the united states government and politics exam? don't miss your chance to be part of "washington journal" cram for the exam program on saturday may 49:00 a.m. eastern for a live discussion with high school government teachers. >> are question is significant. >> logrolling is a word of bill trading. if you had this writer in this court project, and if you had that you will get more supportive books. >> watch "washington journal" cram for the exam on saturday the fourth on 9:00 a.m. eastern on c-span. >> the kaiser family foundation yesterday hosted discussion on the trip administration to an

hiv transition in the u.s. we will hear from an assistant secretary of health and human services. then state health department officials. >> welcome everyone. i am jen from the kaiser family foundation. i am so pleased that many of you could be here today including those watching on a webcast in on c-span. this will be archived after this event if anyone wants to watch it again. thank you. many of you in the room, i listen with great interest to the president's state of the union address. talking about a new hiv initiative and the bold goal of a root eliminating hiv within ten years. i learned about some of the details and thereafter. this has got a lot of attention bringing focus back to the epidemic in the u.s. which would be the new funding in years. almost three months from the announcement what more do we

know, what questions are still remaining, and especially how will it be implemented which brings us to today's event. this event was to hear about the latest on ending the hiv epidemic. it has a panel with different perspectives, questions and answers questions from you and answers from us. a more panoramic view of this initiative. before i go on and what to think and colleagues for their hard work to make this happen particularly craig and lindsey and others on the team. in the communications team that did the same on their end. on behalf of kf f i am pleased to welcome bret gerrard, he served as a public health and science advisor as well is the chief opioid policy advisor, his

office oversees many critical national initiatives including the new plans in the hiv and african-american. he has served numerous leadership positions in the federal government and academic. he is also a pediatric critical care physician. welcome and thank you. >> thank you very much. >> i want to note that he has to leave by 1040, he will have a q&a and then we will open it up to you he has to catch a plane to go. he said he will watch the webcat later. >> thank you for inviting me. let me start with the general question to get everybody here up to speed on what the initiative is about, the key elements, what you are hoping to

try to do, i think a lot of us have a general sense but to make sure everyone is on the same page. fill us in. >> thank you for that. this initiative came about by combination of people who spent their entire life working on hiv, aids. together those of us but certainly taking care of patients with hiv that this is been our entire career. when i was preparing for my position i know personally, i was really shocked to understand that there still remain 38 to 40000 new cases of hiv in the united states we have all the tools and technologies to make that also. i know i personally asked myself, why are there still 40000 new cases of hiv a year in the united states and the answer that i got was really the answer, because no one decided not to make it that way any longer. so over many months, we got together and decided that this really is the right time, that

we have outstanding therapy that is down to one pill. day, very low toxicity and the great majority of people can obtain an undetectable amount. we also know that you equals you. undetectable means and transmittable. combined with that we have prep which is highly effective in preventing the acquisition of hiv in at least 95% intimate be much higher than that. we are proven models of care such as the ryan white program that has been earthshaking in its impact on reaching the hardest groups of patients to reach. those with many social determination. and we also know through the cdc so the whole idea of this epidemic is to really reach ending the epidemic initiative

is to reach those who have not been reached before and we do not underestimate the difficulty of that. we know that one out of every two patients with hiv have been infected for at least three years grade one in four is up to seven years. we know that is worth most of the transmission occurs. this is a community focused plan focused on 48 jurisdictions, san juan in d.c. that accounts for 50% of all new hiv cases. it's a focused and targeted initiative to start that will expand. we are also talking about seven states that have a high rollover. we understand what's important in miami or in houston, and may not be true for rural states. of course, we focus on the demographics that will be the overwhelming burden disease. african-americans, latinos and certainly upfront in our

proposal, american indians and alaska natives. this is an overview, that is generally what this is about, we are absolutely certain that our goals can be achieved, a 75% reduction in five years in a 90% reduction within ten years. the extra 50% gets harder that's why it takes a longer time in the last thing i will say because they do not want to forget. if we are successful, the diagnoses in the u.s. will go up in the next few years. we will be reaching people who have been undiagnosed and operatic care. when -- i will be happy if they go from 40000 to 60000 or 80000 because that means we are reaching the people we need to reach and bringing them into care. thank you for the opportunity to be here to represent my colleagues in the secretary in the treble ministration policy. >> thank you. just for information for folks here. on the 48 counties in the other

