners, which have and not as well documented, if they were effective would have a major role, need to continue. what we are looking at are the addition of these combinations to make huge differences. in terms of tuberculosis, tuberculosis remains a major killer and a major challenge. i think, as i, as some of you know i spent many years working on tuberculosis, so i have to be careful to try to keep my comments short in this topic.

i think we need to ensure tuberculosis that we never lose sight of the basics. i did a review yesterday, a country program where they are treating in dr pete be and have run out of first line drugs. that should never happen. that should never, never happen. and yet that is the case in different parts of the world. we have to keep the core programs functioning effectively. would also have to ensure that the patient always remains the vip of the program. there are programs which have been attempting to do that more or less effectively. but that is a crucial concept that needs to be infused all of our tuberculosis care programs if we're going to be effective. and the third point i would make is that tb is a disease that takes a long time to treat. it's curable but it takes a long time to treat. in the same way, we don't know

for certain yet, but my read of the day is that in many countries with current technologies we can do a lot. we can make huge progress. we can drive down death from key be enormously. we can drive down prevalence of tb very rapidly. we can drive down new infections from tb significantly. but the number of tb cases which arise from people who were infected months, years, or decades ago is likely to continue at significant numbers for a long time. so with tb will be process is not only with individual patients but for programs to continue a long time in effective treatments. so that's something that we need to do and ensure control is something we much do a better job at. we know that infections in health care facility can account

for a significant proportion of new tb cases, especially among people living with hiv and that there are simple low-cost ways separating people with costs, getting people out of the hospital and not hospitalizing them in the first place, using simple inflation methods that can be used and probably are not scaled up to the extent that they should be. so we've seen a lot of progress in tb. i think other programs have a lot to learn from tb, in terms for example, of accountability for outcomes of individual patients. but we need to keep at it for a long time. >> the affordable care act will bring health coverage to millions of americans who don't have it today. the result of that may be somewhat reduced pressures on some of the treatment programs, such as -- but that is years from now. until then we continue to have a challenge to make sure that

people living with hiv get the service they need and have access to care. but the affordable care act, as it will for society generally increase access to affordable health care, we will do that for hiv-positive people as well. but what it won't do is eliminate the need for effective hiv prevention programs and that's something we need to continue to do from the public health field. the issue of efficiencies in the laboratory networks and commodities is an important one. we are looking at in this country, in the united states, we have seen a tremendous fiscal pressure on public health departments throughout the u.s. in fact, compared to three years ago there are about 50,000 fewer people working in health department in the u.s. than they were just three years ago. one of the things we're doing at the cdc is a laboratory efficiency initiative to try to identify shared services, whether its maintenance or reagents, to drive costs down.

in different parts of the world we have seen a variety of transport or other issues but it's harder than we might wish to drive costs down. i think we need to continue to work in that area. we also need to continue to look at new technologies. for example, cdc scientists have developed in another field a rapid blood test, point of care test which remains a terrible threat at the very high fatality rate in parts of africa. that tests cost about a dollar and it is highly accurate. so i think new technologies have the potential to either drive costs up if they're coupled to or drive costs down if they are simple and appropriate and accurate. >> that's it. let's take another round. sir? >> hi, david from the global alliance. i'm going to follow up on the tb question. and while acknowledging that there's a lot more that can be

done better for existing programs and treatments, what about, what is your perspective on new tools, new diagnostics, new drugs, new vaccines, to invest in debt for tb for the long haul? >> do we have some other -- >> i'm sorry, one other thing related to the. we we see hiv, tb co-infection more prominently at the international aids conference, given the fact that there is such an extraordinarily high co-infection rate between tb and hiv/aids? >> thank you. in back, and the rear. >> greg smylie. my question was about the domestic response. you said of the four priorities, we're at 75% of the dollars will be prioritized. the fourth one was around a accountability, particularly around viral load.

i don't know if those community viral load or individual. to those pirg rams target the medical provider, the community, may be becoming more? >> thank you. alicia, can we -- >> high, shannon from the future screw. very diffuse question i think. so thank you for your question. it's really wonderful to be seeing some of the cost effectiveness. being able to show some of these improvements and increments. but with an eye to its 2012 coming in and realizing a lot of times we usually talk to ourselves, this committee group of people who are well-versed in public health in developing and hiv/aids, and realizing this great opportunity we have where the american public and congress and people who haven't been following even hiv/aids or perhaps even the invisible successes of public health are going to be exposed, are going

to be exposed potentially to what we would hope could be reaffirming exciting and new ideas. sometimes when we limit discussions to cost and cost effectiveness we forget to make the next jump to value, and sometimes surprising value. sort of the difference of in difficult budgetary times, what's the value of continued funding, or increased funding, and that can be different from perceptually from non-experts what the incremental cost-effectiveness of doing more and incrementally reducing transmissions versus the value of eliminating hiv/aids for a whole generation. on a normal person level those are very different arguments. those are very different justifications for, you know, budgetary improvement even. higher bar maybe. along those lines, when i came

back from overseas and came back into the domestic epidemic, i found that there was a real range of people being engaged, people who thought hiv/aids, you still couldn't anything about it, particularly in the developing world. it was just utah, so every dollar spent in futile or people about the domestic epidemic example, we have done it all. why bother to spend more? similarly, i think we get caught in right now it's either money going to foreign and international response, or its money being spent here at home. yet a lot of these creative solutions, and really value added leads, can come from that space in between those extremes. and it seems to me when i came to work in d.c., a lot of the improvements were able to make in testing, scaling up coverage and reducing mortality from hiv

here in the city came from some of the systems approaches we have been doing in pepfar abroad. cdcs uniquely paid to tell some of these value-added stories, because of your role, not just with pepfar, but also here with state and jurisdiction health environment. i guess my long winded question is, what are some of those value added stories you think people are unaware of and that are compelling, and are the difference between striving -- driving incidents that all of it and creating motivation for an aids-free generation? >> thank you. do we have one more? >> i am from nih. thank you for the presentation. the question is,. [inaudible] be it, you mentioned the one who provides assistance, and so we're looking through the

increasing quantity, quality and retention of health walkers in their own countries. and so we've been walking in different areas. so how come he also mentioned the cdc cannot do it alone. as u.s. agencies, how does your plan worked together with other agencies so that we can really provide both prevention and treatment and care services to people in an expanded and a sustainable way? >> thank you. >> so, first on tuberculosis, i think we have seen significant progress on new diagnostics in terms of development in the laboratory. laboratory development. we now have to define the role of those new diagnostics. for example, we have rapid tests for gene experts, for tb and

resistance. that could be done in a high volume -- high-volume get people out of the hospital. they have tb to reduce debt. out of life at the best place to do but that's something to figure out. one technology that i'm quite excited about is led fluoresce fluorescent. when i worked in india, my biggest piece of unfinished business there, i'm so frustrated with, was the availability of microscopy in the areas without regular electrical supply. it's not a small problem. in many countries, maybe a third of health centers, don't have any or very little electrical supply, and maybe another third have poor quality electrical supply. so we tried everything. solar doesn't quite work. batteries can be used for home usage and not work well may not last long.

but led resulted, led is a great technology. you don't need to take batteries that last a long time. fluorescence increases. i don't know whether this is an area that will be highly effective or scalable, but let's figure that. so we have new technologies and we need to use them. we have some inklings of new drugs, combinations into the net may get treatment have from six months to five or four. i said in 2000, i predicted that it would be at least a decade before we have a significant reduction in the length of anti-tb treatment. i'm sorry that i was right. i don't know it'll be another decade before we do, but tb bacteria grows slowly. it's tough to treat it, but it's important that we develop a wider therapeutic armament area, and are built programmatic benefits to reducing acidifying treatment regiment.

a tb vaccine would undoubtedly be a nobel prize. we have made significant progress in some of the basic science there. we are a long way from where we would need to be to make it happen. but it's a very important area. and i do hope to see more. i'm sure there will be a lot on hiv/aids at the international aids conference. what we are talking about tb, hiv, i will mention in passing caucus meningitis, a terrible disease and hiv. it's a major problem. it's often fatal. and it's preventable with an expensive medications. and pfizer and cdc are doing studies in south africa and elsewhere or cd scientists have developed a rapid test, or infection i should say. and then we think that just as we give medicine to prevent, we may go to identify which people

would benefit from it to prevent meningitis and make a big difference in age would mortality for a very cost effective prevention. i think there's a lot of development of new diagnostic of new treatments and is figuring out what's the role of those treatments. how can the best and most efficiently be used. the question of how we're going to prioritize treatment for prevention, funds in this country, 75% on prevention and scaling those core interventions up to get published in tech. i think we're still figuring out how to use. would like to see a converge of the use of the viral load to monitor clinical quality, and the use of community who viral load to hold the entire community accountable. so how are we doing at stopping hiv epidemic? and that convergence has tremendous potential for both improving the care of individual

patients and individuals patient's health. because of what viral load is experiencing a ravage of their immune systems and of other parts of their bodies by the hiv virus. at the same time, they're increasing the risk to partners. so i think we hope to see a convergence of accountability through viral load a margin, already about half of states get viral load. we're still pretty out what's the best way to monitor it. the volume of viral load testing is high, and so ensuring that we are able to get information through laboratory systems that duplicated not simple. but i think this is a critical area to learn about, ensuring that we have a complete confidentiality for individuals. and, of course, by saying that we want to get viral load impression on a community level,

we say at all times that nobody is suggesting mandatory treatment for hiv. but what we are suggesting is the treatment facility use that information to hold themselves accountable for whether they're reaching out effectively, to ensure that people are being given every opportunity to come into and continued treatment for hiv. >> in terms of the value proposition, i would make a few comments. first, it's important that we not overpromise. hiv is with us but it's going to be with us until we have a vaccine. but it can be with us a much less burdensome way. we can drive down them we can prevent maternal to child transmission. we can make it no longer the major public health crisis it is today. that's a major value but in terms of economic benefit, i think we can document

significant impact on the health of communities, globally and in the u.s. ultimately, one of the wonderful thinkers in public health is geoffrey rose, whose book preventive medicine, says basically that the best case for prevention is that it is better to be healthy and sick, and it's better to be alive than dead. and that's the real value proposition for public health. but there is a lot of value to not only the hiv care that we're doing, but also the strengthening of systems that we're seeing around the world, whether that's systems for accountability in clinical care, or systems for linkage between community organizations and advocates and clinical providers. there's a lot about you in the. and i think we need everyone thinking of what are the best ways to communicate that to different audiences. there's no one best way. there's no one best message. but to different audiences there's different effective

