in 22 years, which is a very long time, particularly in the narrative and history of the hiv epidemic. almost everything has changed from our understanding to its therapeutics and the prognosis of people with the infection. it had been essentially banned from the united states because of the restriction on hiv-infected people from entering the country which was part of what was an immigration regulation. and the international aids society which runs the conference had decided that this was a form of stigmatizing exclusion that they did not agree with, until the united states changed, there would not be any conferences held in the united states of these international aids conferences.

and it was lifted by president obama very early in his term. >> you wrote the subject of money is always a big topic at peace aids conferences, particularly at this one. why is that? can you tell us how much the u.s. contributed each year to the fight against aids worldwide? >> the u.s. contributes about $6 billion to the overseas aids efforts, and in the year 2000, i believe, the governments total global health spending was about 1 billion. so it gives you some idea of the enormous growth over time. much of it coming through that far, the president emergency plan for aids relief which president bush, george w. bush started announced to everyone's surprise in the state of the

union address in 2003, and that has gone up under obama, and it's flattened out the last couple of years but is still an enormous amount paying for drugs, paying for clinics, paying for labor, paying for the whole, you know, sort of transportation and infrastructure it takes to put millions of people on this life savings, or life extending therapies. >> was there a consensus at the congress this year on the latest and best approaches to prevention and treatment of? >> well, i wouldn't say there was a consensus, but there is more stuff to do. there's more options now than there have been ever before. big ones are the so-called treatment as prevention, and

this means that if you, if someone is infected and you treat them even very early, or perhaps especially very early in their infection, the amount of virus they have in the bloodstream goes almost to zero and to become essentially noninfectious. in other words, they cannot transmit the virus on to anyone else. it occasionally happens, but it's a rare. so that the id is if come everyone as soon as they are diagnosed you put them on the drugs, and the chance of him passing it on to someone else is hugely reduced. so that's one strategy. there's other strategies like circumcision, and then there's even taking prophylactic drugs, people who don't have the virus that are at risk, high risk of acquiring it, they can take

drugs and lower the risk hugely. >> former president bill clinton, one of the speakers at this year's conference, how his -- how has his foundation been so successful in driving down the price of aids drugs worldwide? >> well, his foundation, which has really had a huge effect on the international response, basically has helped rationalize the market for generic antiretrovirals. and it is basically become the makers and consumers of these drugs together and said okay, if we can assure you that there will be, this demand, you know, demand for x. million doses of this particular drug, how cheaply can you make it? and is there some way we can

guarantee that it will be delivered in time, that it's not going to run out on shelves, that it isn't going to be held up in customs? on anton, just make the system seamless and efficient -- on and on, just make the system seamless and efficient. wants the producers know what their market can be, they can ramp up and huge -- make huge quantities at a much lower price but it's basically getting the prize, the price right. >> and what is your sense after this conference of what's left to be done in the fight against aids? >> well, quite a bit. there's still room for prices, for drugs to come down. in the united states, there's very important drugs that are about to go off tablet, which will save, save some money here, you know, up to a billion dollars potential here,

particularly if doctors and patients are willing to make small adjustments to the drug regiments. the whole issue of getting people on drugs the early, and, of course, can't force anyone but perhaps you can make it easier for people to start the therapy early if they are interested. there's a huge amount of room to make that happen more efficiently. and then there's things like option b. which is kind of a brand name for putting all pregnant women who are infected, putting them on antiretrovirals drugs for life, just keeping them on the drugs but in the past it was put them on during the pregnancy and breast-feeding pic and if they don't have a clinical indication, then stop, stop the drug until their own

diseased sort of progress. now the idea is just forget all the stopping and starting, just get them on the drugs and preserve their life for as long as possible. >> david brent with the washington post go along with his post colleagues report on the 19th international aids conference. you can read their report at washingtonpost.com. thanks for joining us. >> my pleasure. >> as you just heard one of the speakers at last month international aids conference with former president bill clinton. he talked about his foundation's work in providing funding for research as well as successful treatment for low income populations. he spoke for about 35 minutes. [cheers and applause] >> thank you very much. thank you.

thank you very much. thank you for the introduction. i'd like to thank doctor, the u.s. chair of aids 2013, and thank you for your leadership as president of the international aids society and the chair here. i wish you and your successor well. i thought she gave a heckuva speech, by the way. [applause] >> i want to talk a little bit about where we go from here, how do we actually propose to implement these goals that have been set for 2015? if we believe there can be an age regeneration, even if you sign in the narrowest possible terms, how can we achieve it?

when the aids conference first took place in america 22 years ago, a passionate group of activists, community leaders and researchers shouting silence equals death made the world a lesson -- made the world listen. we didn't have the first cancer drug. it was treating a grand total of 5000 people all in europe and the united states. and prohibitively high cost. that's a long way from where we are today with a billion people on treatment around the world, and the ability to treat all the rest who need it. [applause] >> back then, aids was a death sentence, and those of us who are old enough to have been fully grown then, still have

lots of painful memories of our friends who did not survive. then we could really imagine and into the epidemic. now, all of you have created the possibility that we could have an hiv free generation to as bill gates said, we still have a good ways to go, but we have come a long way. everything i say today comes from the perspective of the work my foundation has done in the last 10 years. before the global fund was funded, before there was any pepfar, our job was to go around and raise money country by country to figure out how to cut costs, and to provide a working delivery system that would save lives.

[inaudible] made here, and by people throughout the world to achieve universal access, to a limited mother to child transmission, and to cut new infections in half by 2015. we can do that, but it won't be easy. just last week on my annual trip to africa, i visited uganda, mozambique, south africa and rwanda. i saw an amazing progress but i saw leaders committed to offer treatment to anyone in need. i saw a willingness to completely eliminate mother to child transmissions. then i met with program managers who don't know where the money will come from and are not sure we had the systems to do that. to achieve universal access by 2015, we'll have to increase the

number of new people on treatment by 30% a year. for example, in 2005 there were only 10,000 children on treatment in low income countries. thanks to many of you in this room, and a special thanks -- [inaudible] the global effort to accelerate pediatric treatment means there are 500,000 kids on treatment today. [applause] but to reach the goal we'll have to have one and a half million more. to eliminate mother to child transmissions we need to test and treat women earlier, and keep them on the treatment longer, throughout the entire period of breast-feeding, when many of them lived miles and miles and miles from the place where they get their medicine today. to cut new investments in half,

we will have to heed julio years of pleased to implement treatment as prevention, and implement combination prevention programs. [applause] we can save a lot of lives if all this is done but we will have to do it together and do what works to spend the money we do have with maximum impact, and to raise what we will still need. it's worth remember, and i don't think enough has been made of this, that of the dollars being invested annually in this effort, first time in my memory anyway, more than half of it comes from the affected countries themselves. and they deserve an enormous amount of credit for that. [applause]

one of the reasons universal access, we can do it for less money than previously thought. my foundation recently released the results of a costing study that we did with five african governments across more than 160 treatment facilities. in ethiopia, malawi, rwanda, zambia and south africa, i think the leaders of these countries and all the health care personnel for taking the epidemic seriously, and for the progress they have already made in the program. ..

there are real opportunities with the commitment the government have already made. our foundation recently redid the drug tender for the mant last year and this year in just two years they saved $700 million on what they were spending for drugs, and immediately added 340,000 people to the treatment. [applause] more savings are on the way. to note the prices dropped 70% since 200830% since last year is $125 now and it's a good drug. the savings of five drugs alone

by 2015 will be $500 million. we can use that money in this fund. [applause] now i have to be fully candid, but meeting the goals of treatment by 2015 will require some activities, especially community programs. you've got to have community outreach workers if you want to get mother and child transmission down to zero. you just have to do it. you can do it without -- [applause] but clearly, just what i've already said to convince you that we can meet the treatment goals coming and we should. we also need to the tarnow smart investments save money. the united states center for disease control presented an economic model this week suggested implemented test for keep populations like pregnant women and people with tb and

accelerated the scale for others would not only save lives, it will also lower the costs within just five years. [applause] we're well refined the money? we all know last december the global fund had to postpone the funding round because he was short on cash. but the fund is now back in business because the gates foundations, japan, and saudi arabia stepped up on the heels of president obama for failing americas three year commitment. secretary clinton recently announced here more money for the u.s. to meet the 2015 goal. [applause] and i'm hopeful that other donors will do the same, especially big countries that are growing fast like china and brazil. and don't forget as elton john's

presence here and bill gates presence reminds us there is an enormous amount being raised and spent and there will be more from the gates foundation, elton john, vienna, the dutch code lottery, many others. and governments, even in this difficult time, i believe will do more if we prove we are maximizing the impact of the money they have given us. the united kingdom has followed this austerity program without cutting its development assistance. an astonishing fact. [applause] our foundation works with them, with the norwegians, the government of australia. all of whom are giving and giving even in this difficult

time. finally, we need to make something good out of what is otherwise a not particularly wholesome development. the growing inequality of income and wealthy countries. thank god a lot of wealthy people want to give more and would give it to this cause if they knew what an enormous impact their dollars could have. do not minimize the possibility devotee will have more private giving as we make more progress and demonstrate. i also think that -- [applause] we can learn a great deal which has led the way creating a new revenue stream that has saved hundreds of thousands of lives just in my experience with it has done in putting children's arvs out there at more affordable prices of bridging short-term investment for long-term gain. we need for innovative financing.

the international finance facility for immunizations might offer a good model for us. it raises money by issuing bonds in the capitol markets which are backed by long-term commitments from donors so the donors can buy them now that the leader. increasing flow over a five to seven year period and then paying them back over a 20 year period. as we all know now that low-interest. applying this model to raise funds to implement exhilarated treatment, combination prevention would mean that infections would be lower when the time comes to pay the money back. if we all keep producing results, i believe the money will be there. [applause] and i am committed to doing whatever i can to see that. we do have to prove over and

over again that we are making the most of the money. we have managed to lower treatment costs at facility level from what u.n. aid said in 2003 was about a thousand dollars a person in your to $200 today. beyond that, further cost reductions are coming. looking ahead, there are some other things i think we should do. first, we can target the money we're spending more effectively. especially in prevention. ulin aides recently reported in two african countries 30% of new infections were to evan bayh high risk population of less than 1% of the prevention dollars were spent to reach those people most in need of services. we can do better than that. [applause]

last year u.n. aids published an investment freemarket providing guidance on how to prioritize national strategies. to focus on the interventions that have the greatest impact. it's an excellent tool i would like to see more countries adopt. secondly, and this may be somewhat controversial but i feel strongly about it, we need a new level of openness about how every last dollar is spent by countries and in ngo's. [applause] you can't expect them all over the world to make the smartest decision if they are trapped in a financial black box. all donors, all nations, all ngos i believe should make our spending records open and

available, not so somebody can be in their list, so we can see who's doing better and the rest of us can compete. if we work together -- you know this as well as i do -- sifry but the that's been out there we can have a bigger impact with of the dollars that we have. third, i feel we need investments based on evidence, not the politics and interest that too often drive spending decisions. [applause] we are all going to -- to meet these we have to encourage not only the things we need to do but shut down programs that are not working. and to channel more money towards the populations that are driving the epidemic and the evidence based interventions that are working. [applause] finally, we have to make sure that we are paying for services that would directly help the people and involved.