jurisdictions is the idea over time it will be expanded beyond those orders is determined based on how things are going ? >> we are going to take it tractable and have a plan. when you have 50% new cases within 48 jurisdictions, san juan and d.c., that's why we want to start there. number one, as we learn lessons on implementing the plan it will be disseminated immediately to other jurisdictions, secondly yes. there will be a formal transitioning on how it proceeds in the kinetics of what we are seeing to reduce infection to expanded to greater and greater circles to the next levels over the cases occur. >> one of the questions that we have gone, the goals sound great, the idea makes total sense from a health perspective, how do we implement this, going forward how do we make this

happen? >> i will give you a couple answers to that. ii was very impressed with what tony told me. we only government have been working on hiv and other outbreaks for going on 40 years. this is the first time that all the agencies have really gone together, really coordinated synergistic programs. i think is very important that we are going to run for quarters and spend them. we have to find people who are at risk, stigmatize, bring them into care that is primarily going to be a cdc and local health function. i will talk about that in a second period this has to be coordinated with the programs. like the ryan white program to have people treated in community health centers who can provide prep and unfortunately we have about 50% of the ryan white programs that are associated with community health center so they can provide both. the staff of limitations

otherwise that can go into. the mean first part of the program in the predominance of funding in the first year, it's to support local community health workers. local community health department that will create their hiv workforce. this could be people living with hiv, it can be community health workers, social workers, lawyer, people in the community to reach the people who have not been reached before. right now, we are going to award about 12 or $13 million this year, not waiting for fiscal year 2020 money. but to support the development of community plans that will be in the community, by the community, for the community. we will probably start a pilot program with funds that we have for my office of minority aids initiative. it has to be a community focus because the problems are going to be in the community. i'm sure you'll see in the next panel that the problems in mississippi as we know are not the same problems as other parts

of the country and there are different than oklahoma. >> after you show a couple slides i'm going -- can you give an overview of the budget request. >> the budget request turned out to be for $291 million this year, that is new money primarily to her son and the cdc. there also be redirection of funds for the aids research not new money, but new money allocated within the nih to support implementation research. there are two programs that were zeroed previously. a similar initiative, those are not counted in the 291 million but they are part of the presidents budget moving

forward. this is the first year of a multiyear program and they come one year at a time. as you can imagine, as more and more people get into care we need to invest more and more particularly in the first two years, over ten to 15 years this becomes an enormous money saver because every person with hiv will have additional healthcare cost over their lifetime but you need the investment up front. remember, if you have tens of thousands of people who have hiv but have not been diagnosed, and you bring them into the system you will be preventing cases but you will spend money up front in order to treat them or to provide prep for necessary services. >> that was my next question. in other jurisdictions are waiting for the funds are hoping congress will approve them in 2020. there also think it had. so if we put in new infrastructure or initiative, can we be sure what is going to come next?

so the intention is to keep scaling up? >> we cannot see much further than a few years. the principal in our senior staff has outlined a five-year program. very specifically jurisdiction down to the coverage level of people we expect to be entering into the system, again, nobody can be sure of anything except i can tell you that the secretary has made this his number one priority for the year adding to the other four priorities. the president is enthusiastic about this program or would not made it into the state of the union. we have every intent certainly of seeing the program for the time that we are able to steward it. >> i heard you talk like this, how you all thought about the tenure.

in modeling it out. one of the things that i heard you say is that the approach to figuring out what this would take, assume he thanks is the same. for those of us who do models, we say everything remains the same and then we look forward. one of the things that we heard excitement about the goals, excitement about the direction and at the same time the concern about other things happening. such as playback and coverage which is other intentions in the presidents budget. medicaid expansion, or reducing up. what have you approach that or think about the initiative with larger environment that could shift. >> let me see what our assumptions were and i'll talk about our approach. assumptions were inner proposals particularly in the five-year proposal was there was no fundamental change in coverage.