messages and i think we need to continue to show what works and show the reality. because that's the best case for our preventive excellent. >> in terms of what health care workers, we have done an enormous amount in trading and developed of health care workers in nursing, and medical schools, and residencies, and public health programs. and we need them to build on that success. we need to support health care workers in developing countries, and in this country, whether we are seeing real shortages in the areas where there is the greatest need. and that's another strong case for team-based care. getting people from within communities trained, empowered and able to provide life-saving interventions will be critically important going forward. >> thank you. we are getting towards the end of our time. i'd like to close really with consideration around leadership. we talked about, you look

forward to aids 2012, about having the value proposition put forward and consistent messaging, and making the case clear and science and evidence-based way. clearly, leadership remains very fundamental. we have seen this with the impact that president bush has had, president obama, secretary clinton, yourself, mayor bloomberg. we looked at the polio case in india this last phase, it was very much with the indian leadership. maybe you could say a few words about what we can expect going into july, what we should expect, should be calling for with respect to the contribution and leadership can play in debt. sometimes in these conferences in the past there have been dramatic expressions of leadership, and other times

there's been less than adequate. >> we've seen, u.s. leadership in this issue globally for much of the past decade, starting with president bush and continuing in the current administration. we have seen over the past few months tremendous leadership from secretary clinton and president obama calling for an aids-free generation with ambitious targets that are achievable, real world, real life. around the world we see leadership as the leading single predictor for whether a program will succeed or fail. to be blunt, look at south africa. what a dramatic turnaround from the nile to acceptance and leadership in addressing the hiv epidemic. i think we need to hold countries throughout the world accountable, or continuing and

achieving that kind of leadership. in the u.s., i think we need to ensure that there is not what the leadership that we have at the federal level, but also at the state and local level where we are seeing states not treat people with hiv. we're seeing localities step back from commitments they have had before. leadership at every level is the strongest predictor of success or failure of hiv, and other public health programs. >> thank you. dr. frieden, thank you so much for spending this time with us. please join me in thanking dr. frieden. [applause] >> [inaudible conversations]

>> [inaudible conversations] >> [inaudible conversations]

>> [inaudible conversations] >> a live picture of the supreme court this morning where in about 15 minutes from now, about 10 in each and, closer to 10 minute, justice will begin hearing oral argument in a series of cases about the nation's health care law. over the next three days the court will air six hours of oral arguments determine the constitutionality of the patient protection and affordable health care act. cases florida, the department health and human services, three lower level courts have already

heard oral are on the new health care law. in may 2011 the fourth circuit in richmond, virginia, her to cases on the law. and liberty university, the kite, the court decided the individuals in the case could not challenge the law until after goes into effect. and in virginia, the court dismissed the case on the rationale the only plaintiff in the case, the commonwealth of virginia, had no legal right to bring a lawsuit because the individual mandate affects only individuals but the first appellate court with a decision on the law was the sixth circuit court of appeals in cincinnati. thomas moore law center versus obama. the court decided to reject the center's argument at the individual mandate can never be constitutional. it's an argument known as challenge. you can hear it as it is release expected at about 1 p.m. eastern each day. it will be on c-span3, also on c-span radio and at c-span.org where you can listen and add your comments.

and we're also talking about the health care oral argument on her facebook page where we are asking you how interested are you in the supreme court oral argument on health care. you can weigh in on her facebook page at c-span.org -- sorry, facebook.com/cspan. as of this our over 260 people have voted very interested, 13 people somewhat interested in eight votes were not interested at all. >> coming up on c-span2 at 11 a.m. eastern we will go live to the pentagon where general john allen were briefing me on u.s. military operations in afghanistan. he is the leading commander in the country and we will have his remarks and q&a with reporters live in just over an hour here on c-span2. now from senators back in session today. the house returning at noon eastern. this week members plan to take up a short term 90 day extension of a bill dealing with surface transportation programs. they will also consider a house budget resolution which is a

blueprint for spending your 2013. life coach of the house is on our companion network c-span. the senate housing today at 2 p.m. and then at 4:30 p.m. they will start to be on a motion to proceed with bill to roll back oil tax breaks. live coverage of the senate when the gavel back in here on c-span2. >> the woodrow wilson international center for scholars recently welcomed general douglas fraser as the featured speaker at an event. general fraser is the commander of u.s. southern command in central america. it's about an hour and 10 minutes. >> good morning. and welcome. i'm jane harman, the wilson

center's president and ceo. thank you for joining us for this important forum to examine the u.s. southern command, or socom role in countering transnational organized crime and improving citizen security in central america. citizen insecurity poses an ongoing and rising challenge throughout latin america and the caribbean. latin america's crime rates are astonishing by any standards. the highest in the world, creating a crisis that continually traps governments between the need for a comprehensive reform and the public demand for immediate action. usually means the kind of police tactics harking back to the repressive 31980 dictatorships. not a good response. the center's latin american program fosters comparative research and dialogue among scholars and policymakers from throughout the americas in order to address citizen insecurity's.

the program also focuses special attention on the changing sub regional dynamics of organized crime, and it recently released to publication. first, organized crime in central america, the northern triangle, and second, the rebellion of criminal networks, organized crime in latin america and the dynamics of change. as a member of congress for 105 years, that's what it felt like, it was actually only nine terms, i visited latin america and on numerous occasions, especially to assess terrorist threats. but i've seen the disastrous effects of crime and narcoterrorism on countries like colombia, a place where our guest i think spent some of his school years in bogotá. am i right? yes, progress has been made but there is still a long way to go. as one who serve on all the

congressional security committees, i can tell you that beyond latin america and they caribbean, organized crime is a global threat and some of the money from organized crime unfortunately funds terror movements, which are alive and well around the world. segue to the introduction of general douglas fraser. as a four-star general in command of south, he manages the force of over 1200 military and civilian personnel, the gym has enjoyed a distinct career in the air force, logging more than 2800 flying hours in f-15 and f-16s and received a multitude of decorations including the defense superior servicemen and the legion of merit. and given his current assignment, it seems fortunate and foresight that as i mentioned he attended three years of high school in bogotá. notwithstanding a proposed $13 million cut i in the budget and seemingly insurmountable odds, general fraser and his command are hard at work counter the effects of the illicit drug

trade, maritime traffic and organized crime throughout central and south america. we just had a brief discussion in my office, and i was impressed by his view which you will hear in a moment, that military force alone is not the right way to go here. that it is what i called and what was going as the use of smart power, which is a far better strategy, not just by us but by the governments in the region, this enormously toxic and difficult to defeat for it. so general fraser, we are honored by your presence and look forward to your remarks and discussion that will follow. and i'm not sure whether i'm turning the podium over to sending over general fraser. what am i doing? let me just say about doctor cynthia arnson who drives are latin america program, that as i often say, if you want to get the job done right, put a woman in charge last night she is superb and the program is one of our best here at the wilson

center, among many other programs. but it's a pleasure to have general fraser here and to discuss a very hard topic, and i hope to brag a little bit about -- general fraser, the podium is yours. please welcome general douglas fraser. [applause] >> well, thank you very much for that kind introduction. and i will set a couple things and appreciate the great work that the center is doing, especially your publications. they really are important. they really do help us understand the situation and gain insights we wouldn't get otherwise. so really it is a place for me to be here today, have an opportunity to talk with you about a topic from a military

standpoint is not something as i grew up in my military career, a topic i thought i was going to be focused on. but as i look around the region, thank you, as i look around the region and i look at latin america i really look at the western hemisphere with large, for central, south america, the grieving. i don't see an external military threat. as i look within the region, there are some issues, some concerns between some of the country. but again i don't see an internal military conflict anytime in the near future either. governments, institutions have worked through diplomatic avenues and through international venues to address the issues that they are concerned about. i see that trend continuing. so, the issue, the security

issue that i see throughout the region is transnational organized crime and the impact it is having on security throughout. and i'll talk a little bit more about this very specifically. i see it in my terms as a 21st century threat. and it's a 21st century threat again because in my terms i see in two different landscapes. i see it as on a regional basis as one that doesn't start and end in one country. it doesn't start and end in one subregion. if i would look at cocaine specifically, there's a source zone which is the northern part of south america. there is a transit zone, and this as we look at it from the united states. as a transit zone that comes through central america primarily right now to the caribbean, to a lesser amount right now but if you go back 20 years it was much worse in the caribbean. and then in the demand part of that, which is the united states. we have to address each part of

that landscape. there's no way to address each one individually. and then as we look more broadly than that and look at some of the other influences on these criminal organizations, it is not just trafficking in cocaine. we focus on that a lot because that's what we know the most about. but in reality, it's a criminal organization. that criminal organization is looking to fund its activities in whatever activity it can. so we are seeing precursors and growing number of precursors for methamphetamines flown from other parts of the work into central america and then up to the united states. but i think there's another landscape that we need to look at as a look at this problem also, and that is it is a network. it is a network of networks. it doesn't again start and end in one location to work that from the source zone through the transit zone to the demands on. ..