when businesses start operations in new countries, they often send in their people comics beatrix. the help of the work off the ground. but then management responsibility is transferred. i think we've reached a point in the hiv response where we have to do more of that to transfer to national governments at the local ngos. [applause] i don't want to imply that i think spending on international organizations can go to zero. that's not true. many countries still need support to growing at sustain their progress and build the infrastructure necessary, but international and technical assistance can be very expensive. some organizations pay consultants up to $600 a day for the cost of a day of consulting

we could put three people on treatment for a year. [applause] that is -- every time we make the former in the latter choice we've got to know what you're doing and be prepared to defend it in the light of day. otherwise we should go for the life savings. let me say that i think channeling more money to keep all governments is catching on because it will save money and will build capacity and produce sustainable results in the countries that need them. pepfar recently announced its intention to transition greater ownership over its funds to national governments. i'm very grateful for that. just last week, when i was in the national government and the health minister i believe is

here today announced a new effort to dramatically reduce overhead and a workforce of the country. i applaud these efforts, and i think more of this can, should and must be done around the world. now, having said that, we all know that money is not the only impediment to meeting our goals. two years ago in vienna we heard about the promise of combination prevention. we heard about the evidence of treatment and prevention. we agree about the impact of male circumcision and accelerated actions in that area. we heard about promising ways to improve the effectiveness of treatment including increasing print of care technology, something our foundation has been involved in. we didn't know how to implement the programs that scale, but up

the stodgy and most of you in vienna are willing and eager to act and energize. none of these proposals have been taken to scale. many hard questions remain, and we could spend a lot of time talking about the hard questions. how do you find people before they feel sick and get the information they need to make your own decisions, how can we improve retention and care? what treatment is prevention's are best and if we do and we do even more circumcision will it really lead people to give up less costly proven prevention they were observing? all these questions are important, but should any of

them be a bar to doing what we know we should do? i would argue no. i remember in 2003 when they lost the three by five initiative there were lots of serious questions about whether we could meet the goal of increased treatment. there were people who even said if we can't treat everybody the needs it, decide who gets it and who doesn't and wouldn't we be better off because it is cheaper just giving universal prevention but guess what we responded to the challenge and now there's 8 million people on treatment. that's the way we have to respond to these challenges. [applause] sometimes you have to make a commitment before you know how you are going to get there. china, rwanda have announced their treatment has prevention at scale.

we are working with that government in our foundation the prevalence is up out 26%. i have been really impressed by the leadership and foresight. they know this is the only way they are going to achieve their goal and their focus their for on how to do it, not whether to do it. malawi is a country with very severe resource constraints, where i also had the honor of doing a lot of economic work. they made the decision to put all pregnant woman on treatment immediately for life. they didn't wait to figure out how to do it or how they were going to pay for it. they made a commitment and i believe the president showed wisdom and strength in doing it and we should all be grateful to her because -- [applause] because now everyone of you can say if mali isn't waiting, how

can the rest of us we? [applause] you might think this is my eve but i've seen it over and over again. if we build it they will come. a few skilled of the and it works, the money will be there to fund it. [applause] we also talked a lot about improving treatment works, identifying the patient surly year, reaching them where they live, treating disease that kills people like tb, meningitis. today we know that the best practices from groups like partners in health, mothers to mothers, and mmsf. we know the decentralizing services and power members. we know from the pilots and

mozambique, zimbabwe that if we provide testing of the plight of care we can cut the pre-art in half. we know that if the nurses play a larger role caring for patients in putting initiating treatment -- [applause] we will reach more people in an environment where they feel better understood and cared for. so when we scale up, we will stop just paying lip service to the community engagement and we have to start engaging and relying on communities. these are things i believe. i think the money will be there if we prove we are responsible with the money the we've got and if we prove that these approaches work. you have nowhere near the

universe of people but will invest in meeting these 2015 goals and creating an eighth street generation. to have to keep pushing up the hill. speaking of rocks at the health, the prevalence among some groups as as high as it is in countries into an africa. i would like to say a couple of words about that. we have about one plant to million people in america living with hiv. barely more than a quarter of them are getting the care. infection rates are rising among young gay men and exploding among young black demon. latinos come in and of americans and pacific islanders use of some of them go wife. many of them feel because of the overall progress made in the fight against aids they're going

to be left out and left behind. but in this city government community leadership has been reinvigorated around blood testing and testing st strategies. they are making a difference. since 2007, they're has been a threefold increase in the number of people being tested every year. a tenfold and the number of condoms being distributed every year. 300,000 clean needles provided every year. [applause] and 90% of the people who test hiv-positive in washington, d.c. ctr doctor -- see a doctor back in three days. [applause] it was the first to develop a comprehensive effort. the affordable care act, which

thing got the supreme court upheld will provide coverage. [applause] the funding that he and secretary sebelius had this week to close the waiting list is very important. and i want to emphasize something else that in the context the united states can be huge. you'll know that when i do work around the world when our foundation does, we knew and used generic drugs and they have made a huge difference and pepfar can be used to buy those drugs first because american schools the middle of the people agree they should and second because i made an agreement with president bush when he was an office that i would submit all

of the medicine and the world to the fda and she said if the fda approves them as effective and appropriate that in local country could use their money to buy that medicine. [applause] and he kept his word. [applause] and the was the beginning and i am very, very grateful for that. but that means we're these drugs are not available to got to do something for people without insurance who can't afford the drugs. [applause] hauer foundation has partnered with the major pharmaceutical companies to make access to affordable hiv medication available faster and in a simpler way on a longer-term

basis for people who don't qualify but can't afford the drugs. here's the idea. we will provide a one-stop shop for uninsured patients to access all the patient assistance programs available. the program will simplify the work and cut through red tape and i want to thank the pharmaceuticals and merc that have stepped up to support with the discounted medicines, and i hope will for manufacturers of hiv medication will follow soon. [applause] one more word of the united states. the next biggest problem we have where i'm sad to say since it is my home region there is still too much stigma against men who

are drug users of this isn't treated enough as the public health problem and that plus the poverty plus the disproportionately high percentage of people in the country and the south who live in rural areas and have the same access problems that people in southeast asia and other people have. [applause] they've created a big problem for us. i just want to say to a things. it's embarrassing to me to say stigma against people with hiv texas anywhere in america. it's a problem and other places in the world but look at the numbers that came out just this week. yes it is true that 56% of the

people that need medicine now to stay alive are getting at. but look at the numbers in the area where there is more stigma. central and eastern europe, with less than that. in the middle east and north africa not even 25% of the latter. so we can't be blind to the fact that no matter how much we come together and see the evidence that we still ought to fight stigma wherever we find it and support our friends and neighbors who are doing that. and we also have to deal with the fact not everybody treats these problems the way washington, d.c. and a lot of nations to as public health issues.

the degree to ethan bellmon had an amusing article the couple days ago document in the death rate from aids that has come as indirect consequence as a refusal to see a drug related infection as a public health problem as opposed to a criminal justice problem so we have to deal with it. i think for me thinking about where we were in 22 when nelson mandela and i went to the aids conference in barcelona and we were rattling a tin cup for money, by the way i was with him and was 94th birthday i am retired told them i wish them

well. [applause] >> you should be really excited about this moment because you are committed to work with the financial crisis to go beyond infantilism to embrace and vicious goals for 2015. i've been asked to work to the life group with a couple of african countries to figure out how you actually would take the transmissions to zero because they know that it's more than just getting the medicine out there but it's exciting and we will do well as we'll refuse to but we don't have slowed us down

we have to do what we can to get the programs of the ground and the answer the question as we go along their leader in the way towards the vaccine and the cure and more and more people from the private sector bringing their business acumen to the financial questions. civil society pushing us to do the right thinking. communities in america from anacostia and oakland mumbai and sao paulo to petersburg go a long way. all of them taking responsibility for their children and their future. they haven't gotten enough credit the developing world in

the middle-income countries for spending even more money than the donor countries and the individuals to fight this affectionate. they are worth supporting if they're coming up at this moment. [applause] we've also got a lot of policy makers whose team committed to keep working on this if necessary until effort but the in this room is as old and gray as i already hammes that is what it takes. this is serious. i've been doing this a long time. all this happened because a few and the people that sat in these chairs at every previous conference going back to the beginning. millions of people in an aids free generation still depend on your daily tensity encourage.

we don't have all the answers we need but we have you to think for the progress that has been made and to make us believe we can achieve in the sifry generation -- aids freakin' generation. in the places we work we have millions of people nursing their dreams and their children streams instead of giving up. it's worth a lot. we have to deliver for them to be a thank you. good luck and bless you all. [applause]

the idea that we are in this together regardless of who we are or where we come from or how much money we have each of us counts and that by working together to create opportunity and a good life for all of us are enriched not just in economic terms but as citizens and as human beings. [applause] mauney opponent i will when the congress will push me to raise taxes and i will say no they will push a and i will say no and they will push again and i will say to them read my lips

and no new taxes. back to the international aids conference former first lady laroche addressed the delegates about her initiatives to battle nationwide and africa specifically. she talks for about 20 minutes. now, it is my pleasure to introduce the next speaker mrs. laura bush. delauro bush hardly needs an introduction but she definitely deserves one. as the first lady of the united

states of 2001 to 20009 she was universally admired for her approachable style and straightforward and gracious leadership in that role she was then and continues to be actively involved national and global concern with a particular emphasis on education, health care and human rights. during her eight years as first lady of the united states, mrs. bush traveled to all 50 states and more than 75 countries in support of president bush life-saving global health initiatives including the president's malaria initiative, pepfar, mrs. bush visited africa, asia and the americas to help raise cool awareness of malaria and hiv/aids. now as the chair of the women's initiative of the george w. bush institute, mrs. bush continues her work on global healthcare

innovation, and how wering women in the emerging democracies, education reform and supporting the women and men who served in america's military. in september, 2011, the bush institute, the u.s. government coming human aids and the susan g. komen announced a pink ribbon initiative a partnership to leverage pepfar's platform and resources to combat cervical and breast cancer in developing nations. my organization had the honor of having mrs. bush as a keynote speaker at our annual conference a couple of years ago. she was introduced then by her twin daughters barbara and jenna who gave one of the most touching introductions have ever heard. the painting a full picture of their mother and reminded all of those of the multiple roles that women balance every day in ways that are truly remarkable.

and so as they did, i want to present to you a leader of great depth and accomplishment as i have noted, with a woman that is also a wife, a mother and a friend to all of us in this room to fight for equality and dignity for women all over the world. mrs. laura bush. [applause] >> tim jeal also much. thank you. thanks to everyone here. i'm very happy to be with you today at this conference. i am glad that you are meeting our beautiful capital city and i hope you have to enjoy your time in washington and i am especially proud to mark the progress that has been made and to look forward to an even greater response to hiv/aids.

thank you. you're the perfect moderator on the leadership and aids response to women. thank you for your leadership of carey and life-saving work. we just heard from the leader that i had a minor very much from burma her courage and persistence is an example to women and men worldwide. when i thought about why wanted to say about women in today's session i thought of the many women i know and some of whom i will never know and who led us in our response to a pandemic disease. i thought as my own mother-in-law barbara gush while my father-in-law was president of during those early days when people thought you could catch aids from touching somebody barbara bush cradle hiv-positive

babies and house people with aids. she met with families that lost loved ones and she visited the memorial that was on the mall then of like it is now. her graceful example challenged all americans to confront hiv/aids with care and compassion rather than fewer and judgment. when you look around the world, you see that women are in the forefront of life changing progress peaden of tennessee and under the taliban the treen centers risking their own lives to teach women and girls to read. in burma despite years of oppression women remain steadfast in inspiring the world with their grace and courage in the face of brutality. women have been central in the fight against aids a disease one

newspaper compared to the death of the middle ages for. ten years ago aides waged of control. more than 22 million men, women and children have died of and 15 house and people were infected everyday. in 2002 the experts estimated the aids pandemic could double in the next five years to 80 million people and infected with the virus. health professionals and leaders are around the world knew that a dramatic action was necessary to address this crisis. my husband president bush to the to rose garden to hiv/aids starkers the imagination get

shot. he announced a $500 million initiative to combat aids by treating hiv-infected women with the antiretroviral drugs to stop the virus between mothers and their babies and instead of the union address president bush announced the presidency emergency plan for aids relief. the largest international health initiative effort directed at a single disease. [applause] the members of congress stood solidly with president bush and applause echoed throughout the u.s. capitol when he announced this historic commitment. sitting with me in the gallery of the capitol that evening was say ugandan doctor the help

senior bush's at dysart ifill pepfar. dr. peter smiled and repeated chollet. as a medical professional women of the countries hardest hit by this deadly disease he knew the toll of aids. he remembered the patience he couldn't save if he had the medicine and on a cold january evening thousands of miles from home, he knew the outcome would be different for future patients. pepfar committed $15 billion over five years to prevent new infection to treat those already infected with aids and to care for children orphaned by parents that have a diet of aids. in a pediatric clinic in botswana, that your president bush and i saw firsthand the