there would be no tsunami medicaid expansion, there be no tsunami a more people with coverage. we model down to the jurisdiction to the best availability who have medicaid, privately insured, who have no coverage or cause a gap in on expansion state. of course several of the states were not expansion states. the has to be put into the budget. we assume the people who are caught in between coverage would get there prep through community health centers in the ryan white program. our budgetary assumption is moving over the five years is to put all the money into the program because of course, what happens on the global level to who gets covered and where and how it will turn out from congress is not in our control. the second response to the question, we have dynamic, the world will change, we do not know what will happen tomorrow. we have set a structure that the

agencies have a very important role that the directors of the agencies set on a policy team that will be meeting every month to review the situation with an integrated operation team that includes people at her office. and of course, we announced in december, our first meeting would be in march, this is to coincide with this initiative is nice with the plans worked out that way because we weren't sure if the initiative will go forward. we have a lot of smart people, we will listen a lot about what these communities, we have to assume this is a dynamic situation. we can deal with the assumptions now but we have to be fluid and dynamic and responsive. >> uses something i meant to ask you earlier, listening to the community, what is this her plan for that on this?

>> we have started because i think all of us around the table, lisa principles, we are listeners, i am a physician, pediatric critical care physician and if you listen to the parents and the grandparent, 90% of your diagnosis is by listening and understanding. i think we have to get smarter by listening. we are committed to listening -- bob and i have been in atlanta listening to the communities, we were just in baltimore we had a community event where we listen to many different groups and of course we met with other patient groups here. but we will be going to at least one or two of the principles to all the jurisdictions over the next few months as we support them either finalizing their community many have hiv plans already but no funding to make that happen so it will be relatively easy to supply

funding. other communities are starting their plan. we want to work with them. we have a lot of interesting communities, like those in louisiana are trained to do a number of things like different models on ending each cv which we know as part of the same equation i think there is a lot of exciting ideas in models that we want to learn from but make e the jurisdiction can teach each other and learn from each other. >> with that reminds me as well, there is a national hiv strategy that is in the process of being updated. how is that working with the initiative? >> there are several strategies that are being developed that really relate to each other, let

me say how this initiative relates to the strategy. this initiative is a subcomponent to the national hiv strategy. the national hiv strategy being developed again in my office. it is meant to be much more holistic taking into account all aspects of hiv and need for research and other advancement where this plant is a subcomponent of that. it is not equivalent to the strategy, and by design we want to make sure that the president and congress no, no miracles need to happen, we do not need a new vaccine, no new therapy, not that we don't want that, if we had a vaccine in be great, but we don't need a miracle of science to happen for us to achieve our goals. there are many interrelated strategies and as you understand, obviously in the senior advisor for opioid policy and this is part of this

endemic. 10% of hiv is associated with iv drug use, there is a component that we need to bring us together, if you're in a program you are to be tested for hiv, you are to be vice about prep and that is not happening all the time and also for the first time the same office during the hiv strategy is doing the first stri.2% of hiv is associated wih increase. of sexually transmitted infection. and impact on infertility in cancer risk. these are all independent but correlated. you will see pieces across all of the strategies but because of the importance of the diseases we believe they deserve their own strategy but in correlation with the other. >> i want to turn to prep, we know that the key part in the

end of 2018 there was almost 200,000 people in the u.s. using prep. the cdp estimates that 1.1 million could benefit and drama faxes. can you speak a little bit more about how that will be in community health centers? >> inner modeling, we need to get somewhere between 50% and 60% of all people who have prep indicated on prep. i would love to have 100%. our goal will be one 100% but we need to get the 50% to 60% level which is a significant increase over the 200,000 that we have. we really envision -- as a recent survey shows, people have

a better understanding about prep but there is huge knowledge gap about prep, there's a knowledge implementation gap for hiv testing and provision of prep among the healthcare area. these are all things that we need to fix. we predominantly think prep is going to be administered to community health centers. because we feel that many of the individuals who will be coming into the system will not have insurance coverage. community health centers leveraging 340b program where we get highly competitive prices are really the way to go. but there a lot of things happening the prep world. there should be generic prep by 2021, there is a preventative service task force recommendation, which there are several steps to go through before this happens but conceivably within the next couple years. the recommendation would be prep is provided without out-of-pocket expenses. there are a lot of things