>> and into the demand zones of the middle east. so this is an issue that connects much more broadly than just in latin america and the western hemisphere. and from my standpoint as i step back and look at it, we have a role to play from a u.s. military standpoint. we have a supporting role. and i see it as a limited and a supporting role in supporting u.s. government efforts and international efforts around the region and, more broadly, around the globe to play a part in

that. and i'll explain our role specifically here as we go through the morning. and i'll be happy to answer your questions or discuss this after we -- so bottom line to it is right now within my area of responsibility, central america, south america and the caribbean -- and that's the responsibility for u.s. forces in that engagement -- i see the biggest concern right now in central america. that's where violence is causing the biggest impact on the stability and security within the region. and some of that violence is caused by organized crime. gang members cause part to it. there are some social issues that are also represented in that violence. so, again, we can't just confine this to one key issue that it's all being caused by transnational organized crime. so we need to understand the relationships and the capacities there better. but it is an issue, and it is an area that we continue to focus

on. why do i see this as a 21st century problem that we weren't facing last century or last century? from that i see it there a globalization standpoint. globalization and all the capacities that have helped support business and commerce and grow our economies around the world have had a negative result in supporting the growth of illicit trafficking and kidnappings and facilitating their ability to move product around the world as well. as a result of that, it falls and it crosses some of the boundaries that i talked about before and, again, i'll explain that as i go through the morning. the impact it is having because of the resources that it can now garner, and our estimate is that the profit gain from a transnational organized criminal activity in central america on

an annual basis is $18 billion a year. that's profit. so you take that profit, and you look at the gross domestic products of countries, you look at the capacities of governments to fund their security forces, and these organizations really outclass their ability to fund and support their activities. and that is having a destabilizing impact in the region as we've talked about not only from the illicit trafficking, but the violence is a concern, but it's also the bribery, the coercion, the other impacts that it has for them to facilitate their activity. these organizations within central america are very diversified. as i mentioned, they work in precursor chemicals, weapons move back and forth be throughout the region from military-grade weapons to, also, commercial weapons. there's trafficking in if

persons. there's trafficking in if bulk cash, and that moves back and forth throughout the region. it's not just a one-way street into the united states. a lot of that activity comes back out of the united states. and so it is having an impact there. if we talk cocaine specifically, 90% of the cocaine coming into the united states transits through central america in whatever manner. again, i'll talk a little bit more about that in a minute. it is a very lucrative business. and these businesses also support all those activities. as i look at what they support and how they conduct their activities, these are very smart and capable organizations. and as we from an international community, as local organizations put pressure in one location, they look for a way to move to other places where there is less resistance. and they look for other capacities to build. many of you are aware of semisubmersible vessels as we call them or fully submersible

vessels that we have seen more recently. these vessels are built primarily in the jungles of colombia and ecuador. 100 feet long, crew of four people can travel from the coasts of south america to off the coast of mexico, guatemala unrefueled. can carry up to ten tons of cocaine. and if you look at that from an economic standpoint, our estimates are it costs $2 million to build one of these vessels. the market value for ten metric tons of cocaine is roughly $250 million. so it's a pretty significant return as you look at it. and these vessels are very hard to detect. they have very low water lines, they're painted to be camouflaged in the water, and so they're very difficult to find. and we're seeing, then, an evolution into fully submersible. these are vessels similar in

make, wood, fiberglass that can submerge when they detect that there is law enforcement activity or international activity that's trying to detect them and stay there for some amount of time and be then continue to transit. sophisticated vessels that have periscope systems that have exhaust and intake systems so they can operate in a submerged basis. and these are all built, homemade-built vessels again throughout the region. so that gives you some idea as you look at that capacity along with a lot of other different types of maritime activity as well as aviation activity of how they're transiting these goods through the maritime environments into central america. and why are they using maritime means as they transit? primarily because there is no road connecting colombia with panama. and so they work to move around that obstacle, if you will, and

then make land wherever it's most favorable throughout central america. today that happens to be primarily honduras, the eastern and northeastern part of honduras is where we see both aviation and maritime activity principally. panama is the second location where that activity comes ashore, and guatemala is the third. and the reason they do that is then once they get on ground, they can distribute their loads. it makes it much harder to detect, and they follow the road systems up through mexico into the southwest border and across the u.s. border into the united states. so a very difficult challenge. and those networks are support being one another all the way along the path through central america. and as you, we talked about the violence has grown to pretty dramatic dimensions within central america. honduras today, 2011, has a homicide rate of 86 per 100,000. guatemala has a homicide rate of 41 per 100,000, and in el

salvador it's 66 per 100,000. there are pockets that it's even worse. san pedro sula is the most violent city in the world now, and it's 159 per 100,000, a city in honduras. so pretty significant. and it's having an impact as you look at the lives of the people who live there. it permeates entire societies, if you will. for example, if you're a prosecutor and you're focused on a high-profile case against drug traffickers, there's a high potential that you'll be dismembered, and, you know, be left as a warning to governors and to local officials. journalists, it's a very difficult to be a journalist who are now focused on addressing and writing on corruption and illicit trafficking. that's become, in many places, a difficult place as well. and it even impacts students

walking back and forth to school. if they're in the wrong place at the wrong time, they could be victims of incidental violence. it is having a significant impact throughout the region. as a result, because of this deteriorating situation and because of the capacities of law enforcement, countries in the region especially in the northern part -- guatemala, honduras, el salvador -- have asked their militaries to support their law enforcement capacities to address this situation. and as i talk with those militaries, they clearly understand their role. they understand that they have limited authority, their job is to support law enforcement. but they focus on what the government have asked them to do in the these situations. so we see enormous challenges as we look across the region then in helping support. and so that's where i see our reality is as we focus and approach this issue. it is the reality that militaries are being asked to come in and support this activity, so how do we help

train, how do we help them work so that they can better integrate and coordinate with law enforcement activities? as you look in the international waterways and air space, the caribbean and eastern pacific, that has been a traditional role for the united states military to support activities. joint interagency task force south celebrated its 23rd anniversary this past year. an interagency group, law enforcement, military, intelligence organizations all working together to address this common problem. so i see us as part of the solution. i don't see us as the solution. and i see us a part of the solution in working our capacities and working our, within our authorities to support law enforcement and other government agencies to address the overall problems that we see throughout the region. and i see us as we work to help

coordinate those activities country by country. our mechanisms from a 20th century standpoint all have very defined lanes, and that's all good. but we have, we've learned how to work within those lanes, and a lot of those ties when we work country by country we'll work bilaterally. but this is a regional problem, it's not just a bilateral problem. so how do we coordinate the activities of one country with another country with another country so that we make sure we're adding this whole way along the line, and we look at it from a regional problem. that's where i see that we have a role to play in supporting the state department and other agencies of u.s. government to address this problem. and i see the entire interagency approach growing very, very deliberately throughout the region. and from my perspective our goal, my goal -- i'll put it very specifically from a u.s.

southern command standpoint -- is to support this engagement, if you will, and support our interagent agency and our partner militaries to the point that this is not a regional security problem, but it becomes a problem that local police and law enforcement capacities can handle. and right now that is not the situation that i see within the region. so let me give you just a couple of ideas of how we support the central american region security initiative pillars, goals. because we are integrated very directly into the state department's goals as we look through central america. but before i do that, let me just also say that as i see our engagement, and we're talking the united states engagement throughout the region, it is a, it is a coordination of more than one program. so the program with merida in mexico connects with the central american region security initiative which connects with the caribbean basin security initiative which also connects

with the support to u.s. goth -- government to colombia. and we're also engaged very much with peru in a very similar manner now to help support their fight against cinder human know saw. all these different strategies are all connected, and be i think we need to look at them as a connected whole and not just as individual programs. and we are working to support each one of those with the exception of merida because that's u.s. northern command responsibility to work with mexican military in that capacity. so from a, as i look down through the pillars, the carsi pillar two is to disrupt the movement of criminals and contraband. and here's where we work very directly in the maritime and air environments to direct the detection and monitoring of illicit trafficking as it flows through those regions. but i want to make sure we

understand that this is a connected whole. all we're doing is one part of this link of that traffic as it moves through the region. as it departs south america, that information normally comes from law enforcement, intelligence and law enforcement information. that is passed to joint interagency task force south which now directs aircraft or ships to monitor that traffic as it transits through the maritime environment. and once it gets to a location where there's a ship or a capability that can intercept, that vessel intercepts, but that vessel has law enforcement capacity onboard, and so the law enforcement will then detain and move those individuals to prosecution whether that be in a host nation or to other parts to the united states. so it is a truly interagency operation. everybody working within their own authorities, within their own capacities towards a common goal to focus and support that

effort. that has been our focus for up to over 20 years now. we've recently changed strategy in our approach in the maritime environment. we call it operation marteel. it focuses on a little more, on a more persistent focus on the traffic as it's moving back and forth throughout the region. using the same capacities, same authorities that we have always used, just changing the approach that we're using to see if we can reduce the impact of these organizations and the movement through the caribbean. we can force them to move other places that makes their trafficking and their movement of their capacities in a more difficult area. if you -- and that's primarily where we're working as we support the carsi pillar two. the carsi pillar three is strong and capable governments, and the goal really of safe streets.

our programs really look to foster professional militaries, civilian-led militaries, foster respect for human rights, the rule of law and help support their engagement in the region. we're also looking to see how we can be creative within this area as well. where does it make sense to have u.s. military police go down and help support that engagement back and forth of how armed forces support law enforcement as they work back and forth within each of these areas? we also conduct exercises and training with these militaries to help build their capacity. very traditional military-to-military engagement, that still continues today. in addition to that, the next carsi pillar is pillar four, the

effective state presence, and we see that very much working with usaid, with other parts of the u.s. government with coordinating where we can support humanitarian assistance projects, where we support really building disaster response capabilities. how do we coordinate and continue to support usaid efforts and other government efforts to build those capacities where they need to be built because that's where the biggest problem is in here. so it really is working with each part of the u.s. government coordinating our efforts so that we're making the most of what we have. and then finally, pillar five is enhanced cooperation. and we do that on a routine basis through military-to-military exchanges, through international military education and training programs which help train militaries,

help educate militaries on their roles in society and help build the relationships between one another. and then the exercises that we routinely conduct throughout the region also. that are, again, very traditional, defense-related exercises that help build those relationships. as well. we find that interaction and that engagement is critical to our role in sustaining our partnerships within the region and building and growing capacity throughout the region. so let me conclude by saying, um, i think as vice president biden demonstrated as he visited the region that this really is a, from are a united states standpoint, a whole-of-government effort. but i see it as a whole-of-international effort as we look at a group of friends that is supporting this effort internationally. we see growing support from nations within latin america --

colombia is an example -- of bringing their experience, bringing their understanding to help support the countries in central america to address this key issue as well. so i see growing strength and growing connection within u.s. interagency and within the international community in building the capacity to support the governments in central america to address this critical problem. i just want to leaf you with that -- leave you with that thought that i started out with though. it is a regional, and it is a hemispheric problem. and there is no one solution from one organization that will solve this problem. it is one that we have to work together whole of government and an international basis, and i will take it one step further be, to a whole of societies also because it is the societies that ultimately will benefit from this. and everyone needs to be involved to reduce the impact of

this criminal activity. and we will play our role in supporting u.s. government efforts and international efforts to address this problem until we can help move it to a place where governments working with one another really have the capacity and the capability to address this on their own and can coordinate that on a regional as well as an international basis. i think we have a road to go on that, but that's the way i see our goals writ large from a government standpoint. thank you, i'll be happy to take questions. [applause] be. >> general fraser, thank you very much for those remarks. and while you're getting micked here for the question and answer period, i'd like to throw out, perhaps, a first question. i just returned from guatemala

where, obviously, president no lee nas has made headlines by calling for forms of decriminalization. and i think as we speak the presidents of central america are meeting in antigua to discuss proposals to bring to the summit of the americas for alternatives, you know, drug policies. um, i'm struck by, um -- and i think we all, all of us who follow this phenomenon know that for a long time the drug problem or cocaine production was center inside colombia and peru, and now we see the displacement of that. so is there, you know, if you're successful in the stopping some of the trafficking through mexico and central america, where do you think this will go next, and is there more that should be done within the united states on the demand side; ceasing weapons flows, improving money laundering.