devastating toll of aids. dennett pediatric clinic, my daughter barbara and i met another that lost her little girl. she dressed her daughter like an angel in a lovely lavender and white dress to me to the american president. this precious little child lay on the examining table so frail and sick. her mother's last hope was to make her beautiful. today with access to antiretroviral that little girl would have another chance at life. in fact, three weeks ago we returned to botswana and we saw the same pediatric clinic and it now has so few patients that they are looking for a new use of the facility. [applause] barbara, our daughter, was so

affected by this beautiful child that she resolve this to help confront the challenges this little girl faced read today barbara leaves the global health corporation in an effort to recruit young small college graduates to work in the health field in underserved areas. while george was president -- [applause] thank you for plotting for barbara. while torch was president i traveled to africa five times, and george and i returned there together two times since leaving washington. on each visit, i saw the consequences of aids, widowed women left to find jobs and care for their family, orphaned children forced to grow up quickly and provide for themselves and their younger siblings. and i have seen what many call the lazarus effect. aids patient returning from

death's door and living a vibrant life. [applause] rather than waiting quietly many that suffer from hiv are now working and participating in their communities. in zambia in 2007, my daughter jenna and toured a center of a woman whose husband died from aids. the center provides home-based care for more than 150 aids patients in zambia. the center offered support groups for female victims of violence and promotes hiv prevention campaigns for young people, suzanne beah's next generation will be hiv free. [applause] jenna and i helped pack madison, mosquito nets, beatles and toiletries in the baskets of the

caregivers bicycles so they could write into the community to provide home-based care for their patience. later we sat listening to stories of those being helped at the center. two girls wept as they told us how the contract aids through sexual violence. afterwards, jenna walked over to hug them and tell them they were not alone and that she was writing a book called anas story about a girl that she met who suffered as she had. and they said to her right about us. tell our story. just by revealing their tragic past, these young women are building a hopeful future for the next generation. i heard stories and every one of the 12 pepfar countries i

visited during george's eight years in office from africa to asia to the americas, in rural villages, in the capitol cities, women have led efforts to confront hiv. women starting their own businesses to provide for themselves and their families. mothers, teaching mothers to prevent the spread of hiv to their unborn children, and women in leadership, using their influence to reduce the stigma associated with hiv and to write and awareness for testing and treatment. we know that education, especially for girls is vital for the efforts to stop the spread of hiv. educated girls have lower rates of hiv. the have healthier families coming and they have higher rates of education for their own children. last december, president bush and i traveled with barbara and

jenna and her husband henry to tanzania, and ethiopia. we met a woman whose husband was hiv-positive, but she didn't know it until she had contracted the disease. when he died, she was shunned by her own family. while they allowed her to stay with them, she wasn't allowed to sit with them or eat with them. they even gave her her own replete and utensils as a belief that they could catch aids from her. then she was introduced to a faith based organization that provided education and training for widows and orphans. it means remembrance and taught her how to make beautiful purses, a few of which we bought a out of recycled material so she could support herself and her children. as her finances improve, she moved out on her own with her

children. and now, she supports the family that once shunned her and extending the grease that she received. [applause] her story is a powerful testament to why we must do more to promote the good health of women everywhere. the health of women affects families, communities and the whole country. healthy mothers help make healthy families. when the mother dies, her children are up to ten times more likely to die themselves, and are less likely to ever go to school. we've seen the benefits of strong partnerships to fight aids. nearly 7 million people are living with hiv now because of access to antiretroviral therapy. and new hiv infections have fallen by nearly 20%.

the success of pepfar has given a proven strategy and the resources come from other health challenges. we've added a first to prevent malaria through the malaria initiative and because now we see women living with aids but dying from cervical cancer, the bush institute has launched the pink ribbon red ribbon. last fall with the global health summit in washington, d.c., president bush announced the institute's new partnership. the bush institutes partnering on pink ribbon red ribbon with the united states state department and pepfar, with unaids and suzanne g. komen for the cure to screen and treat breast and cervical cancer among women in the developing world.

[applause] i am so pleased our partners, secretary who runs unaids and my good friend, nancy brinker, foundation for the cure, are here with us today. since you all for joining us. [applause] we are happy to have several private sector partners supporting this initiative. bristol-myers, the carrying foundation, smith kline, ibm, merc, airborne lifeline and the national breast cancer foundation. cervical cancer is the leading cause of cancer death in sub-saharan africa, and it's a preventable and treatable disease. it's up to five times more common in women whose immune systems are already compromised with hiv.

the pinker event ret redican initiative will build on the pepfar platform to screen and treat women for breast and cervical cancer. george and i launched the pink ribbon of red ribbon in december when we just returned to zantia earlier this month president bush and i were thrilled to see their progress. pinker been red ribbon has expanded beyond the capitol city and across the country. multiple clinics are now screening, diagnosing and treating women for cervical cancer. already more than 14,000 women have been screened more of the communally 40% are hiv-positive and nearly one-third of all of the women that are screened tested positive for precancerous or cancer is cervical cells. of those that tested positive, more than 80% can be treated immediately with cryotherapy.

[applause] zambia's first lady is a doctor in obstetrics and gynecology and she's a champion for the pink ribbons red ribbon effort throughout her country. since her husband became president in zambia last fall she has worked to focus national attention on maternal health and mortality. earlier this week she host a conference for african first lady's to discuss aids and cervical cancer. her strong leadership has set an example for african first lady's and for women everywhere. [applause] in our fight against aids, we learned that any measure of success requires sustained leadership at every level from

international organizations like unaids to political leaders in each nation and for the ministries of health, the local community of workers. that's why i'm so grateful to everyone in this audience today for your courage and your persistence, your persistence. you are the proven agents of change around the world. by working together we can give hope to mothers and fathers and sisters and brothers and wives and husbands and sons and daughters so that they and their families can live full and productive lives. thank you all very, very much. [applause]

thank you all so much. [applause] nancy pelosi talks about more funding for aids research and she calls for a greater commitment to the fight against the disease. she spoke for about 15 minutes. >> thank you very much. good afternoon. what a beautiful sight you are to seek. thank you, diane, dr. hadler for your generous introduction and tremendous leadership of this has a co-chair of this year's international aids conference. watching the film and the slides and by all accounts, this

conference is a tremendous success. [applause] we've thank dr. diane hadler for their great leadership in cochairing this conference. let's give them our fullest appreciation. thank you. [applause] san francisco takes special pride in her leadership as the chief of hiv/aids at the university of california san francisco, because that is where for us all of this began. this is where we started to turn the tide together. it was 31 years ago when we first heard in our community that doctors at the university of california san francisco were seeing cases unlike anything the scene before, symptoms that

harken back to the middle ages. many of you could tell the same story. quickly aids began to take a terrible toll. soon we were going to as many as two funerals each day. quickly we knew that this was an emergency, and we had to pull out all of the stops. we expressed our grief, we took comfort, we had renewal and remembrance in the memorial growth. 25 years ago when i was elected to congress and my first speech on the floor of the house, i said i have come to congress to fight against hiv and aids. [applause]

after my comment a colleague said to me why would you want fighting needs to be your introduction to the congress of the united states? why did you say you came here to fight aids? i said i said it because that's what i came here to do. [applause] but recognize that was the sign of the times in washington, d.c.. meanwhile in san francisco we were ground zero as we saw a of the aids assault on our health, our economy, our community, on the lives with a deft, denial and discrimination against those with the disease aids was not only a challenge to our scientific and medical professionals, it was a challenge to the conscience of

all of us and remains so to this day. we knew that we had to organize, not just agonize and organize not agonize we did. over time we learned as many of you got your croswell that the aids virus is a resourceful virus that escaped defeat by mutating and so too did we have to be resourceful. we adapted to the challenge all of us. we were innovative and our thinking, pursuing new science, new ways taking a fresh approach to convention, care and research for a cure all of it community-based and evidence

based. we knew early on that we needed an international mobilization against aids. we needed public private and nonprofit partnership. we had to make in national decision to act. here in the united states congress our decision to act changed the lives of many people within our borders and around the world. what congressman mike henry waxman of california and senator ted kennedy. [applause] we had the community-based ryan white care act to leon. [applause] funding for pediatrics aids care

and the list goes on the anthon. most recently with the passage of the affordable care act, we are delivering to people with hiv. [applause] we work in a bipartisan way first with president clinton to authorize and fund the global fund. then with president bush to establish pepfar. thank you, president bush and president clinton and president obama to strengthen these initiatives. we think president obama for totally listing the travel ban -- [applause]

enabling this international aids conference to return to the united states for the first time since 1990. i was at the conference in san francisco and i can tell you that we have come a long way. not only because we don't have the ban and therefore scientists could come and join in the exchange of ideas and the intellectual challenges and sharing ideas, but because in this conference so many people with hiv/aids can join us. you are our strengths and we welcome you. [applause] so i say to decades after being criticized for mentioning the word aids on the floor of congress and in the four years i

served as the speaker of the house to work within the congress on many have to work with barbara lee and at tickets on the outside, bono, listen to this, to double the funding for global health from 4 billion to $8 billion per year. 4 billion to 8 billion. [applause] to make far-reaching progress and turn the tide, action was needed, required from parliament worldwide. on behalf of members of congress who want to welcome the many parliamentarians who were with us at this conference. thank you for joining us. cause for our country to be able to act, our legislative bodies must make the decision to move

forward and many have. even in these difficult fiscal times cutting back on our hiv/aids investment is a false economy that costs us more in the future in lives and resources. hiv is still adapting in so much to turn the tide together. george bernard shaw said the sign of a truly intelligent person is that he or she is moved by the statistics. clearly everyone in this room mix that standard. most of us though were also moved by individual stories. one patient, one person at a

time that led to these big statistics that are so staggering that many of you have personal stories to tell. my introduction to one of the personal stories i have is i lost so many friends in california and across the country but i always remember souci, the flower girl in my wedding. suzie who died of aids but not before becoming a champion fighting against the disease in schools and colleges and the rest. mike hatch and the aids quilt was stitched in her memory. a coming together here again many of you have your own story to share these stories have brought us to this conference. >> thank you for helping fund the global fund. [applause]

>> speaking to you at this final session again i say by all accounts, this conference is a tremendous success. we leave here with increased optimism whether about advancements in science and prevention, prevention of mother to child transmission, yet this optimism must not make us complacent. it cannot. it must instead - milward results. we have an obligation to be innovative and courageous in our thinking. where there is scientific opportunity, we have a moral obligation to fund it. [applause] where there are people in a need of drugs and care, communities

and meet us prevention, we have a moral obligation to provide it [applause] and where there is discrimination, we haven't obligation to continue to fight. [applause] on the brink of the aids free generation must carry on with determination, with hope and courage. courage is one of the defining policies that feel always must bring to this. in doing this we will succeed in turning the tide together. i think all of you, each and every one of you for your leadership, to your activism, your commitment in the hiv/aids once and for all.

[applause] congratulations to all of you for making the 19th international aids conference such a tremendous success. we all look forward to working together to bring an end to aids and turning the tide is together thank you all very much. [applause] is anybody from california here? [applause] welcome to all of you.