and are there alternative strategies that might be worth considering given the tendency that we've seen over a period of decades really, um, of the production and the trafficking, you know, moving if from are one place to another? i know that that's a pretty broad question on the table -- [laughter] but i think some of the, you know, those of us who follow this issue closely, you know, have those kinds of questions in the back of our minds. um, i'd like to sort of leave that on the table and have you, you know, perhaps touch on it in various ways and invite the participation, um, of members of the audience. i'd ask you to, please, wait for the microphone and, also, identify yourself by name and by institution. um, let's start with this gentleman here. if it's okay, we'll take maybe three questions. >> okay. >> so we'll start with this gentleman. yes, veronica, right here. >> thank you, general fraser. my name is david nelson, i'm with ge now. my question is, actually, i have

two closely-related questions. one is does the definition of one of these trafficking groups as a criminal group or a terrorist group effect the doctrine of how southcom or other u.s. military engages with them and, second, your emphasis on the whole-of-government approach to dealing with the issue is, um, is important, but one can foresee a situation where the budgets of most u.s. agencies decline relative to the pentagon budget. um, you're faced with the dilemma of stepping up to fill in the gaps that are left behind as other agencies are forced by budget reasons to cut back or, um, are cut back with them leaving a hole for the traffickers. how do you address that? thank you. >> to your first question, it does differ on how we approach whether we see it as a criminal

organization or a terrorist organization. i think colombia provides the best example where we see the farc which really crossed those lines. and so our approach changes a little in that realm, but it still requires a whole-of-government approach because there's, you know, the military's not going to solve the problem by itself. no part of our government is going to solve it by ourself. we have to work all those different avenues. as i look at the whole of government, i would argue that as our budgets get pressed that that puts more emphasis on the need to improve our coordination. because more limited budgets mean that we still have the same problem, and we have to address it in a more focused manner, if you will, and it still takes each part of our government to address it. again, the issues that i see one of the reasons i think

militaries are being asked to sport -- support law enforcement and for most of the region they're the highly-regarded institution within those governments. and the populace and the government has more confidence in them than they do in other agencies. the real solution then becomes building the other capacities within governments so that the military isn't that organization that comes in and plays that role. and that's why i say it is not going to be our solution to this. we can help support those activities, but the real solution is in building the other capacities within government and the rest of society so that there isn't the opportunity for criminal organizations to have the same impact that they are today. >> okay. this gentleman here on the side. right behind you, yeah. >> [speaking spanish] my name is alex sanchez, i work for the council for --

[inaudible] what do you think of what the future role of the u.s. basis role in central america -- [inaudible] do you foresee, for example, flying out uavs of el salvador to look for narco airfields, or do you foresee that you will expand a presence there to look for drug trafficking organizations? thank you. >> i think that those locations have remained critical to the support to address the problem. and the issue as you look at the aircraft that are patrolling, they only have so much fuel on the aircraft. and so the closer you can get to the location where they need to patrol and operate from that location means you have more time to spend looking for that traffic. the more transit time you have, the less time you have there. and that's why the value of these locations has been

important to that overall international effort to counter the traffic through the maritime environment. and be i find within joint task force bravo in honduras it provides support there, but it also provides the ability to support parts of our government as well as other governments in addressing directly the trafficking through those regions. we are not involved in any operations. we just provide support. and it also helps respond to disasters and provide humanitarian assistance where required. and it really provides a pretty immediate capacity to do that where it would take us longer without that location there. so i see those locations remaining important. where and how that changes we will work with the governments in the region to see where the demand is and where the opportunities are. we'll look to see as forces

become available from wars in iraq and afghanistan whether there's a better application and more application for those capabilities. but we need more surveillance and reconnaissance capacity, and we see or more of that coming, hopefully, in the future just because of the availability of force. >> um, i'm going to take this young woman here in the blue. >> thank you very much. my name is alex -- [inaudible] i represent florida international university in miami, florida. we have quite a few relationships with southcom, usaid and many departments here in the government, and i was wondering where you saw the future of academic institutions such as ours playing a role in your objectives and the government's objectives in central america and around the world? >> i see a great relationship. we have today, as you mentioned, a very close relationship with fiu. we have a close relationship with the university of miami and

other academic institutions. and your ability to go out and study programs, help educate one another on the capabilities or requirements there help us see the solutions maybe in a different way than we would be looking at it otherwise are going to be important. and finding those solutions, i would argue, as we look even more broadly -- and i'll give you homework since you're at fiu and supporting fiu -- it's how do we look at this in a more what i would say is a nontraditional manner. how do we approach addressing the problem in a manner differently than we have traditionally approached the problems. and i'll go back and address colombia for that example. we focused a lot from a u.s. government standpoint in supporting colombia. colombia really is the success story because of their focus and their efforts to do it. we just provided support where it provided a good leverage

opportunity. be but as a result -- but as a result, as you see, trafficking organizations are moving other places. so we have to keep pressure on all parts of the organizations, not just on one part. and our systems are built to work bilaterally, less to work regionally and be less to work across agencies. so you all can help us determine solutions and find ways to address this problem differently than we have in the past. >> this gentleman here in the middle. >> my good friend. >> thank you, general, good morning. >> good morning. >> i'm guillermo from the u.s. naval world college. with the reductions in your budget and you mentioned coordination, how do you see the participation of the countries in the region to help each other, and do you see it's

feasible problems, what problems are there, how do you see that it could be solved? >> this is a very difficult issue as we work through, and let me just use the u.s. government as a example. and i'll use the u.s. military as an even more defined example. we have been working on being more joint and operating more joint for almost 30 years now. we're still evolving how we work jointly. we're evolving today the interagency coordination, and we have varying degrees of cooperation as we look within u.s. government of how we work on an interagency basis. as you go to embassies and country teams, they normally work pretty well together, but as you get to the regional basis, the interagency doesn't coordinate as well as it could there. now as you start bringing in each government and each agency with the government, it gets to

be a very complex problem. but that's the problem we have to address, and that's the problem we have to solve. and i see that there is opportunity and there are solutions there if we all focus on that single problem which is citizen security. and citizen security is all in the interest of us all, and each part of our government and each part of our interagent is si partners as well as international partners have a role to play. but we can only do that working together. so i go back to our educational institutions' standpoint. we need solutions, and we need new ways of thinking about how to approach this, and we need that from us as well as those other institutions. and the last thing i'll say going back again to the fiu question is that we've started a private/public relationship. how do we work better with the private sector. we talk a lot about governments here, but we cannot forget the

private sector. and the private sector, nongovernmental organizations, we're all part of the solution. so we all have to see ourselves as part of the solution, and we all have to work to that end. >> general fraser, if i could just jump in to pick up on some of the things you've been saying about the budgetary limitations, i think all of us who work on foreign policy face the constant challenge of making these issues of and relevance to the u.s. public. and i'm really struck by, um, the figure that you cited in your presentation of the 10 or $18 billion value of ten tons of cocaine, of one shipment. and then i sort of balance that against the amount that we've been spending over, basically, the last three or four years, and all of carsi comes to about 450 million. we, obviously, face budgetary constraints in this country. do you see the american public and the congress in particular,

um, in growing to understand the magnitude of this problem and being prepared to, perhaps, do more to support the variety of efforts that you've talked about? >> i think it's a complex problem, and it fits within a mosaic on a global basis that there are other issues that our government and our nation is looking at. so we just, we put it in that context, and we keep working within that context. and so i'm comfortable with where we are and how we're approaching it, but the real issue and real capacity for me is how do we connect those capacities that we have better to make a difference in that manner? and then we need to continue the efforts that we already do. i don't talk about what's happened in the united states a lot because that's not where my focus is. but the government, u.s. government is spending, investing over $10 billion a

year looking to reduce demand, looking to educate, looking to help support, counter drug activities in the united states. but the one thing we don't talk about in the united states is drugs are directly related to the deaths of over 37,000 americans a year. that's more than we kill on the highways. but that doesn't get resonated. there are criminal organizations who have networks, are part of these networks in u.s. cities. there are problems within the united states also. this is not, we're not divorced from the problem. so both domestically as well as throughout the hemisphere we need to help support all parts of it and do our part within the united states as well. >> thank you. here in the middle in the back, yeah, right here. >> [inaudible] >> not sure the mic is on.

>> thank you. [inaudible] partners for democratic change. i was wondering if you've set concrete metrics for success for southern command, and as you discussed citizen security a lot does that mean you're looking particularly at homicide rates increasing sort of indicators within that area? would you consider an increase in the price of cocaine on the streets of the u.s. to be a successful indicator? what, what are you using to measure progress in this? >> we have traditionally looked at the national drug policies number which is to get to disrupt 40% of the cocaine flow that comes into the united states as that goal. and there has been a steady goal up to 2015 to address that issue. that has been a traditional because our focus has been in that detection and monitoring. if you look at the price of

cocaine, it's gone up, it's gone up 50% over the last five years. the quality has come down, so those are indicators. actually, the use of cocaine has been going down in the united states over the last three to five years, but the use of other types of drugs is going up. so there's still a demand issue here, and we can't just focus on cocaine. so that's what i'd say there. but beyond that x this is from an interagency standpoint as well, we're really in discussions right now of what are the right metrics, how do we look at this as we cross interagency boundaries, and how do we focus our efforts to improve the way we have been supporting and working. so that's -- i don't have the answers exactly. if you've got ideas, i'm open to whatever there are good metrics that would help us measure that better.