>> one of the fascinating things about the olympics if he has been that this -- and i think it will be really interesting for the media, the people in the media industry to understand this change that we are going through from the felch heard an outside view of the evin where deer is a broadcaster and the interview michael phelps before or after the reason you get this kind of linear progression delivered to you in a certain way. now, before, during and after the event, you've got this very much unfiltered inside out view of the event from the

participants and people that are at the evin and even some of the participants taking a photograph st leans over and tweeting. >> they spend all this money to do something which is delay and the of inserted lots of ads and feature stories and wonderful narrative's about how their personal stories and so forth. there's an alternative narrative which is watching the olympics over twitter. boom, boom, boom. it's a different twist. we return now to the international aids conference for remarks by health and human services secretary kathleen sebelius. she announced in public private initiative in the fight against aids that includes the use of text messages to update and inform patients. the conference was held in washington, d.c. which marked

the first time it's been held in the u.s. since 1990 after a travel ban was lifted that prohibited hiv-positive travelers from entering the united states. >> good evening everyone. i want to greet my fellow speakers and delegates and colleagues, friends, on behalf of president obama who tonight is with the survivors and family and community in aurora i'm pleased to welcome the conference back to the united states. [applause] and i am particularly proud to be part of an ad fenestration that respects and celebrates diversity not just in words, the people appointed to high

positions. i want to get a special welcome to those living with hiv who traveled here from around the world. as has been said over and over tonight, the hiv ban that ran contrary to america's deepest values and we are so proud that the obama administration overturned it and we are proud to be your host once again. [applause] we have many reasons to feel helpful. around the world new infections are falling. the ranks of those on the treatment are growing and in countries where aids has taken a toll, life expectancies are beginning to rise once again. in the united states infections injecting drug users have dropped more than 80%.

pediatric cases are down more than 90%. the last time the conference was held on american soil 22 years ago, there was no effective treatment for hiv. today someone diagnosed with hiv and treated for the disease is too far advanced can have a nearly normal life expectancy. please have been accompanied by long-awaited breakthroughs in science including the finding that treat itself is among the best forms of prevention. we have reached a goal where the aids pre-world once a far off dream is now within sight. yet we don't have to look too far to be reminded of how far we still have to go. right here in washington, d.c., our nation's capital.

one in every 16 black men is hiv-positive and the data shows an alarming increase in the infection rate among some black women. nationally our hiv infection rate has stopped falling and is actually rising among young gay and bisexual young men and millions around the world living with hiv are not getting the antiretroviral treatment that could save their lives. as we have come together this week because we know that now is not the time for easing up, slowing down or shifting our focus. if we are going to reach our ultimate goal of an aids free generation, we must all challenge ourselves to do more, to reach even more people come to make programs even more effective and accountable to push the boundaries of science even further. for president obama that has

been started from day one to build on the extraordinary legacy of pepfar left to us by president bush's administration. pepfar needs to be celebrated as one of the great success stories of the 21st century. [applause] it's a terrific achievement the american people and the the program partner countries can be very proud of what our task is to make it even stronger. under president obama to achieve an ambitious goal of reaching an additional 2 million people around the world by the end of 2013 and at the same time we are putting a renewed focus on the key combination prevention intervention that is proven most effective in combating hiv. we are also looking to the future in strengthening

partnerships with local governments and organizations to ensure our efforts are sustainable and have a lasting impact. i am proud that about half of the treatment and pepfar is supported by the centers of disease and prevention through local partners including ministers of health, which can often achieve better results have lower-cost. i want to personally think our colleagues at usaid and the department of state for their terrific partnership and certainly to the ambassador for his tremendous leadership three [applause] we must also continue adding to our arsenal for fighting this disease. this week the department's food and drug administration will announce more than 150 antiretroviral drugs are now available through pepfar coming

and we are pushing forward in other areas, too. for example our department recently devotees simple laboratory test that detects recent hiv infections. a major development that will help us better our prevention efforts. and we must continue to support efforts to make life-saving aids drugs more affordable. [applause] one of the most important developments of the last decade is the drop in price of the generic medications from what was $10,000 a year per person to know as little as $85 per person in some countries today 10,000 to 80,000 is a big step but

there's much work to be done. that's why the united states has increased support for the global fund and why we will continue to support the declaration on trips and public health. [applause] which affirms country's rights to protect public health including through the flexibility is afforded by the trip's. here in the united states and is much work to be done also. when we work with countries through pepfar the first thing they do is establish a comprehensive national strategy. but until president obama keen into office we have never taken that basics to procure a home and now we have. [applause] the national hiv/aids strategy unveiled two years ago has given a new sense after the auction and purpose to our domestic

response it starts with more funding. for roughly a decade before the president came into office, domestic hiv prevention funding had been flat. since president obama has come into office, resources have increased every year he has been here and on thursday we announced nearly 80 million new dollars for hiv/aids treatment. [applause] ..

and we are focusing on the interventions that have been proven to work best, including testing, linkage to care and treatment. and i'm proud to say that today, americans have better access to these life-saving interventions than ever before. thanks to the historic legislation signed by president obama over two years ago, america's fine on its way to join the rest of the world in making affordable health coverage for up to all of our citizens. all of our citizens. [applause] and with that comes the outlawing of the worst abuses of the insurance industry that

often sought to lock people with hiv/aids totally out of the insurance market. to put a cap on the coverage, or cancel their care without cause. and yet we know it's simply not enough to make hiv testing and treatment more available. too many people are still slipping through the cracks. we can do better. we must do better. just last week, i visited an organization called the committee education group just a few miles from here, and they are getting some really impressive results with their approach to hiv testing and treatment. when you get tested, instead just than the patients our referral slip when they get a positive result, they immediately schedule a doctors appointment for that day, or at the latest the next day. then they provide transportation for the first five visits. and if someone stops going, they can find them and have them come

back to treatment. now nationally, our linkage to care rate is just 77%. with ctg it's up above 96%. [applause] which is a huge step forward. but we know we need to do is scale up proven practices that help close the gap between testing and treatment. and we have to recognize that the health care system can't do it alone. the key interventions that helps someone stay on hiv treatment might be substance abuse counseling to help deal with an addiction. it might be protection from an abusive partner. it might be an education campaign that helped reduce homophobia or promote gender equality. so our goal has to be to do whatever is necessary to get and keep people and life-saving treatments.

perhaps the most important principle in our national strategy is one we've been reminded of over and over again in our response to hiv/aids. nonetheless, can do this alone. and that's all we're making an effort to reach out to community-based organizations, to business leaders, to foundations, ngos, to faith organizations and others. and this evening, i'm proud to announce four new public-private collaborations that make it easier for americans to get hiv care. first, we are launching a partnership with walgreens to begin a three-year trial exploring how pharmacies can help their patients stay on medication. second -- [applause] and that's a good deal. second, we're working with medscape, the leading provider of online continuing education or u.s. clinicians to create new

training programs to help our health care providers better understand and address the needs of their patients with hiv. [applause] third, we are announcing to partnerships with the mac aids fund, a mobile texting pilot program called ucare4life, to help patients get important reminders and tips for managing their disease, and a joint project with pepfar that will bring together international leaders to explore how lessons learned through 10 for -- through pepfar can be applied back in the united states. [applause] and finally, we join together with the eight largest aids drug companies to create a single application form for aids medications offered through their patient assistance program.

[applause] long overdue but on its way. [applause] this application will make it easier for patients to get their life-saving drugs, and all eight companies, abbott laboratories, boehringer ingelheim, bristol-myers squibb, gilead, genentech, johnson & johnson, merck have agreed to begin accepting the forum starting september 1. [applause] i want to thank all of these partners were stepping up. we're going to continue to seek out new public-private collaborations that will help us beat this disease. the unifying principle behind all these efforts, at home and abroad, is that they're guided by science and evidence. i'm so proud of the leading role that america's national

institutes of health have played in a research breakthrough that are brought us within the site of an aids-free generation. carter this week we took another step forward with the approval of the first drug shown to reduce the risk of hiv infection. [applause] in uninfected individuals at high risk. the first time. so in the days ahead you will hear about promising next steps in other areas from basic science to the crow besides for women, to voluntary male circumcision, to improved therapies, to potential vaccines for hiv and tb, and to the ultimate goal of a cure. science is the reason this conference got started, and it remains the driving force behind

our efforts to combat this disease. in the weeks leading up to this conference, aids 2012, i've been feeling and thinking about the aids quilt, which is now being displayed at this conference and at locations across the city. some of those 40,000 panels hang on the first floor of the building where i work. the panels of personal, covered with photos, family jokes, love letters, prayers, and doodles. from the careful cursive of mourning parents and partners, to the crooked lock letters of children too young to fully know what they have lost. many of those individuals memorialized designed their own quilt pieces as one of their final acts before succumbing to a disease that was, at one time,

a certain death sentence. if we were to gather all those people together and tell them about all the progress we've made in the last two decades, about the scientific breakthroughs, about the millions that one treatment, about how people can now live long and productive lives with hiv, i think they would say you've done a good job. but then i think they would immediately say, how could we have effective care and treatment but still have millions of people living with hiv who go without it? they would ask how we could have done so much more understanding of prevention and still have millions of new infections every year. and they'd asked what we're doing to make sure that hiv is no longer a death sentence for anyone, anywhere in this world, for anyone. [applause]

i think they'd say that's great, but you've set a goal for an aids-free generation, now you must hurry up. and that's what brings us together for this important dialogue this week. this is a chance for each of us to arm ourselves with the latest size, to trade best practices, to learn from one another, and then go back to our communities and our countries with renewed energy and a determination to finish the job. so again on a half of the united states, we are proud to be your host for the 19th international aids conference. and we are honored to be your partners in this most important work. thank you, and goodnight. [applause] >> we are showing you some of the recent 19 international aids

conference held in washington, and talking with david brown of the "washington post" who cover the conference. david brent, what was the significant about the event being held in washington? >> well, it was the first time it'd been held in the united states 22 years, which is a very long time, particularly in the narrative and history of the hiv epidemic. almost everything has changed from our understanding of the disease to which therapeutics and the prognosis of people with the infection. it had been essentially banned from the united states because of the restriction on hiv-infected people from entering the country, which was part of, was an immigration regulation, and the international aids society which runs the conference had decided that this was a form of

stigmatizing exclusion that they did not agree with and until the united states changed, there would not be any conference is held in the united states, of these international aids conferences. and it was lifted by president obama very early in his term. >> you wrote the subject of money is always a big topic at these aids conferences, particularly at this one. why is that? can you tell us how much the u.s. contribute each year to the fight against aids worldwide? >> the u.s. contributes about $6 billion to the overseas aids effort, and in the year 2000, i believe, the government's total global health spending was about 1 billion, so it gives you some idea of the enormous growth over time. much of a coming through pepfar,

the presidents emergency plan for aids relief, which president bush, george w. bush started i announced to everyone supplies in the state of the union address in 2003, and that has gone up under obama and its flattened out the last couple of years, but it's still an enormous amount paying for drugs, paying for clinics, paying for labor, paying for the whole, you know, sort of transportation and infrastructure it takes to put millions of people on this life-saving, or life extending therapy. >> was there a consensus at the conference this year on the latest and best approaches to prevention and treatment? >> well, i wouldn't say there was a consensus, but there is

more stuff to do. there's more options now than there have been ever before. big ones are the so-called treatment as prevention, and this means that if you, if someone is infected and you treat them, even very early or perhaps especially very early in their infection, the amount of virus they have in the bloodstream goes almost to zero and that he, essentially nonexpert -- noninfectious. in other words, they cannot transmit the virus on to anyone else. it occasionally happens but it's rare. so the idea is that everyone come as soon as they are diagnosed, you put them on the drugs, then the chance of them passing it on to someone else is hugely reduced. so that's one strategy.

there's other strategies, too, like circumcision, and then there's even taking prophylactic drugs, people who don't have the virus but are at risk, high risk of acquiring it. they can take drugs and lower their risk hugely. >> former president bill clinton, one of the major speakers at this year's conference, how has his foundation been so successful in driving down the price of aids drugs worldwide? >> well, his foundation, which has really had a huge effect on the international response, basically it's helped rationalize the market for generic antiretrovirals. and it is basically gotten the makers and consumers of these drugs together and said okay, if we can assure you that there will be this, this demand, you

know, demand for x. million doses of this particular drug, how cheaply can you make it, and is there some way that we can guarantee that it will be delivered in time, that it's not going to run out on shelves, that it isn't going to be held up in customs, on and on, just make this system seamless and efficient. and once the makers, the producers, the generic producers know what the market is going to be, they can ramp up and produce huge quantities at a much lower price but it's basically getting getting the price, the price right. >> and what's your sense after this conference of what's left to be done in the fight against aids? >> well, quite a bit. there's still room for the prices of the drugs to come down. in the united states there are

some very important drugs that are about to go off patent, which will save, save some money here, you know, up to a billion dollars potentially a year. particularly if doctors and patients are willing to make a small adjustment to the drug regimens. the whole issue of getting people on drugs early, of course you can't force anyone, but perhaps you can make it easier for people to start the therapy early if they are interested. there's a huge amount of room to make that happen more efficiently. and then there's things like option d., which is kind of a brand name for putting all pregnant women who are infected, putting them on antiretroviral

drugs, for life, just keeping them on the drug. in the past it was put them on during the pregnancy and breast-feeding, and then if they don't have a clinical indication, stop, stop the drug until their own diseased sort of progresses. now the idea is sort of forget all the stopping and starting. just get them on the drugs and preserve their life for as long as possible. >> david brown with the "washington post" who, along with his post colleague, reported on the 19th international aids conference. you can read their reporting at washingtonpost.com. thanks for joining us. >> my pleasure. >> this afternoon a live discussion on new technology and health care industry. with the remarks of information technology officials from the health and human services department with the possibility of challenges moving from a paper to record to an electronic health record. the event is hosted by the alliance for health reform. you can see it right here on

c-span2. our road to the white house coverage continues this afternoon. president obama is in iowa started a three-day bus tour across the hawkeye state. we wish to life rally in council bluffs that gets underway at 12:25. this afternoon republican presidents or candidate mitt romney concludes his bus tour through battleground states. he has a campaign event in miami would you will be joined by marco rubio. you can see that live at 5:15 eastern also on c-span. >> the idea that we're in this together, that regardless of who we are over where we come from or how much money we have come each of us counts. and that by working together to create opportunity and a good life for all, all of us are enriched. not just in economic terms, but as citizens and as human beings.