>> sure, right here. one second. >> luis cardona. about two years ago i had the pleasure of being part of an initiative that i believe led by secretary gates called unconventional warfare where it had in place it was like this war games scenario, right? we were focus being on central america, and it talked about the level of coordination that you've been talking about, general fraser, in terms of how to address not just trafficking, but a wide array of citizen security issues. and coming from the more grassroots perspective and experience myself and not being in government, i was really impressed with the process. so my question to you is, well, two questions. the first question is how do you see something like unconventional warfare being used as a strategy to bring

about the level of coordination and everyone getting on the same page? because it's my belief that i think there's some serious potential there. um, the second piece is if that strategy continues to stay as such, is there a possibility that we could then try and make efforts to involve some of those other countries in the exercise like that? that was the first thing that came to mind as i sat through those ten days, um, out here in potomac, maryland. if we could just have a wide array of people from those countries involved in this process, i think we could do some incredible work. >> there's already a lot of support and a lot of initiatives going down. i won't call it an unconventional warfare approach, but the state department has a group that is working very

deliberately on how we work this interagency effort and focus those efforts to build that strategy. it supports carsi, but it is how do we help put a little more finality, detail into how we approach that effort. we look at countries within the region. sica is focused on this effort as well. other countries as well as latin america and the international community are also bringing their capacities, and i see a lot of different efforts that are focused here. there's efforts within the united states government as well as sica to coordinate those efforts. so this is a work in progress. and it is improving. maybe not as fast as i would like it to see improve, but it is improving, and we are moving and taking very positive steps forward. and that needs to just continue

to be our focus. and i get a sense from everyone i talk with that that is a key focus, and we will remain engaged in that manner. >> gentleman here on the -- with the -- yeah. with the moustache. >> yes. i'm ramon with the scale group here in washington d.c. you mentioned in passing the caribbean. would you care to comment on the role of puerto rico which is rapidly increasing entry and transshipment points and where drug-related violence is approaching central american levels in the middle of an economic crisis which is beginning to look like a collapse? >> well, the trafficking organizations are looking for any opportunity they have and looking for those areas. today on an overall basis the traffic through the caribbean is much less than it is in central america. we continue to monitor that. it has a differing impact as you

look at central america, but the same kinds of programs as we look at the caribbean basin security initiative, and that's where i'm focused. but other parts of our government are helping address and support the issue within puerto rico. so that's just, again, as we look at carsi, all these different elements. the united states and territories of the united states are all part of that solution. so i don't have specific answers to you right now other than it remains as i work with u.s. northern command and work with other agencies within the u.s. government a very clear focus that it's not just central america, it is a regional look. >> all the way in the back over there. >> hi. my name's tara, and i'm a public policy scholar, and i'm also a journalist. i write for "newsweek" and "the

daily beast." can you tell us about the submarines, the ones you described. like how many are there, are there more and, also, how do they build them in the jungle? >> a lot of those questions i can't answer. [laughter] >> this is not an open session. >> well, they are built in the jungles, like i said, they pull them or they have construction sites in estuaries along the coast of colombia and south america. very hard to find, very hard to discover. and they take commercially-available products, and they construct a vessel. again, the dimensions, 100 feet long, a crew of four to six, some pretty sophisticated vessel s. the ecuadorans captured one over a year and a half ago that had both diesel motors and electric motors, it had batteries, it had

a video system so that they could look outside and see whether or not there was an approach from another vessel. it had a navigation system. and so it had not gotten under way, and so that was an opportunity to understand this capacity. i can't tell you how many there are. i just don't have that information. and it's a difficult vessel to detect. and so we're working on both where they're building them, see where the opportunities to detect them in the transit area, where and how they work and offload their cargo to figure out where is the best way to continue to address those problems. we have seen a growth, though, that's fully symmetrical. they take a little longer to build, maybe a year or longer than that. and cost a little bit more money, but the return is the same as we've talked before.

this is the first year, also, we've seen semisubmersibles, built a very similar vessel, just stays on the surface. we've seen them for the first time in the caribbean. so we're seeing expanded use of these types of vessels for the transport of not only drugs, but we see, we've captured some cases bulk cash moving back south. so it is a transportation vessel. ..

to get the armed forces out of an internal security role so i guess given that, that sort of contradiction or conflict, what role should the u.s. government play? is there a role for southcom and reinforcing the law enforcement capabilities in central america and how are you working or how a is southcom working to bolster that element of the government response? >> we work very deliberately with our partner in the military and focus on respect for human rights, rule of law, their role in the government organization and a civilian governments, and what i see very deliberately and very consciously from the militaries that i work with is a very keen respect for their role and where they should be conducting operations. the governments decide on a case-by-case basis how they

choose to bring the military into that focus. we have a very limited role in helping support some law-enforcement capacity, and that really is helping build facilities that help them operate, but the real training is the department of state and other parts of our government so our efforts are to coordinate with them. and ice bicmos cemetery in country bike country but they are providing security for law enforcement, so they are not arresting people and again a very center by country but they are providing security where those law-enforcement agencies might not have it otherwise. so they are looking for the solutions that respect their role in society, but understand that they have and the governments are asking them to play a role in the citizen

security problem. >> in the blue shirt. >> good morning. i am jill wheeler and i was intrigued by your comments about this public/private sector engagement. i wondered if you could just expand and describe a little further what form that is taking or are there certain countries or activities in which you have seen the most progress or seemed the most potential? >> a lot of that public/private and we are just expanding to see where the other opportunities are, and it really, you know it's just an opportunity where we can connect some engagement where we might not otherwise. for example, if we go in and build a school, we don't have the authority to equip it and we don't have the authority to pay for teachers or to provide teachers or other capacities so we will look to see if we can find a private organization, who

can provide that capacity. we are just linking up opportunities, so that overall, again we respect our authority and i'm not trying to change that. we are just looking as we cross all these problems, that there are solutions. we just have to look in a different manner and a lot of this goes back to disaster response. haiti is my best response to that. is responded to haiti there were lots of private organizations that were looking to us. in some cases there were organizations that had products that they needed moved and there were other airlines, cargo companies who could move, but they didn't understand how to connect to the opportunities. so we just provided the connective tissue to help them do that, working with a sid, with trying to help support those opportunities so as we look to the future, that is what i see. as we work with a.i.d. projects

and we work with a lot of different programs, how can private industry support government activities and not just the u.s. led post-government activities as well. is an area where i think there is a lot of growth opportunity. >> if we can do the 32nd advertisement, the central business school is involved in just that kind of project to engage the private sector in citizen security issues and there'll be a conference on april 19 at the world bank, with dean kai and also playing a role so i think across across-the-board a lot of people see this is a really vital part of the solution, coming from countries themselves. i think we have time for two more questions. >> and i just added in one thing? it is when the society decides

it is their problem to fix that we will find a solution. and that is the real crux of this, and that is why i think from my standpoint it's important to enlist and help them understand how they can connect with various government activities to provide part of the solution. and that is why we are looking at where those opportunities are and to support our duties and as we support other government activities to build those relationships and those opportunities. >> thank you. my name is -- and you mentioned there are some concerns in the region. i would like to know if venezuela is one and what specifically are these concerns? you mentioned recently some issue involving drones and

venezuela and i was wondering if you could make some comments on that? thank you. >> we will take, right here. >> she asked a question. >> no, do you want to take a couple of questions and come back for one final answer or do you want to go one-on-one? however you prefer? >> let me just answer. on a military-to-military bases, we have very small relations with venezuela today. and that has been more their intent been our intent, but there is just no cooperation that we have have seen back and forth between venezuela and the united states. we face common problems. the issue we are we are talking about is a common problem, and

from my perspective venezuela has not stepped up within the u.s., within the international community to support these efforts to the level in which they could, and i think there's an opportunity for them to help support and address this problem because as i mentioned, it's a supply-side to a transit to a demand side demand-side and all parts of this effort needs to be addressed. the coordination that they have between colombia and venezuela has improved. over the last couple of years. i think that is a very helpful indication and i just would like to see that cooperation grow as we face this common problem. >> thank you. my name is alexander. i may former civilian government official. i wanted to go back to the question on the intervention of the military that is being called out to help with law

enforcement. what are some of the metrics to determine whether that has been a successful, whether that is a successful effort? both metrics of policymakers should be looking at it to determine the decision are we making progress or are we not making progress because want to once you get the impression that, i don't want to call it a publicity measure. it's visible. the soldiers are out in the streets but what does it specifically -- how does it specifically add value in terms of solving the problem? >> again, each country has to decide what that is and what the standpoint of el salvador, they have asked, now more than half of the military is engaged in supporting law enforcement activities, and they are supporting the operations of prisons as you know as well as supporting law enforcement.

and what i see is, it is the security and homicide rates is one measure. i think we need to look at some other definitive measures also, but that is not again the only measure and i think the best understanding of that is that we put pressure on some of these organizations they will become more violent rather than less and i guess the other impact that i would see is i understand that some of these organizations are starting to focus on attacking the police and the military because of the impact that they are having on their operations. so in my mind that is not a very good measure. it's not a positive one but it shows the impact of their security and more folks on the streets. again, that is not from a law-enforcement standpoint. it's from a security standpoint and the cooperation that goes back and forth to help them out. that is an area i think we need to do more work in to figure out

what are the exact metrics that help us understand where the positive factors are and where they are not. and going back to colombia i think there's an opportunity to understand that from colombia's perspective, and that is just a perspective because they have been working this issue. we need to understand in each of the countries as we go forward and see how we can move those metrics, so i don't have a very, a specific answer for you yet. again, we are working our way through to understand how best to measure that impact as we support governments and as they address this on their own terms. >> do we have time for one more question? all the way to the back. >> to go back to the original question. >> if you could identify yourself. >> larry heilman from the anthropology department at the

smithsonian. to go back to the original question that you post and the platform that you are using to address the issue, i would like to add to that equation. i am surprised that libya was the intervention -- mentioned as being a problem but maybe that is because of the fact that we have rls as the president but are you saying that to protect this enormous development that we stayed in bolivia for 60 years, seems to have some real progress in that area, but also the whole area of alternative development and agricultural production. i'm just curious to see if this is still on the radar scope and if there is anything that has been done in this area in terms of joint efforts, between the military and the state department and a.i.d. etc.? >> it is still part of our focus. we are engaged with all of our

partners in the region through military-to-military engagement. our military-to-military engagement with bolivia has been reduced over the years. their desire, not our desire and from a drug enforcement agency standpoint, that has been a very much reduced as well. but, we are and there is a trilateral agreement that has been formed between brazil and bolivia and the united states to help address this transnational organized crime issue across the borders, brazil and olivia so began a is playing a role in that effort, and not us directly. that really is other agencies and the united states government so there is still -- and we are looking for the opportunity to continue to work together with them. again we all face a very similar problem and it is only in

working this together that we are going to really be able to address. i talked a lot about central america and the impact there, one because that is where i see the biggest violence issue and the biggest impact on security and from a u.s. perspective that is the area that expects us most rackley from a standpoint. that said we are very engaged with all the other partners. on a mutual relationship and a mutual partnership and i see that very much continuing. >> general fraser would you like to make a final comment, one last thought that you would like to leave us with? >> i will begin or end with how i started and that is there is no one solution to this problem. we all have to decide that it is our problem and we are going to be a part of the solution. every one of us has a role, whether it's here domestically or whether it is supporting

activities in governments internationally, so i would ask for your ideas, your thoughts, your engagement on how we can address this issue writ large because it is an area and it is an issue that is going to continue to impact us. i would ask us not to focus just on drugs either, because it is criminal activity. my example of that is, i was in colombia about three or four weeks ago. the problem, because of gold prices, the problem of illegal gold mining is growing. the problem of illegal mining is growing in other places to support criminal activity. the same organizations are engaged in this same type of effort, so we need to look at it from what it is and what roles we play to address that problem overall. thank you for the opportunity to talk about it. [applause]