>> my opponent won't rule out raising taxes, but i will add the congress will push me to raise taxes and i will say no. and they will push and i will say no. and they will push again and i will say to them, read my lips. no new taxes. >> c-span has aired every minute of every major party convention since 1984. this year watch the republican and democratic national conventions live on c-span starting monday august 27. >> we continue now with the international aids conference. remarks and secretary of state hillary clinton. she now -- funding for battling hiv/aids saying the u.s. stands behind the goal of an aids free general society. this is 40 minutes.

>> [inaudible conversations] >> please welcome the executive director of u.n. aids. [applause] >> friends, when we got the opening ceremony, i challenge you all to dream big dreams, to be born, to think of opportunities, we have to end this epidemic. to be able to say, 10 or 20 years from now that our generation took this to the finish line.

our generation made the decision to fight aids, and leave a legacy for all of us. this morning, i am honored to be given the honor to introduce a great leader who already is turning our aspiration into reality. she is part of american dream team for hiv. [applause] president obama, secretary clinton, secretary sebelius, and my brother and friends, dr. eric goosby. secretary clinton is -- courage and intellect.

around the world and leadership has touched so many people from people in island communities to end of states. she was the first leader to use foreign quality as a tool to promote global health. for example, appointing america's first ambassador for global women's issues. she was the first global leader to speak out against economic -- against women. [applause] and last november, she was the first global leader to call for an aids-free generation. [applause] she challenged us all to imagine

a world where all babies are born free from hiv, where everyone has access to treatment, where the rights of women and girls are protected and promoted. [applause] where shared responsibility is met with global diversity, and where all people, but especially those most affected by this epidemic are not feared of the stigma of discrimination. she understands that that if we -- [inaudible] it will produce -- [inaudible] across health and development around the world. history will remember as not only as one of the world's most

inspiring leaders, but also as one of its most effective and committed visionaries for change. [applause] at the moment when she asked so many of your countrymen from syria to afghanistan, to the human rights council, a powerful testimony of her heart and sincerity. and global commitment, she has always found time to be a caring mother. it is my tremendous pleasure and honor to introduce picture champion of the aids movement, secretary of state of united states of america, hilary rodham

clinton. [cheers and applause] >> roo[applause] >> good morning. good morning, and. [inaudible] >> hillary, hillary. >> now, what would an aids

conference be without a little protesting? we understand that. [applause] part of the reason we have come as far as we have is because sony people all over the world have not been satisfied that we have done enough. and i am here to set a goal for a generation that is free of aids. [applause] but first, let me say five words we have not been able to say for too long. welcome to the united states. [applause]

we are so pleased to have you all finally back here. and i want to thank the leaders of the many countries who have joined us. i lost to acknowledge my colleagues on the administration and the congress who have contributed so much to the fight against aids. it mostly i want to salute all of the people who are here today to do the hard work that has given us the chance to stand here and 20 to actually imagine a time when we will no longer be afflicted by this terrible epidemic and the great cost and suffering it has imposed for far too long. [applause]

on behalf of all americans, we thank you. but i want to take a step back and think how far we have come since the last time this conference was held in the united states. it was in 1990 in san francisco. dr. eric goosby, who is now our global aids ambassador, ran a triage center there for all the hiv-positive people who became sick during the conference. they set up iv drug trips to rehydrate patients. they gave antibiotics to people with age-related pneumonia. many had to be hospitalized, and if you died or even at a time

when the world's response to the epidemic was sorely lacking, there were places and people of caring where people with aids found support. but tragically, there was a little that could be done medically. and thankfully, that has changed. caring brought action, and action has made an impact. the ability to prevent and treat the disease has advanced beyond what many might have reasonably hoped 22 years ago. yes, aids is still in terrible, -- in terrible, but it no longer has to be a death sentence. that is a tribute to the work of countless people around the

world, many of whom are here at this conference, others who are no longer with us but whose contributions live on. and for decades, the united states has played a key role. starting in the 1990s under the clinton administration we began slowly to make hiv treatment drugs more affordable. we began to face the epidemic in our own country. ..

we knew that if we were going to win the fight against aids, we could not keep treating it as an emergency. we had to fundamentally change the way we and our global partners did business. so we have engaged diplomatically with ministers of finance and health but also with presidents and prime ministers, to listen and learn about their priorities in order to chart the best way forward together. now i will admit, that has required difficult conversations about issues that some leaders don't want to face.

like government corruption and the procurement and delivery of drugs, or dealing with an injecting drug users. but it has been an essential part of helping more countries manage more of their own response to the epidemic. we have also focused on supporting high impact intervention, taking tough decisions driven by science about what we will and will not fund, and we are delivering more results to the american taxpayer's dollar i taking simple steps, switching to generic drugs which have saved more than $380 million in 2010 alone. [applause] and crucially, we have vastly improved our coordination with the global fund, where we used

to work independently of each other. we now sit down together to decide for example which of us will fund aids treatment somewhere and which of us will fund the delivery of that treatment. that is a new way of working together for both of us but i think it holds great results for all of us. [applause] now all of these strategic shifts have required a lot of heavy lifting, but it only matters in the end if it means we are saving more lives, and we are. since 2009, we have more than doubled the number of people who get treatment that keeps them alive. we are also -- [applause] reaching far more people with prevention, testing and

counseling. and i want publicly to think first and foremost dr. eric goosby who has been on the frontlines of all this work since the 1980s in san francisco. [applause] he is somewhere in this vast hall, cringing with embarrassment, but more than anyone else, he had a vision for what pepfar needed to become and the tenacity to keep working to make it happen. and i want to thank his extraordinary partners here in this administration, dr. tom frieden at the centers for disease control and dr. raj shop of usaid. [applause] now with the progress we are making together, we can look ahead to a historic goal, creating an aids-free generation.

this is part of presidents to obama's call to make fighting global hiv/aids at home and abroad a priority for this administration. in july 2010, he launched the first comprehensive national hiv/aids strategy which has reinvigorated the domestic response to the epidemic, especially important here in washington d.c., which needs more attention, more resources and smarter strategies to deal with the epidemic in our nations capital, and last november at the national institutes of health, with my friend dr. balaji there are, i spoke in depth about the goal of an aids-free generation and laid out some of the ways we are advancing it through path far, usaid and the cdc. and on world aids day president obama announced an ambitious

commitment to the united states to reach 6 million people globally with lifesaving treatment. [applause] now, since that time, i have heard a few voices from people raising questions about america's commitment to an aids-free generation, wondering whether we are really serious about achieving it. well i am here today to make it absolutely clear, the united states is committed and will remain committed to achieving an aids-free generation. we will not back off. we will not back down. we will fight for the resources necessary to achieve this historic milestone. [applause]

i know that many of you share my passion about achieving this goal. in fact one could say i am preaching to the choir. but right now, i think we need a little preaching to the choir. and we need the choir as a congregation to keep singing, lifting up their voices and spreading the message to everyone who is still standing outside. so while i want to reaffirm my government's commitment, i am also here to boost yours. this is a fight we can win. we have already come so far, too far to stop now. i want to describe some of the progress we have made toward that goal and some of the work that lies ahead. let me begin by defining what we need.

it is a time when first of all virtually no child anywhere will be born with the virus. [applause] secondly, as children and teenagers become adults, they will be at significantly lower risk of ever becoming infected then they would be today, no matter where they are living. [applause] and third, if someone does acquire hiv, they will have access to treatment that helps prevent them from developing aids and passing the virus on to others. so yes, hiv may be with us into the future, until we finally achieve a cure, a vaccine, but

the disease that hiv causes need not be with us. [applause] as of last fall, every agency and the united states government involved in this effort is working together to get us on that path to an aids-free generation. we are focusing on what we call combination prevention. our strategy includes, counseling and testing and places special emphasis on three other interventions. treatment as prevention, voluntary medical male circumcision and stopping the transmission of hiv from mothers to children. since november we have elevated

combination prevention and all our hiv/aids work, including right here in washington, which still has the highest hiv rate of any large city in our country and globally we have supported our partner countries, shifting their investments toward the specific mix of prevention tools that will have the greatest impact for their people. for example, hate tedious daily -- scaling up its prevention to prevent mother-to-child transmission including full treatment for mothers with hiv, which will in turn of course prevent new infections, and for the first time the haitian ministry of health is committing its own funding to provide anti-retrovirals treatment. [applause] we are also make an notable progress on the three pillars of our combination prevention

strategies. on treatment as prevention, the united states has added funding for nearly 600,000 more people than in september, which means we are reaching nearly 4.5 million people now and closing in on our national goal of 6 million by the end of next year. that is our contribution in the global effort to reach universal coverage. on male circumcision, we have supported more than 400,000 procedures since last december a lone. and i am pleased to announce that pepfar will provide an additional $40 billion to support south africa's plan to provide voluntary medical circumcision for almost a half a million boys and men in the coming year.

[applause] you know and we want the world to know that this procedure reduces the risk of female to male transmission by more than 60%. and for the rest of the man's life, so the impact can be phenomenal. in kenya and tanzania, mothers asked for circumcision campaigns during school vacations so their teenaged sons can participate. it in zimbabwe, some male lawmakers wanted to show their constituents how safe and virtually painless this receipt or is so they went to a mobile clinic and got circumcised. that is the kind of leadership we welcome. [applause] we are also seeing the development of new tools that would allow people to perform the procedures with less training and equipment than they need today without compromising safety and with such a device is

approved by the world health organization, pepfar is ready to support it right away. [applause] and on mother-to-child transmission, we are committed to eliminating it by 2015, getting the number 20. over the years -- [applause] we have invested more than $1 billion for this effort. in the first half of this fiscal year, we have reached more than 370,000 women globally and we are on track to hit pepfar's target of reaching an additional 1.5 million women by next year. we are also setting out to overcome one of the biggest hurdles in getting 20.

when women are identified as hiv positive and eligible for treatment, they are often referred to another clinic, one that may be too far way for them to reach. as a result, too many women never start treatment. today i'm announcing that the united states will in best an additional $80 million to this. [applause] these funds will support innovative approaches to ensure that hiv positive pregnant women get the treatment they need to protect themselves, their babies and their partners. so let there be no mistake, the united states is accelerating itwork on all three of these fronts in the effort to create an aids-free generation, and look at how all these elements

come together to make a historic impact. in zambia we are supporting the government as they step up their efforts to prevent mother-to-child transmission. between 2009 and 2011, the number of new infections went down by more than half. and we are just getting started. together we are going to keep up our moment him some on mother-to-child transmission. in addition we will help many more zambians get on treatment and support a massive scale up of male circumcision as well. two steps that according to our models will drive down the number of new sexually-transmitted infections they are by more than 25% over the next five years. so as the number of new infections in zambia goes down, it will be possible to treat

more people that are becoming infected each year. so we will for the first time get a head of the there, and eventually end aids-free generation of zambians will be in sight. think of the lives we will touch in zambia a loan. all the mothers and fathers and children will never have their lives ripped apart by this disease, and now multiply that across the many other countries we are working with. in fact, if you are not getting excited about this, please raise your hand and i will send somebody to check your pulse. [laughter] [applause] but i know, i know that creating an aids-free generation takes more than the right schools as

important as they are. ultimately, it's about people, the people who have the most to contribute to this goal and the most to gain from it. that means embracing the essential role that communities play, especially people living with hiv, and the critical work, a faith-based organizations. we need to make sure we are looking out for orphans and vulnerable children who are too often still overlooked in this epidemic. [applause] and it will be no surprise to you to hear me say i want to highlight the particular role that the women play. [applause] in sub-saharan africa today, women account for 60% of those

living with hiv. women want to protect themselves from hiv and they want access to adequate health care. and we need to answer their call. pepfar is part of our comprehensive effort to meet the health needs of women and girls working across the united states government and with our partners on hiv, maternal and child health and reproductive health including voluntary family planning and our newly launched child survival call to action. every woman should be able to decide when and whether to have children. [applause] this is true whether she is hiv-positive or not. [applause] and i agree with the strong message that came out of the

london summit on family planning earlier this month. there should be no controversy about this, none at all. [applause] and across all of our health and development work, the united states is emphasizing gender inequality because women need and deserve a voice in the decisions that affect their lives. [applause] and we are working to prevent and respond to gender-based violence, which puts women at higher risk for contracting the virus, and because women need more ways to protect themselves from hiv infection. last year, we invested more than $90 million in research on

microbicides. all these efforts will help close the health gap between women and men and lead to healthier families, communities and nations as well. if we are going to create an aids-free generation, we also must address the needs of the people who are at the highest risk of contracting hiv. one recent study of female workers and those trafficked into prostitution into low and middle income countries found that on average, 12% of them or hiv-positive, far above the rates for women at large. at as people inject drugs account for more than one third of all the people who acquired hiv outside of sub-saharan africa. and in low and middle income countries, studies just that hiv

prevalence among men who have with male partners could be up to 19 times higher than among the general population. now over the years, i have seen and experienced how difficult they can be to talk about a disease that is transmitted the way that aids is. but if we are going to beat aids we can't avoid sensitive conversations and we can't fail to reach the people w are at the highest risk of. [applause] unfortunately today, very few countries monitor the quality of services delivered to these high-risk key populations. we are still rigorously obsessed

whether the services provided actually prevent transmission or do anything to ensure that hiv-positive people in these groups get the care and treatment they need. even worse, some take actions that rather than discouraging risky behavior actually drive more people into the shadows where the epidemic is that much harder to fight. and the consequences are devastating. for the people themselves and for the fight against hiv. because when key groups are marginalized, the virus spreads rapidly within those groups, and then also into the lower risk the general population. we are seeing this happen right now in eastern europe and southeast asia. humans might discriminate but viruses do not, and there is an

old saying that goes, why rob banks? because that is where the money is. if we want to save more lives, we need to go where the viruses and get there as quickly as possible. [applause] and that means science should guide our efforts. today i'm announcing three new efforts by the united states government to reach key populations. we will invest $15 million in implementation research to identify the specific interventions that are most effective for each key populations. we are also launching a 20 million-dollar challenge fund that will support country plans to expand services for key populations, and finally through the civil society network fund we will invest $2 million to

bolster the efforts of civil society groups to reach key populations. [applause] now americans are rightly proud of the leading role that our country plays in the fight against hiv/aids. and the world has learned a great deal through pepfar about what works and why. and we have also learned a great deal about the needs that are not being met and how everyone can and must work together to meet those needs. for our part, pepfar will remain at the center of american commitment to an aids-free generation. i have asked ambassador, dr. goosby to take the lead on developing and sharing our blueprint of the goals and objectives for the next phase of our effort and to release this blueprint by the worlds -- world

aids day this year. [applause] we want the next congress, the next secretary of state in all of our partners here at home and around the world to have it clear picture of everything we have learned and a roadmap that shows what we will contribute to achieving an aids-free generation. reaching this goal is a shared responsibility. it begins with what we can all do to help break the chain of mother-to-child transmission, and this takes leadership at every level from investing in health care health care workers to removing the registration fees that discourage women from seeking care. and we need communities and family leaders from grandmothers to religious leaders, to encourage women to get tested and to demand treatment that they need. we also have a shared responsibility to support multilateral institutions like the global fund.

in recent months, as the united states has stepped up our commitment, so has saudi arabia, japan, germany, the gates foundation and others and i encourage other donors, especially in emerging economies to increase their contribution to this essential organization. [applause] and then finally, we all have a shared responsibility to get serious about promoting country ownership. the end state states where a nation's efforts are led, implemented and eventually paid for by its government, its community, it's double society, its private-sector. i spoke earlier about how the united states is supporting country ownership but we also look to our partner countries and donors to do their part.

they can follow the example of the last few years in south africa, botswana, india and other countries who are able to provide more and better care for their own people because they are committing more of their own resources to hiv/aids. [applause] and partner countries also need to take steps like fighting corruption and making sure there system for approving drugs are as efficient as possible. i began today by recalling the last time this conference was held here in the united states and i want to close by recalling another symbol of our cause, the aids memorial. for a quarter-century, this quilt has been a source of solid

solid -- solace and comfort for people around the world, a visible way to honor and to remember, to mourn husbands and wives, brothers and sisters, sons and daughters, partners and friends. some of you have seen the parts of the quilt that are on view in washington this week. i well remember the moment in 1996 when bill and i went to the national mall to see the quilt for ourselves. i had sent word ahead that i wanted to know where the names of friends i have lost were placed so that i could be sure to find them. when we saw how in norm is the quilt was, covering acres of ground, stretching from the capitol building to the washington monument, it was

devastating. and in the months and years that followed, the quilt kept growing. in fact back in 1996 was the last time it could be displayed all at once. it had just gotten too big. too many people kept dying. we are all here today because we want to bring about that moment when we stop adding names. when we can come to a gathering like this one and not talk about the fight against aids, but instead commemorate the birth of a generation that is free of aids. ..

>> thank you all very much. [applause] [applause]

>> and more, now, from the 2012 international aids conference with remarks from dr. anthony fauci. he outlined the necessary steps to end the global pandemic. he's followed by phill wilson of the black aids institute. this is about an hour. >> to introduce our first plenary speaker, please welcome professor fran soiz barr si news si, nobel prize laureate for medicine. [applause] >> thank you. ladies and gentlemen, dear colleagues, it's a real privilege and honor to introduce the first speaker of the very

first plenary station of the aids 2012 conference in washington, d.c. after 25 years. [applause] only one person could give this very first talk, a person with a real vision of science and what science can do for public health. it's the reason why i'm really delighted to introduce this person. ny fauci. -- tony fauci. [applause] tony is the director of the national institute of infectious disease at the nih since 1984.

he has overseen an extensive research process to preventing, diagnosing and treating infectious and immune disease. where he has made numerous important discovers related to hiv/aids and is one of the most cited scientists in the field. he's the author of more than 1,200 scientific publications including several major textbooks. mr. fauci has received numerous awards for his scientific accomplishments including the national medal of science award

for public service and the presidential medal of freedom. ladies and gentlemen, i am pleased to call tony. [applause] >> thank you for that kind introduction can. ladies and gentlemen, i want to thank the organizers for giving me the opportunity to kick off the scientific component of this international symposium and to take the theme that was developed last night with great enthusiasm and to discuss with you over my time allotment why we now have the scientific basis to be able to even consider the feasibility and the reality of an hiv/aids-free generation.

i want to start first by a little background. i love math. i love the deep blue of the oceans, the refreshing green of the plains and the awesome mountains. but when we now look at maps, many of us in this room over the past couple of decades, they have taken on a difference complexion. the dreaded differential shadings indicating prevalence in different regions of the world with now 34 million people living with hiv/aids. if you look in the upper left-hand corner of the slide, you see the united states where we have 1.1 million people living with hiv, and focus in a little bit and you see washington d.c. now, there are a couple of additions about washington. we all welcome you here, but it was 25 years ago that the international aids conference was in washington.

i had the privilege and the opportunity to participate in every one of the 19 conferences of the international aids society. but i want to play a little bit moment with you with washington when you talk about what we share globally. like i said, i like maps. this is a google map of washington d.c. this is where you are sitting. again, the dreaded shadings. because in washington, d.c. we have a prevalence that in many respects equals some of the pepfar nations. as michelle said last night, it is the best of times and the worst of times. the worst of times is the prevalence. the hope for the best of times is, as you heard from the mayor last night, washington, d.c. has implemented an aggressive and

innovative program to have a major impact which can serve as an example, and i'll get back to that in a moment. but let's get to the gist of what i want to develop with you over the next several minutes. we want to get to the end of aids. that will only occur with some fundamental foundations, and these foundations are the basic and the clinical research which will give us the tools which will ultimately lead to interventions and then ultimately these will need to be implemented. together with studies about how best to implement them. so let me briefly go through each of these with you. the basic and the clinical research. we have had a stunning amount of advances in the arena of basic and clinical science. which are delineated on this slide. i don't have time to go through each and every one of them with you, but there are some that

stand out, some as breakthroughs such as the initial identification by francoise and her colleagues. the demonstration that it's an ideological agent, the intensive incremental -- if that was a breakthrough, the incremental science each year learning more and more about the hiv virus itself as well as the pathogenic mechanisms. now, this is a confusing slide and i put on one slide of about 30 years of incremental research. and what we know now, a lot about this virus, the primary infection, the establishment of infection in limb body tissue, partial but never complete immunological control, accelerated virus replication and in the absence of therapy, destruction of the immune system. very important in that process of incremental scientific

knowledge is understanding the early events in hiv, particularly at the surface where there's vulnerability of the host and vulnerability of the virus. and understanding that interdingation is extraordinarily important in insight into both transmission and vaccine development. probably the most important of the accumulation of scientific advances is understanding the hiv replication cycle from the binding fusion, insertion of its rna, reverse transcription, integration and then viral budding. because each of that year after year has given us targets of vulnerability on the part of the virus. and it's that kind of basic science which brings us to the next step. and that is the step of intervention, predominantly in the arena of treatments and prevention.

let's start with treatment. i dug this slide out of my archives, it's a picture of me and some of our fellows and students in the very early 1980s when we were frustrated clinically, but beginning to make headways scientifically. i refer to these as the dark years of my medical career. but what kept us, myself and my colleagues not only here but throughout the country and the world, going forward even though we were much in the dark was realizing what people were going through in the community eloquently stated by queen jones in some of the films that you see that was going on in san francisco, or by larry cramer in his play "the normal heart," describing what was going on in green witch village -- greenwich village. but things began to happen to science-led innovation. and the you look at the

evolution of treatment strategies, the first drug in 1987, a glimmer of hope. virus goes down very little, doesn't stay down. resistance occurs. years go by. two drugs, virus goes down further for a little bit longer, but not enough. then the transforming meeting in vancouver in 1996 with a three-drug therapy brings down the virus to below detectable levels, stays there potentially indefinitely, and we have a new dawn of therapeutics with hiv/aids that has transformed the lives of individuals. we have now up to 30 hiv, anti-hiv-approved drugs by the fda. multiple classes used in combinations that have completely transformed things. but we can't stop there, because there are still those who are not responding to these drugs, and we still need long-acting drugs, particularly with regard

to adherence. the results have been spectacular. i'm going to pick out just a couple of examples. if you like, and this is a study from holland. i told you back in the dark year of my experience the median survival of my patients was 6-8 months, 50% dead in 6-8 months. now if a person walks into our clinic at the nih or any other place that has availability of treatment, is young, 25 and recently infected, you put them on combination therapy, and you can look them in the eye tell them it is likely if they adhere to that regimen that they will live an additional 50 years. this is not only confined -- [applause] this is not confined just to the developed world, because we know now in countries, for example a cohort analysis in uganda got the same similar results with near-normal life expectancy.