>> you have been very generous with your time and we certainly all appreciate the leadership you have provided to south, and we wish you well. >> thank you very much. >> thank you. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] from this program we go live to the pentagon where general john allen is about to brief the

media on u.s. military operations in afghanistan. he is a leading commander in that country. just last week general allen was on capitol hill testifying before the senate and the house armed services committees regarding force levels and the tension between the u.s. in afghanistan following a deadly shooting rampage of afghan civilians and the accidental burning of the korans. we expect this to get underway in just a moment. [inaudible conversations] [inaudible conversations] [inaudible conversations]

[inaudible conversations] [inaudible conversations] [inaudible conversations] >> again we are live at the pentagon this morning. general john allen is expected to brief the media on u.s. military operations in afghanistan. it should get underway in just a moment. while we have a second the supreme court has apparently completed its first hour of oral

arguments in a series of cases about the united states health care law for the next three days the court will hear six hours of oral argument to determine the constant change now the of the patient protection and affordable health care act. the court also a release same-day audio the argument throughout the week and you can hear it as it is released. is expected around 1:00 p.m. eastern each day. it will be on c-span3 and also on c-span radio. if you go to our web site c-span.org you'll find it there. add your comments. [inaudible conversations] [inaudible conversations]

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[inaudible conversations] >> general john allen coming to brief the media momentarily. the house and senate are in session today. the house returning at noon for morning our. 2:00 for legislative business and this week house members plan to take up short-term 90-day extension of the bill dealing with service transportation programs. they will also consider a house budget resolution which is the tax and spending blueprint for fiscal year 2013. live coverage of the house and her companion network c-span. the senate will gavel in today at 2:00 p.m., at 4:30 they will start debate on a motion to roll back oil industry tax breaks. a vote on that coming up is five-time for 30 this afternoon. see the senate of course here on c-span2.

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[inaudible conversations] >> as we wait for general john allen from the "associated press" this morning, two british troops are dead after the latest attack i afghan security forces under international allies. officials say an afghan soldier opened fire on the troops at nato coalition bases in southern afghanistan before being shot and killed by international forces. so far this year, 15 nato servicemembers including eight americans have been killed by afghan security officials or by militants disguised in afghan uniforms.

[inaudible conversations] [inaudible conversations] >> i would like to welcome to the pentagon pressroom in the podium general john allen, the commander of the international security assistance force in afghanistan. general allen will have a short statement and then we'll take your questions. captain john kirby the pentagon

spokesmen will moderate and direct questions to him as he will call on you. general allen. >> ladies and gentlemen, good morning and thanks for coming and giving me this opportunity to join you today. some of you may have seen my congressional testimony last week and in fact i have seen a good head of the coverage from those hearings so i suspect you are familiar with the basic points that i try to make about the progress that we are making in afghanistan. i won't repeat it all for you here this morning but i like to make a few points before we take your questions. first the case of staff sergeant dale's i extend once again my sincere condolences to the loved ones, family members and friends of those who were killed and injured in that senseless act of violence. i also extend my deepest sympathy to the bales family who are going through a great deal right now. they deserve our support as they

come to grips with the inevitable changes that will cause a change in their lives. charges as you know have been referred against that sergeant bales and compensation payments to the families, the families of the victims in keeping with cultural norms have been paid in both the criminal desiccation as well as an administrative investigation continues. i'm sure you can understand that because these investigations are ongoing and jurisdiction has been passed to officials the joint race willis mccord i will not be able to go into more detail about this case today. i would like to assure you that the investigators have and will retain my full support toward the facts and take them where they may. let's let the investigative and judicial processes play out in their own time in accordance with our regulations. speculation in the media and through anonymous commentary serves no one's purpose in our

interest and in our earnest desire to see justice done here. second on the issue, the future troop levels, it was very clear in my testimony that after recovered the surge the september i will conduct an analysis of the kinds of combat power we will need in 2013. i said i believe that the power to be significant but i did not say it will need to rest at any certain level throughout this year or 2013. the truth is there is no way i can know that right now. certainly not until we have emerged from the fighting season and not until after i've had the chance to assess the state of the insurgency in the aftermath of the fighting season. the operational environment that we anticipate in 2013 and the capabilities of the afghan national security forces going forward. it is not just a matter of what to do with the remaining 68,000 u.s. troops. i must also carefully consider the combination of forces in

theater. there will still be some 40,000 isaf forces in the field and increasingly capable, increasingly numerous afghan security forces. force levels will represent a composite number. that is a key point. at american forces as a component of the international and indigenous force on a separate and distinct entity. and as i said it is not just about the numbers either. it's about the operational environment in which we will find ourselves in 2013. we have done much to deny taliban resources and sanctuary. i believe we have made it harder for them to succeed in a spring offensive of their own but we need to get through this fighting season for me to fully understand that amount of combat power that we will need in 2013. i owe the president and my chain of command a conference of recommendation about all of this. i owe them options to consider and to think through and i know i have their support to take the

time i need in the fall to develop those options further. finally a word about his transition. i meant what i said about transition being the lynchpin of our success of the four priorities i laid out to our command when i took command on the 18th of july. the first of these was to keep up the pressure on the enemy and we have certainly done that. but a very close second was to focus even more sharply on our efforts to grow and to develop a nsf capabilities. they really are better than we thought that they would be at this point. more critically, they are better than they thought they would be at this point. i use an example the bravery and the skill which they demonstrated when they attempted to quell the violence that resulted from the protest last month, bravery that cost them lives in more than 60 wounded. i could just as easily point to the literally thousands of operations, some large, some

small, that they conduct a long isaf troops and often in the lead every month as we go forward. in just the last two weeks alone afghan security forces across the country on their own arrested more than 50 and killed nearly half a dozen insurgents including several who were planning to assassinate the governor of the province. over the course of what turned out to be more than 20 operations nationwide they have also captured several caches of explosives, weapons and bomb-making materials and it isn't just about the army doing good work. the police too have been contributed to the security in the cities and the towns. most recently protecting the celebrations. i know people will look at these and other examples and say they are anecdotal, that we still face real challenges in attrition and ethnic opposition and even corruption and some of the ranks. i'm not saying things are perfect. much work remains to be done that for every bribe accepted and for every insider threat or

what is known as agreeing on blue incident and i think you are rather tragically we had one overnight as two young british soldiers were killed in a helmand province. for everyone afghan soldier that doesn't return from leave i can cite hundreds of other examples where they do perform their duties, where the partnerships are strong and the confidence of the afghan forces are building and the trust and called in and we have in them and that they have in themselves grows steadily. those who would make the argument otherwise will never convince me that these brave men don't have the will to fight for their government and for their country and for their fellow citizens and that willingness i believe is the thing most hopeful about the entire effort of transition. they want this responsibility, they want to lead and we are going to help them to do that. with that i've will take your questions. >> general one question.

there has been some ongoing confusion over the number of casualties from 16 to 17 and i was wondering if you could address that briefly and then secondly considering the corruption and the green-on-blue incident, can you talk a little bit about how you think the kent can give the afghans some advanced notice or use a procedure for the night raids and how do you think that can be done without damaging or hurting operations? >> i am getting your one question in three parts so just the second. there is, there was an increase in the number of what we believed to have been those who were killed tragically in this event. but this is the number increased was based upon the initial reporting by the afghans and so we should not be surprised that

in fact as the investigation went forward, that an additional number was added to that. so that is something that we understand and we accept and as the investigation goes forward we will get greater clarity on that. on green-on-blue, what we also call the insider threat we are going to continue closely to heart and with the afghans because they think you are where we have done that significantly in the last several months. the afghans themselves who also suffer from what is euphemistically called green on green, they have taken a lot of steps themselves in the vetting process. they have worked very closely within the national director of security to place counterintelligence operatives inside their schools, inside their recruiting centers and inside the ranks. the idea being to spot and assess the of potential emergence of an individual who could he an extremist or in fact

a taliban infiltrator. they have done that themselves and we have taken action within isaf with respect to a tactical corrective, orders that i've issued pre-deployment that we have asked services to undertake both within the u.s. context but the nato context as well to better prepare our forces across the board. so i think between what the afghans have done for themselves and what we are doing for ourselves and how we are partying together, we seek to reduce this tragedy to the maximum extent possible and with respect to the night operations mou, we are actually at a pretty delicate moment in the negotiations. i am confident that we will end up where we want to be on both sides and i will just leave it there, so thank you for the question. >> general, speaking of green-on-blue, about a month ago the afghan interior ministry, there were two american military

officers who were killed, murdered and as the people at the pentagon put it. initially afghan officials said they had a suspect in that case, a driver for an afghan official. i think recently told cnn there are no suspects in the case at this point. could you elaborate on where that investigation is and how can there be no suspect or arrest made in the case where the building is highly secured, were there cameras and people would know who is going in and out of that building? >> we will need to let this develop a bit more and at this juncture i think they are still significant investigation that remains, not just on who they believe might have conducted the shooting, but also wear ties may be elsewhere outside the building into the taliban so more investigation needs to be conducted at this point. [inaudible] >> not that we have, not that we have been presented at this point. >> have you allowed all the advisers to go back into the ministry's? >> i have permitted by

commanders to do assessments on all those areas where our advisers are involved, and they will come back to me with their assessment that the situation is now sufficiently secure for our advisers to go back. most of them are back at this point that we will continue to evaluate the security situation as it develops. >> if i if i could follow up general? with the two deaths today, 15 isaf servicemembers have been killed in the screen on blue incident. that is about 25%, almost 25% of all the isaf casualties so far this year. what accounts for the increase in these kinds of attacks on isaf forces? do you considered a significant threat and is there evidence that the taliban is actually purposely planting, infiltrating the afghan forces or are these just random acts? >> that's an important question.

the taliban of course takes credit for all of them, when it that the majority are not a direct result of taliban infiltration. is also no secret that the taliban has had as an objective for some period of time infiltrating the ranks of both the ansf and those elements that support is directly. it is difficult to tell right now whether this is an increase in the operational tempo, but i think that we can all probably assume that with some of the incidents that have occurred, in the last several months, that has been a potential causal factor in some of the extremism that resulted in the green-on-blue events. >> general, how does the u.s., how does the british and the french, how can they work side-by-side and at many cases sleeping in the same and can't meant with this kind of threat looming over them? >> in many cases the

relationship is very strong, in fact in most cases the relationship is very strong. they know each other well. we have taken steps necessary on our side to protect ourselves with respect to infect sleeping arrangements, internal defenses associated with those small bases in which we operate. the posture of our forces to have someone always over watching our forces. on the afghan side, they are doing the same thing. they are helping the troops to understand how to recognize radicalization and the emergence of extremism in some of those individuals who may in fact be suspect, but they are also being trained and through the use of the mds. they are also very quick to be able to report this as well. there have been some break-ins in fact in afghan investigations and arrests that have been

elements that potentially could have been a perpetrator for green-on-blue so the process of that is important. your question is a very important one and we will watch that closely to see if this is a trend over which we have to take even more issues. >> a follow up on that. are you concerned about revenge killings based upon the bales case and the perceptions in afghanistan as you may be getting just as not being done and then i have a second question. >> i don't connect the two of those but in any case, it is prudent for us to recognize that as you know, revenge is an important dimension in this culture so we would be prudent ourselves in looking for the potential for that to emerge. so it is something that we will keep an eye on. i have seen no indications yet that it has emerged as a potential factor, but we will certainly keep an eye on that.

>> and a second question on the safe havens. two major challenges you pointed out last week to congress for corruption in this safe havens. what level of degradation to the safe havens do you need to see over the next year to give the president some level that is you transition the safe haven still won't remind a vibrant sanctuary for the taliban and haqqani network? >> an important question. we will need to see the cross-border movement of insurgents and the safe havens reduced. we believe that as a result, if you have been following and i'm sure you have the reduction and the enemy. if we see that a second year there will be important indicators about whether the safe havens have in fact or are operationally relevant to the insurgency. but we will also continue to push for as much philosophy as

we can achieve in reintegration. that has also helps is recalling that many of folks who lived in the safe havens lived in afghanistan and they were there for sure period of time. if we can accelerate the value of reintegration that is another means of neutralizing the safe havens. and then of course the process of reconciliation. i'm not personally involved in reconciliation but it is a peacemaking process which could in fact, should a political outcome ultimately emerge from reconciliation in conjunction with the reintegration process. it could in fact inflate the fact the value of the safe havens ultimately to the insurgency because many insurgents will someday go home to become part of the future. >> do you see more pakistan military involvement? >> well, we would always enjoy pakistani military assistance across the order but i will tell you they are deeply engaged across the border. in the last couple of years they

have suffered 3000 dead and a couple thousand wounded, and they have an ied problem from the taliban on their side of the border that is substantial as well. so while i would not purport to dictate to general kayani how he should conduct his operations there are rigorous operations across the border and my hope is that as his relationship and mine continue to unfold, we could perhaps cooperate with complementary operations. >> just a follow to follow up with one question. general, given the string of initiatives that you have talked about, do you think that there is a problem with leadership by your senior ncos? had they been worn out by repeated deployments and so therefore are missing things are not enforcing things? is leadership breakdown a common thing between your nation and

the koran burning, the killing of afghan civilians and what are you doing about that if so? >> each one of those was a result of a leadership failure in some form or another but i think as i understand your question, as i think back across how many tens of thousands, hundreds of thousands of our forces have served in afghanistan, these incidents have been so in frequent. as i know the force myself and i have to speak more as a marine than as a soldier but although i believe there is virtually no difference in the institution of the army and the marine marine corps in this regard. after this period of time of war, we find that our staff ncos and our noncommissioned officers and our young officers are extraordinarily well-trained, and so repeated

tours in afghanistan and prior to that in iraq don't inherently reduce the effectiveness of the force or reduce the effectiveness of small unit leadership and indeed over the years in our school systems and i recently spoke at one of the schools down in quantico for example, the kinds of institutional emphasis by our great army and marine corps are insuring that high standards of leadership and supervision are not just sustained by the enhanced, still remains at the core of those two institutions. .. know, in a

counterinsurgency is where the most important leadership occurs on any given day. >> sir, can you please explain why there was a decision to pay out compensation to victims' relatives before we even have a verdict? >> it is a natural and a cultural norm that we would pursue. we've done that in the past. and in this case, it was appropriate we believed given the circumstances of this particular tragedy.

>> can we get a total of the comps paid out for this incident and for the war and can you explain how it's done of using these suitcases of cash given to four families -- >> we can provide all that to you. we'll get that information for you. >> general, can you elaborate at all about the defense department ordered review of the antimalaria drug, when you were made aware of that and deployed troops and when you were given -- were made aware of it. >> i was made aware of it. as i understand it within the department so i think that's the best i could do for you on this. >> you were not told there was a specific concern regarding troops that were deployed, being given this drug? >> no. there are reviews constantly of our medical processes and procedures. that's not uncommon at all. and so when i hear that one of the antimalaria profolaxic drugs

are under a periodic review i think that's a very natural and important process that is pursued regularly and off the secretary of defense so i would suggest that you ask them that question. >> sir, when do you expect the border with pakistan to be opened? and have you asked the haqqani group be left as a terrorist group? >> i think the border -- i don't know specifically when the border might be opened. but as you know, there's a review of the relationship underway on the pakistani parliament and i believe probably as a result of that review, the policy relationship by the parliamentary committee of national security, i believe it's called, we might find a recommendation in that -- in that review. otherwise, i have no particular indicators at this point. >> have you asked the haqqani group to be listed.

>> yes, i have, yes. >> and why not charge anyone in the killing of the 24 pakistani troops? >> well, the investigation was clear that there was no criminal dereliction of duty but i did take administrative measures. [inaudible] >> sir, do you share the analysis of some in nato that most of the heavy lifting for prison is on track to be completed by mid-2013? if so, how does that affect your analysis of what continued troop component you'll need and when you talk about analyzing the combat power that you'll need after this fighting season, where are you looking for this distribution to consolidate games in the south to perhaps launch a greater offensive in the east? >> those are two very different questions but i'll try to bring them together. and i'm not sure that there has been analysis that has specifically the heavy lifting of transition is done by the latter part of 2013.

if you know about lisbon transition there are about 5 tranches of afghan geography that actually move into a process of transition. the fifth and final of those tranches will occur -- president karzai will announce it probably in the latter part of 2013 and we'll begin to implement that tranche probably in the early part of the fall. and technically, the ansf moves into security lead with a fifth tranche across the entire country but that process will continue until we reach the end of 2014 where technically the ansf is fully in the lead across the at that point where that fifth tranche enters into implementation, enters into the transition process, we will then be in support of the ansf as they move into the lead for security across the country. did i get your question into that? >> well, you think we're on track -- that you're on track to

actually do that and if so, how does that impact -- >> great, thank you for the follow-up on that. as you might imagine, some of those tranches -- or some of the components or the elements of the tranche 4 and 5 are in the east. and so we would both anticipate that in the natural course of the campaign, which will emphasize this coming year, consolidating our hold in the south while still operating -- conducting counterinsurgency operations in the east we will see eventually a confluence of the movement of geography into the transition process and the campaign seeking ultimately to facilitate and accelerate afghan security operations in the south and ultimately in the east so the two come together. >> and they'll come together you believe in 2013? >> probably 2013 but we will continue in '14. >> general, going back to the

incidents, secretary panetta has suggested in his comments recently that we're not going to see the end of these and that this is part of the price of war. would you agree with that? >> i think it is a characteristic of counterinsurgencies that we've experienced before. we experienced these in iraq. we experienced them in vietnam. and on any occasion where you're dealing with an insurgency and where you're also growing an indigenous force which ultimately will be the principal opposition to that insurgency, the enemy is going to do all that they can to disrupt both the counterinsurgency operations but also disrupt the integrity of the indigenous forces that developed. so we should expect that this will occur in counterinsurgency operations and as we saw it in iraq and as we've seen it in -- historically in counterinsurgencies but also in

vietnam, it is a characteristic of this kind of warfare. >> did the -- just to be clear did the afghans miscount? did someone die after the initial assessment? >> we'll have to let that come out in the investigation. >> this will be the last question. >> general allen, i want to go back to julia's question if i might on the issue of command climate if you will. how do you know -- how do you know yourself that troops aren't exhausted to a breaking point, commanders ncos are exhausted. the notion that there's alcohol on the base and people go on and off a base -- it's not what anyone would think of as typical in your area of command. so how do you know -- how do you know that you don't have troops at the breaking point, some troops from ptsd or traumatic brain injury? >> well -- >> what are you doing to look at

these questions yourself? >> well, on a regular basis i talk with our average command chaplain. i talked to our command surgeon. i talked to my command sergeant major, all of whom are traveling. all of whom are taking the temperature, if you will, within their areas of responsibility and all of those have a very important interconnection. i'm traveling myself on a regular basis just before i came back here. i met with the commanders of every one of the regional commands and they gave me an assessment on the state of the command and the state of their campaign as they see it unfolding right -- not just today but how they see it unfolding in 2012. and i'm very fortunate because of small leadership because that's what generates success in a counterinsurgency. so there could be as your question implies. there could be troops that at an individual level do, in fact, demonstrate or evidence the traits of ptsd. but i have to implement the

services in this way. the army and the marine corps have gone a very long way to try to help both predeployment preparation or the deployments to afghanistan but also while we're in theater with our behavioral health and operational stress teams, the religious support teams, the constant review by leaders by how the troops are doing in the context of an after-action review and when they go home -- what the services do for the troops on their return from the deployment. >> something went terribly wrong. investigation pending, something went terribly wrong. how are you making sure something like that doesn't happen again? >> very important question. we're investigating this one very thoroughly. and i'm looking at command climate, in fact -- >> of that unit. of that unit, in fact, as a direct result of these actions and while i'm not going to get into the details about

describing the unit or this particular event, i will be satisfied when i get the report that we have looked closely at the potential contributing factors that might have permitted this event to have unfolded tragically. >> thanks, everybody. i appreciate it. that's all the time we have. >> thank you, ladies and gentlemen. have a good morning. >> and a live picture of the supreme court here in washington, dc, where oral argument has been heard today and will be for the next two days in a series of cases about the nation's health care law. the justices are hearing a total of six hours of oral argument that will determine the constitutionality of the law. the court will also release same day audio of the oral argument throughout the week and you can hear it as it's released at about 1:00 pm eastern each day. that will be here -- actually on

c-span3 also on c-span radio and at c-span.org where you can also listen and add your comments. and we're also talking about -- [inaudible] >> how interested are you in the supreme court oral argument on health care? you can weigh in on our facebook page at facebook.com/c-span. and so far 338 people have voted very interested. 16 people somewhat interested and 9 votes for not interested at all. senators are back today. the house returning at noon eastern for morning hour and 2:00 pm for legislative business. this week they plan to take up a short-term 90 day extension of a bill dealing with surface transportation programs and they'll also consider the budget resolution for 2013. live coverage of the house is on c-span. the senate gavels in at 2:00 pm eastern, at 4:30 they'll begin on a debate on a motion to roll back oil industry tax breaks. votes on that at 5:30 eastern.