that's the good news. but then there's challenges. this is a very scary slide because if you look in the united states at the 1.1 million people infected, 20% don't know they're infected, 62% are linked to care, 41% are retained in care. only 36% are on antivirals, and 28% are suppressing their viral loads. we must do better than that. we have the tool, and as i'll get to in a moment, we need to implement that. it can be all around. we can take examples from the developing world. but what we need to do is that we need and are doing it, having a care continuum that is speaking out, testing, linking to care, treating when eligible and making sure they adhere. and, in fact, getting back to the district of columbia, there is a study ongoing now with six cities, two of which are implement cities, the south bronx and washington, d.c., where we're starting to see that this can actually occur if you

put the effort in. and i'm sure you'll be hearing more about that later from my colleagues. it doesn't only happen in the developed world, and that's what people keep saying. if this is really going to be able to be done, well, take a look at what's going on in rwanda where you have a community-based program, the two-year retention on treatment was 92% with 98% tested at two years at suppressed viral loads. similar results in botswana. extending the intervention, what about prevention? [applause] combination hiv prevention. the message for this is prevention is not unidimensional, and we all know that. there's a combination that's come prehence i. on the lower level of these building blocks are interventions that are not necessarily biologically driven. we were implementing them before we even knew there was a virus, what the virus was.

but then as the years went by, science led us. some examples briefly, prevention of mother-to-child transmission, the breakthrough study of '07-'6 indicating that by treating the mother you can actually decrease dramatically. now we treat mothers for their disease and then secondarily, together with the mother's help, the baby is born unaffected. in the united states, this has transformed what you see now on these red bars, the estimated number of hiv-infected infants. but, in fact, remember what the mayor said last night. in this city with hard prevalence, there has not been a child born hiv infected since 2009 in a city with high prevalence. [applause] that's the good news, that 600,000 pediatric infections

were averted by propose lactics. but we still have a challenge. there are 330,000 new infections in 2011 alone. what about male circumcision? this is a stunningly successful intervention. the initial trials in south africa, kenya and uganda show efficacy, that in the confines of the trial it works. the real question is, will it work in the field? if as a matter of fact, uniquely this is one of the few prevention interventions that actually gets better with time. because the initial result was 55-60%. as you go to a district in uganda five years out, the effectiveness in the community is 73%. topical microbicide, good news and challenging news. the capricious study proved the concept you can have a women-mandated intervention by a

gel that has tenofovir. when you adhere to it, this study and the prep study has been soberly -- [inaudible] biological interventions work, but they don't work if you don't adhere, which tells us why we have to marry biological with behavioral. there's no doubt about that. what about -- [applause] we know that from the boyd study that showed due to fertility, hopefully we'll get the answer from the fact study. getting back to the long-acting oral, the same thing has to do with microbicides, and we're very pleased that the approach of now-monthly use in two studies which started in the year, the aspire and ring studies, which will hopefully bring a greater degree of adherence to show that efficacy can equal effectiveness. preexplosion prophylactics, again, mixed results.

the breakthrough study and the recent approval by the fda both for men who have sex with men and heterosexuals, even couples are at risk. but there are some studies that show it doesn't work. it doesn't work almost certainly with some biological effect, perhaps the concentration of drugs, but importantly adherence again. hammering home to us the concept that biological efficacy will not be effective without adherence. probably the most game-changing advance over the last couple of years of treatment and prevention was the now very famous hbn052 trial which reduced by 96% the likelihood that someone will transmit to their uninfected partner. if you treat early, a great argument for getting people on treatment. now, before i go on to the implementation, i just want to

mention that i'm theming you a lot of good news -- telling you a lot of good news about science, but we still have challenges. we have challenges in the arena of vaccination, we have challenges in the region of cure. if we were able to plug in a vaccine block, we would surely have a very robust combination prevention package even if it wasn't a perfect vaccine, even if it wasn't 90% or 80%. we could do it. let's take a look at where we've been with that. you're all familiar with the rp144 trial. it's a humbling trial because it showed a modest degree of efficacy. but when you mine down and try and figure out the potential -- [inaudible] we find out that it's nonneutrallizing, nonpda-related response against a variable region of the envelope. something that the classic paradigm would not have predicted.

but the mutualizing antibody approach is also very important and, in fact, naturally induced neutralizing antibodies as few as they are, as ineffective as they are and as late as they are on giving us scientific clues to identify mutualizing end taupes on the envelope which will do two things. and you're going to see parallel research going on. you're going to see structure-based imknew no general design for a vaccine at the same time the provision passively of neutralizing antibodies either by transfer or by gene-based vectors. we need to show if neutralizing antibodies actually do protect, otherwise a vaccine could be moot. what about a cure? francoise and her colleagues a couple of days ago sponsored an extraordinary symposium about approaches to an hiv cure. two general types, either eradication purging it which would be very difficult, or

perhaps what i called years ago a functional cure, namely either enhancing hiv-specific immunity or modifying the host cells to be resistant. i want to make sure that, i know people in this room understand, but others don't. this is not an implementable intervention. this is way upstream on the fundamental, basic discovery level. so that you can put an end to the hiv pandemic which is an epidemiological phenomenon without curing anybody, and you can cure a few people without putting an end to the hiv pandemic. so this is a scientific challenge. let's go on to implementation. we've been able to implement from what we've discussed over the last day or so the extraordinary effect of the pepfar program, the global fund philanthropy such as the bill and melinda gates foundation, the clinton foundation.

but importantly, recently the assumption by host countries of their own responsibility, and this has really been very important. so i want to -- let's take a look at this. just a couple of minutes of this. what happens when you take an efficacious clinical trial-based observation and you try to scale it up regionally or locally to see if it becomes effective? there areany examples. i'm just going to give you a few. what about the positive impact of scaling up antiretrovirals in botswana? take a look at the red dot, which is a percentage of mothers who are actually being treated. take a look at the diminishing blue bars, the number and percentage of children who are born of hiv. it works. what about the fact that if you treat people, do can you really save their lives? we now have eight million people receiving antiretrovirals in low and middle income countries which, in fact, 840,000

aids-related deaths have been averted in 2011 alone. ask the question, what about the positive impact of therapy on the hiv incidence? you go to a place where you have 30% coverage and another section where there's 10% coverage. a 38% lower risk of acquiring hiv in those high-coverage areas. treatment as prevention works in the field if you implement it. we know that scientifically. [applause] what about impact of voluntary male circumcision? again, if you look at a study taking nonmuslim populations who generally don't get circumcised and you increase the circumcision up to 35%, by 2011 you have a 42% decrease in acquisition of infection. what about comorbidities?

art and tv, a very nefarious marriage between those two diseases. look what art is doing to tb, the best way is to treat hiv. it decleeses it by 60%. it reduces mortality by up to 90-plus percent. now, you're going to hear a lot of models over the next few days, important models. models can be complex and confusing depending upon what the assumptions are. you could model microbicides, pmcc, male circumvision and even stick a vaccine in there. rather than go through the complexities of the models, i want to talk to you just for a minute about a very uncomplicated aspirational model. we know now that the incident is going down from 2.7 to 2.5.

so the slope is going down. notice in the lower right i don't have a date there because we can't talk about a date. but for sure the decline is not steep enough. so when you talk about scaling up the things that others have been talking about, this is what we hope for, that we would see a major deflection of that curve. and if we're fortunate enough to add a vaccine to that, this is what e hope to see -- what we hope to see. no promises, but we know it can happen. so if you go back to what i've been saying about the science, today in july of 2012, the statement that we don't have the scientific basis to implement is no longer valid. we do. [applause] that's the point. [applause] the critical question is, what's going to happen?

because this will not happen spontaneously. what it will require are the things that secretary clinton spoke about when she introduced the possibility in november of 2011 at the nih of an aids-free generation. a lot of people, a lot of countries, a lot of regions have a lot to do. from country ownership, capacity building, help system strengthening, increased commitment by current partners involving new partners, coordination. get rid of what does not work, concentrate on what does work and remove the legal, political and stigma barriers. only then -- [applause] only then will this occur. so let's get back to this dreaded map. i mentioned in the beginning of my talk that i have had the opportunity to present at every one of the 19 meetings. this is a map that i led off this meeting for.

what i hope for over the coming meetings of the international aids society is be able to start to show a map that goes like this and this and this until finally we can say that we are the generation that opened the door through our scientific endeavors and our implementation to an aids-free generation. thank you. [applause] >> introducing our second

speaker, please welcome ebony johnson -- [cheers and applause] >> ceo of -- [inaudible] prevention and member of the athena network. [applause] >> good morning. first, as a member of the united states, i am so pleased to welcome you back and to thank and congratulate the exceptional, bold leadership of president obama for lifting the travel ban. [applause] but as a black woman residing in washington, d.c., we face the highest rate of hiv, and where black women are at the center of vulnerability. it is a pleasure to welcome you back, to be a voice and for this to be a call of action. [applause]

it's my pleasure to introduce from the u.s. phill wilson. phill wilson is the president and ceo of the black aids institute. the black aids institute is the only national hiv/aids think tank in the united states, focused exclusively on ending the aids pandemic in black communities by engaging and mobilizing black institutions and individuals in efforts to confront hiv, by interpreting public and private sector policies, conducting training, providing technical assistance and disseminating hiv and aids-related information and advocacy from a uniquely and unapologetically black perspective. wilson previously served as the aids coordinator for the city of los angeles as the director of policy and planning for project los angeles, as co-chair of the los angeles health commission

and as an appointee for the advisory committee. wilson has been involved in a myriad of agencies from their inception across the united states. they include the national black community gay leadership forum, the national task force on aids, the chris brownie hospice, the aids health care foundation, the national minority aids council, the los angeles county gay men of color consortium, the k air corps mission, and mr. wilson has also worked very extensively across eastern and western europe, in sub-saharan africa, india and mexico. in 2001 phill wilson was named as the leadership for change in the world recipient. in 2004 he received the discovery health channel medical honor. he has also been named as the

2005 black history makers in the making by black entertainment television. mr. wilson is a prolific writer who has published several articles and newspaper writings. please welcome him to the stage. thank you. [cheers and applause] >> i am both honored and humbled to have been asked by the conference organizers to share my thoughts with you this morning. but i'm also a little intimidated to have to follow dr. tony fauci, one of the greatest heroes in this movement. and i'm more than a lile nervous to stand between you and one of the highlights of this conference, secretary of state hillary clinton. i'm thinking something about a rock and a hard place right now. [laughter] but on behalf of the estimated 1.1 million americans living

with hiv and the tens of thousands of doctors, nurse, researchers, advocates, counselors, activists and volunteers who serve them and work every day to end the aids epidemic in this country, welcome back to our house. [cheers and applause] twenty-two years is a long time, and we missed you. and welcome to the first international aids conference where we know that we can end aids. thirty-one years after this disease was discovered right here in this country, we finally have the right combination of tools and knowledge to stop the epidemic. no, we don't have a cure or a vaccine yet, but david only had a slingshot, and he felled goliath. our tools are not perfect -- [applause] but they are good enough to get the job done if, and this is a big if, if we use them

efficiently, effectively, expeditiously and compassionately. and that's what i want to talk to you about this morning. i'm an openly gay man who has been living with hiv for 32 years. [cheers and applause] treatment may be prevention, but i'm proof that treatment is treatment. [applause] when half of the people living with hiv in this country are black and over 60% are men who have sex with men, i understand why the organizers of this meeting would invite someone like me to give this talk. you see, i'm a creeper. i'm black, i'm gay, i'm hiv positive, and according to aarp

i can -- [inaudible] as well. [applause] but it is not lost on me all the things that i am not. i am not a woman, a straight man or a transgender person. i am not an asian pacific islander, latino, native american, white or an immigrant. i don't speak spanish, creole or vietnamese. i'm not a drug user. i don't live in the rural south, and i've never even been to anchorage or business -- business mark. but i know this, we will not end the aids epidemic in this country unless all of those voices are included. [applause] all of what i am and am not must

be a part of the conversation. the united states spans nine time zones. it has a population of over 300 million speaking 311 languages. and 14 million american households, english is not the primary language. you might think that the united states has it easy, and in some ways we do. we have great universities that generate superb science, we have a entrepreneurial and a can-do spirit, and we're wealthy. but even so many be -- many of our residents live in debilitating poverty. we have unacceptable levels of homelessness, addiction and mental health illness. we have large numbers of people with hiv who suffer from other diseases such as hepatitis b and c and are marginalized and stigmatized. we not only have the largest epidemic in this evolved world, we have one of the most

complicated epidemics in the entire world. we face gigantic challenges, challenges that demand we rely on lessons learned in many other countries, lessons learned by you in this room, and challenges that offer the possibility for learning lessons that in turn can be applied all over the globe. approximately 50,000 people get infected each year in the united states. that's a dramatic decrease from where we were in the mid '80s. but our prevention efforts have been stalled for at least the last 15 years. demographically our epidemic is 75% male and 25% female. estimated hiv prevalence among transgender persons ranked from 14% to 59%. our epidemic is 43% black, 34% white, 19% latino, 1% asian/pacific islander and 1%

native american and hawaiian. 44% of the epidemic lives in 12 cities, but new hiv infections are rapidly rising in rural communities, especially the south. the u.s. epidemic is primarily a concentrated epidemic. but in certain populations we have generalized epidemics. for example, with a background hiv prevalence of almost 3% and 835 new hiv infections in 2010, the aids epidemic in washington, d.c. right here is a generalized one, and it is one that is worse than the aids epidemic in port-au-prince, haiti. black men who have sex with men are engulfed in a raging epidemic. according to a new report released by the national black gay men's advocacy program,

black males are at an elevated risk for hiv infection regardless of aids. the increase is from 1 in 4 at age 25 to 59.3% chance by the time he reaches 40 years old. now think about that for a minute. by the time a black gay man reaches 40 years old, nearly 60% of him, 6 out of 10, will be hiv positive. the aids epidemic in america is a tale of two cities. that seems to be a theme this week. it is definitely the best of times and the worst of times. we have a system that can work very well for some of us, but for many of us the system is terribly, terribly broken. the other day i was talking to my friend david, the president and ceo of the aids foundation of chicago, about his friend,

luis. a mexican immigrant who lived the last nine years of his life in the united states. he worked six and sometimes seven days a week as a busboy and dishwasher at two restaurants. he paid taxes and otherwise obeyed the law. he was privately jovial, silly and loved to dress in drag. don't we all. [laughter] his health declined rapidly, and tragically in 1995 at the age of 25, luis died of aids-related complications. his friends pulled together the resources to bury him. but what followed next shocked everyone who knew him. his name was not luis. that was an alias he assumed for work papers, social security and medicaid. he lived the most secretive life of all. in fact, his sister who traveled from mexico to collect his

remains learned only after his death that her brother was gay and had aids. luis' deception helped him access american health care that he otherwise could not afford. but it denied him a chance to live and die with dignity. lawrence is in the audience today. he was 17 years old when he found out that he was hiv positive. it only took one mistake for the virus to become a personal reality for him. lawrence's father, once he found out that his son had hiv, reacted by going into the bathroom and closing the door. lawrence eventually got lengthy care, found a job working in hiv. unfortunately, his job didn't offer health insurance and did not pay enough for lawrence to pay for his own treatment. so he was forced to choose between working or staying on

medication. what kind of choice is that? luis and lawrence are not isolated examples. this next model, first described by dr. edward garner at the university of colorado, estimates how many people with hiv in the u.s. are engaged in the various steps, in the continuum of care from diagnosis to -- [inaudible] there are three things in this slide that strike me most. first, about 80% of hiv positive people in the united states know their status. now, we can do better, but that's not too bad. second, once we get people on antiretrovirals, around 71% get to suppression. again, we can do better. but the real problem is in this middle section here. we do a terrible job of moving people from testing to being on

antiretrovirals. between testing positive and going on antiretrovirals we lose 54% of people with hiv. remember, these are people for whom we have some kind of contact. in the richest nation on the planet, barely a quarter of the people with hiv are in fully effective treatment. more than 70% are either not on treatment at all or on -- [inaudible] treatment. that's bad for them, and it's bad for everyone else. because when they are not on treatment, they are much, much more lakely to spread the virus -- likely to spread the virus. we, you and i, the people in this room, the people in the global village, the people doing work back at home every day who couldn't afford to come to this conference, have to change that. luckily, there are people and programs that are showing us how. right here in this city the

community education group, a small organization that serves predominantly black neighborhoods offers hiv tests and a whole lot more. of the people who turn out to be positive, 95% -- 95% -- are linked, relinked or confirmed to be receiving hiv care and treatment services. [applause] rather than giving individuals a paper referral, they provide clients an immediate personal escort, and if needed, financial incentives to go to medical providers. ceg uses new technology to conduct risk assessment and enroll community members in insurance programs and/or medicaid. they also provide patient follow-up such as text messaging reminders and indications of when they have medical appointments.

something else happens here in washington d.c. there's a huge help to people with hiv. it's called the affordable care act, better known as obamacare. [applause] because of this law no insurance company can deny you coverage because you have a pre-existing condition. jack up your rates or drop you because you get sick or because your care costs too much. for people with hiv and aids, these provisions are absolutely life saving. leadership matters. two years ago president obama released the first-ever comprehensive hiv/aids strategy in the united states. according to the vision of the strategy, the united states would become a place where new hiv infections are rare.

and when they do occur, every person regardless of age, gender, race, ethnicity, sexual orientation, gender identity or socioeconomic circumstance will have unfettered access to high quality, life-extending carefree from tig ma and discrimination. -- stigma and discrimination. [applause] together we can manifest that vision if we do the following things. first, we must fully implement the affordable care act. [applause] this will deliver health coverage to more than 30 million people who are currently uninsured. single, childless adults who are typically not eligible for medicaid, a critical failure in the epidemic concentrated among low income, gay men. but under the affordable care

act, everyone will have a means to pay for life-saving treatment. [applause] this most important piece of legislation over the last 40 years has generated a lot of opposition and misinformation. aids advocates must be at the forefront of opposing any efforts, any efforts to roll back reforms on the affordability care act. [applause] we need to assure that the packages under the legislation include an annual physical for everyone, an hiv at every physical including at least two annual hiv test for high-risk individuals, twice-a-year viral load tests for people living with hiv and comprehensive coverage of arv both for treatment and prevention. [applause]

second, everyone living with hiv must come out. we all must come out. living openly and proudly with hiv not only confronts hiv stigma -- [applause] but it also helps build demand for essential services. [applause] openly hiv-positive people serve as living, compelling reminders of the importance of knowing one's hiv status. and that is that, and that also communicates that it's possible to live a full, healthy life with hiv, and that is important. [applause] when you come out about your hiv status, you not only save your life, but you save other lives as well. [applause] my family is here in this room this morning.

my brother, my dad and my mom. when i was 24, i gave my mother a book called "loving someone gay." and she said to me, why do you give me this book? i don't love anyone gay. yes, you do, i say. you love me. and i was right. i'm alive today because i have the love and support of family and friends. [applause] but they could not support me if i denied them a chance to truly know me. not just some one-dimensional avatar of me, but all of me. despite the quilt being on the mall this week -- which is really about our death -- the story of our lives go largely

untold and unnoticed. we want our families to love us and to support us, but they cannot love us if they don't know us. and they can't know us if we continue to hide from them. [applause] now, i'm not naive. i know it's too dangerous for some of us to come out right now, but some of us can. and if we do, others will be able to join us later. third, we need to put as much emphasis on building demand for treatment as we do on insuring access. our health care system has long been a source of shame. the united states is the only industrialized country that is does not guarantee health coverage for its citizens. but through a come combination of programs such as medicaid and the ryan white care act, we've built a robust system of care for people living with hiv. yet only about one in four people with hiv in our country are now receiving the care they

need and deserve. if we demand it, they will have to build it. health services aren't meaningful unless they're actually used. too many people are intimidated by the medical system. too many still believe that a positive hiv test is a death sentence, and too many people believe that hiv treatment requires a fistful of pills every day with horrible side effects. we need a massive investment in community education, in hiv science treatment literacy. [applause] we need an army of patient navigators that link individuals to the care they need. fourth, we need to integrate the biomedical and the behavioral in our prevention and treatment efforts. some people in the aids field continue to resist the so-called medicalization of aids while others promote these new biomedical tools as a panacea. neither perspective is correct. these new biomedical strategies,

the treatment and prevention, prep and the others still to be developed, are more powerful than anything we've ever had in our tool kit before. [applause] but to work, these powerful biomedical tools will need to connect with actual people, those who deliver them and those who use them. our biomedical interventions won't be effective if people are frustrated by the complexity of our medical delivery service system. and they simply give up. if they don't understand the importance of adhering to the prescribed regimen or if the providers are judgmental or display that they don't understand what our lives are like, over the course of this epidemic we've learned a lot about how to influence human behavior. and we need to apply these lessons as we put our new biomedical tools into practice. the crucial point here is that

it is not an either/or, but a both and and. the biomedical model only works when education, counseling, behavioral change, adherence and support are all there. the whole history of the epidemic has shown us that while education and social and behavior interventions are necessary, they're absolutely not sufficient. if they were, the epidemic would be over already. it's the addition of biomedical intervention that can lead us to a promise of ending aids. we must turn this tide together. finally, the fifth thing we need to do is that aids organizations need to retool themselves to a rapidly revolving landscape. communities will always remain central to our ability to end aids, but most of our

community-based organizations have focused their expertise on behavioral interventions only. few have meaningful scientific expertise, and fewer still actually deliver health care services. with biomedical tools rapidly becoming a critical part of our aids response and with the affordable care act poised to dramatically alter the terrain for health and social services, many aids organizations risk become withing wholly irrelevant. fortunately, some visionary organizations have already begun to retool. harlem united, for example, has actively worked to adapt to the dynamic environment, readying itself for state medicaid reform and shifts in the nation's health care system. it began as a small organization, but today it is a federally-qualified health system with 3,000 patients. harlem united connects the dots

between medical care and social services. eric is also here the morning. he's a health educator and youth advocate for a unique peer-based social service organization serving latinos in los angeles. they serve by building an infrastructure that connects prevention and treatment and science with advocacy. harlem united, ceg and vienna star are three examples of what effective aids service organizations must look like if we're going to end the aids epidemic. i have a reoccurring dream in which a little boy citizen -- asks a wise old woman, what did you do when millions of people were dying from aids? >> i always wake up before the wise old woman has a chance to answer. i'm afraid i wake up because i'm afraid of the answer. i'm afraid the answer will be,

not enough. i work for a tiny organization, and for all i know we may close our doors next week. but this week, this week with our 30 black advocates and our black scientists, this week with our journalists we are going to bleed every drop of information out of this meeting -- [cheers and applause] my worst nightmare is that we will squander the historic opportunity, and this is what i know. the day will come when this epidemic will be over. and it's important for them to know that we were not all monsters, that we were not all cowards, that some of us, some of us dared to care in the face of it. some of us, some of us dared to fight because of it. and some of us, some of us dared to love in spite of it. because it is in the caring and

the fighting and the loving that we live forever. this is our time! [cheers and applause] this is our society's moment. together we are greater than aids! [cheers and applause] >> and we now conclude our coverage of the 2012 international aids conference with remarks from assistant secretary of health how'd howard koh. he talked about chances to lower the infection of the disease by 25% through 2016. it's about 20 minutes. >> the next speaker, it's my pleasure to introduce is dr. howard koh. he is the assistant secretary of health of the united states department of human and health services. a former commissioner of public

health of the commonwealth of the state of massachusetts, he has also served as a professor of medicine and associate dean at the harvard school of public health. a graduate of yale college and medical school, he is the author of over 200 papers and the recipient of numerous awards. it was not until 2010 that the united states had its first national aids strategy introduced by president obama. this strategic plan has shaped the public health response for our country over the last two years. so now i welcome dr. koh to address building on success, a national strategy to save lives. [applause]

>> dear friends and colleagues, i am so honored to join you this morning on behalf of the united states government to present the status of our commitments for an aids-free generationment in -- generation. in particular, i am so pleased to review the development and implementation of the first-ever comprehensive national hiv/aids strategy which addresses many of the domestic challenges already reviewed at this conference. this strategy also incorporates lessons learned from our many domestic and global partners. it was more than 30 years ago when the first hiv cases were