live coverage of the senate when they gavel back in here on c-span2. the stockholm international peace institute recently hosted a panel discussion on international arms transfers and trade and its impact on global security. leading experts who took part in the discussion agree there are very few controls in this area and that means change. the u.s. along with several other countries will attempt to negotiate a legally binding arms trade treaty this summer. this is about an hour 40 minute minutes. >> good morning. and welcome, everybody. i'm the executive director of sipri north america. this is the newest research center of the stoke holm international peace institute based in washington, dc. now, as many of you may well know, sipri is a very

international research institute dedicated to research on armaments, arms control, disarmament but also regional and transnational security issues. i think many of you might be familiar with sipri's annual yearbook which provides very authoritative information data and analysis on security and conflict, military spending and armaments, nonproliferation, arms control and disarmament issues. what you may not know is that sipri is increasingly present in the major decision-making centers of the world. a few years ago, sipri opened an office in beijing in china and since february 6th we now have an office here in washington, dc. and i must say i'm absolutely delighted that we're colocated

with a terrific institute is he stimpson center. now, the aim of the sipri north american office is to bring new global innovative offices to the security and foreign policy debates across north america, to strengthen cooperation between european, american and international experts and institutions. and we will be doing that by bringing our colleagues from stockholm to this side of the atlantic by organizing events and round table discussions like the one today. by seeking partnerships with other institutions, university think tanks, governments on this side of the atlantic. now, in terms of research, sipri north america will initially have a focus on four main areas, the first is women, war and peace, gender issues if you want

and we have already a number of projects in the pipeline we have a conference on staten island violence in post-conflict settings that will be held in november later this year. and a multiyear project on the u.n. security council resolution 1325. this was the resolution adopted by the security council some 11 years ago that -- a mandate that states to pay greater attention to the participation of women particularly in peace negotiations. a second area of research will be on global health and security, a third on regional security issues and here we'll have a particular focus on central asia and what's going to happen in that region in the broader central asian region after the drawdown of allied troops. and then last but certainly not

least, arms control and disarmament. the sort of bread and butter issues of sipri. now, back to today, this is one of our first events, first big public events and i think it is very fitting that it features one of sipri's flagship programs, namely, the conventional arms transfer program. each year paul holtom and his colleagues of the expenditure program do a superb job and provide us with authoritative data that many inside and outside of government have come to rely on. i think these type of data are crucial if we want to better understand what is going on in the security field. it allows us to identify potentially destabilizing,

forces and in hence and in theory it also allows us to develop policies to de-escalate policies of tension. i think the sipri data for 2011 shows that the conventional weapons trade doesn't seem to have suffered much from the economic crisis. and while we're all preoccupied particularly in this town, with nuclear proliferation, the conventional weapons are the ones that are actually killing people around the world. 2012 is going to be an extremely important year in terms of conventional weapons we might see the conclusion of the treaty that will regulate the global arms trade. this treaty will be negotiated in july and in new york. and we will have a small arms trade of weapons and action -- a plan of action that was adopted in 2006 and a preparatory

committee for that conference actually met this week in new york. now, today we really have a terrific panel with -- i would say really the leading experts in the world on these issues. and we will examine and look at the trends and efforts to control the transfers of conventional weapons. we'll start off with my colleague, paul holtom the director of the sipri arms forum who will introduce new sipri data and sort of set the stage. before joining sipri in 2006, paul was associated with prestigious institutions. in germany, in russia, in the u.k. and has always worked for the council of europe. paul has has expertise in russian and east european issues since he did his ph.d. on that particular issue. he has written extensively and

let me just -- i'll make a little plug for you, paul. just written implementing an arms trade treaty as well as another publication on china's energy and security relations with russia. after paul, i'd like to turn to matt schroeder who's aner analyst of the federation of american scientist and a consultant for the german survey. matt is a prolific author and is the co-author of the small arms trade and the coordinator of the first comprehensive global studies of the authorized trade and small arms and light weapons. so matt will talk a little bit about what's happening in the small arms field and talk in particular about transparency issues. we will then turn to rachel, rachel stohl who's a fellow at

the stimson center, a fellow at the american across boundaries program and we asked rachel to look a little bit at the future and particularly look at the prospects and possible impact of the arms trade treaty. rachel has been an expert in this field for a long number of years at chattam house the british, the royal british institute of international affairs. she was also a senior analyst at the center for defense information in washington, dc. she's been a consultant for many organizations who has recognized her expertise in these issues, including oxfam and the u.n. and finally but certainly not least we'll turn to bill malzahn who's the deputy director and senior coordinator for multilateral control of conventional weapons in the state department.

he had u.n. participation in the u.n. register, offconventional arms since 1995 and i think that is almost the beginning of the effort of the register. he has been the u.s. expert to u.n. groups of governmental experts throughout the '90s and in 2000, 2003, 2006 and 2009. he's also the deputy head of the u.s. delegation on the arms trade treaty and so, bill, you have great responsibility coming up in july. so without further ado, let me turn it over to my colleague, paul. paul? >> thank you, chantel and u-it for arranging this event and securing some excellent panelists to put me under the pressure as the first person to speak. as chante noted the arms program

is one of the longest established projects at sipri. back in 1968, it was set up and today we have really three, of course, pillars of work. the first is monitoring international arms transfers. the second is to promote transparency and international arms transfers and the third is to conduct research and prevent findings and have recommendations to strengthen recommendations for arms transfers. in today's presentation i'll just present some of the highlights from my newly released data which you can find in the sipri arms transfer database online and this provides information on orders and deliveries of major conventional weapons between the years 1950 and 2011. we think providing this information as chantel noted is forming policy analysis, identifying destabilizing trends but also can be used as an indicator for the strength of interstate relations in certain cases too. my intention is to appeal to fans of joe friday and dragnet

and just present the facts although i'm more than happy to discuss more details behind the drivers in some of these trends and going to the minor but perhaps concerning transfers that we see. and i guess the general headliner as chantel indicated we see an international upward trend in international arms transfers so our data for the period 2007 to 2011 indicates that 24% increase over the period 2002 to 2006 on the side we see how that breaks down by major regions, so asia -- i know accounting for 44% of volume of international arms transfers, imports followed by europe, the middle east, the americas and africa but i think it's worth flagging that i'll be happy to discuss later some regional subincreases to deliveries in africa, north africa, southeast

asia and the south caucuses but before talking about the imports in a bit more detail i'm going to talk about the situation with regards to the supplier. and the headline here is really it seems that not much has changed. the same five major suppliers continue to dominate that is the u.s. followed by russia, germany, franz and the u.k. but i think that one of the things we find interesting is that although they remain the same, the share of the international trade is declining. i guess a caveat, i think that israel is probably underestimated in our rankings and our accountings and i think it's also interesting to know outside of the top 10 there's a number of non-european supplies that are emerging as major competitors on the international arms trade. they've noted increased deliveries and they've not exceeded in international tend hers but among the established players so, for example, south korea, south africa and brazil. but i think that those of you who have hopefully seen some of the media this week covering the release of our new data, china

has been mentioned quite often and that's what i'll focus on in the next couple minutes. so the volume of chinese imports has been declining but the volume of our volume has increased significantly by 95% of the two periods we've talked about. it's the 6th largest importer from 2006 to 2011 and this is within touching distance of the u.k. but i think beneath that it's worth stressing the main reasons of the increase in the volume of chinese arms export with the increase in volume of exports by pakistan. china accounts for around two-thirds of the volume -- i'm sorry, pakistan accounts for two-thirds of the volume of chinese exports between 2007 to 2011. and in particular there's deliveries of aircraft, naval vessels and tank. i think it's worth stressing that according to our data, china has yet to make a major breakthrough in another major recipient state although, of course, there's smaller volumes that can have a significant impact on regional balance of

power or internal conflict dynamics and there's certainly a number of states that depend upon china. i think it's also perhaps worth flagging up that russia is taking concerns with regards to china emerging as a potential rival in some of its established markets and we've seen since 2010 significant efforts on the russian side as a competitor in the medium term. with regard to the picture of the recipients the headline we had this year was that the top 10 -- top 5 recipients are all based in asia. but i think it's also worth noting that in 2011 we saw some major deals being concluded with states in the middle east. but when it comes to the top 5 we have india there as number 1. accounting for around 10% of the volume of international arms imports and we believe it's likely to remain a major import in the coming years. deliveries of aircraft, naval vessels, armored vehicles and artillery expect to continue at a significant rate as india

modernizes and upgrades its modern forces. the drivers for this are obviously with regards to the regional situation, pakistan's a traditional rival, internal conflicts and i think also to some degree a desire to project power at a greater distance. a lot of attention on the merits of the acquisition of an aircraft carrier from russia perhaps this year, perhaps next. the promises always seem to go back each year we try to cover it. and also a submarine. although russia has enjoyed a dominant position as india's supplier, israel emerging as a significant supplier and, of course, the u.s. seeking a greater share of the indian market. but i think with regard to these top five exporters one of the tendencies we note with regard to them is a tendency for a license production network is facilities and these seem to account for a significant share of deliveries with regards to china, india, singapore and

south korea. now, arguably the record of using a licensed production and technology transfers to build up and develop an indigenous arms industry is a mixed record and in some cases very limited. with india we see a number of challenges with this regard, china i would argue has been more successful in recent years and we've seen south korea and singapore develop significant niches. i think its also worth noting that in many of these cases they're not seeking indigenous capabilities for their own national defense but also for launching of export sales as i mentioned earlier. although many of these products will still rely upon foreign exports. with attention with regards to the deliveries on asian industries, i think it's important to talk -- the decline by 8% it's the only region where we noticed a decline but i think it's worth stressing it's n