channeling down. in our models, we need prep at 60%. we envision community health centers as a primary. community health centers take care of 27 million people in united states. they are growing with her ability to do comprehensive care. they did to million hiv test last year, their mental health services, mat services for opioid, particularly since rest the jurisdiction level, he is targeted about hundred and 50 community health centers at the ryan white programs that will be in the centers that we focus our effort first. i think you have the opportunity to go into some of those during the panel. >> one other thing on prep, there's a lot of challenges to increasing prep access. i have to ask price, in media and others ask about the person

prep and patented ownership, how is all going to play out. can you comment on that? >> i cannot play, on how it will play out but i tell you that drug prices are a major issue for my secretary across the board. the ability to lower cost to patients without all the games in the system losing. we are very cognizant about the price of prep. the left is about $1600. month. there are number of programs now that make that accessible if you are below 500% of poverty level. but number one, we intend to use a 340b program which allows prep to be obtained at a much lower cost to the government at a substantially lower cost. i say this because the secretary has said it, we are an active

negotiation to try to make prep much more available, not just nibbling around the edges but in a major way. the patent issue, i'm not a lawyer and i don't pretend to be. they could sue for pain royalty. it doesn't mean you can block things or take things over. the royalties that would be owed would take years in the making to get that and it would make a difference on the pricing. we are going down different avenues to try to make sure the pricing is much lower moving forward in the negotiations are ongoing. i'm very hopeful that we will have positive things to say in the near future. >> one more question before i will let you all ask your questions. one of the things i heard you talk about is a recognition that continues to play a role in his

a barrier for people at risk, people living with hiv to getting the services, feeling comfortable, or doctors outreaching to them. how is a government initiative and deal with the structural challenges. how can your honey envision having stigma in this? >> stigma is the enemy of public health across the board. whether you have an opioid use and need to have treatment, or whether you're a risk or have hiv. if there was an easy answer, i think we would be done with the problem right now. let me give you a few thoughts on how we approach it. number one, we're talking about hiv as an public-health issue. when you have people like the secretary and myself in a gets to the state of the union address to talk about it to very important aspect to it. treating it as a public health

issue. number three, it has to be community by community. the communities do differ. i've been educated a lot on the american indians was stigma in very similar although in a different way to msm, african-americans in the south. it is gotta be a community-based initiative. we have already spoken to, we had two major phone calls with state -based organizations. we think they need to be on the team. i have been very encouraged by what i heard. the people across the country really want to attack this issue. i think the people within the principles, particularly our only goal is to help people. i went into medicine to make a difference in to help people in their lives. wherever they are, whatever they

do, is not a judgment of anything but it's something you need to do. i think all of us are ready to open their arms, roll up her sleeves and work together on a community-based level to make this happen. i think it can happen, i've also been a realistic. and i take it as my responsibility to implement this. >> thank you. now it is your turn. let me tell you how this will work. i'm going to take the people when you ask your question say who you are and where you're from and will collect the questions and go from there. can we have a microphone going around. >> we will get you next.

>> one of the things that have been discussed about the initiative for quite a while is what model the administration is making the assumption that they made a run how this will work. are you going to release the data to other people to take a look and see what other assumptions might be missing or tracking on that we can better improve. also when you're thinking about community engagement do you have parameters of frameworks for these communities building plans so it's not in a vacuum and act accretive. what you can see our data-driven as far as. >> a very good question. quick and specific. >> my question is how you plan to address issue of criminalization in high-risk behaviors. so particular for latinos who are undocumented. who are under constant threat, workers, change genders, there's

a long list. >> we have our last of the first three over here. >> taryn with the national collisions and stds. my question is around you mentioned a couple pilot programs and i heard you mentioned this before, do you know where those pilot areas for the pain will be located? >> let me go to the gentleman in the back first. there is no secretive data that we have and were absolutely happy to talk about our assumptions. we know it will be different from community to community. the core of the data are really where the new diagnoses occur in their publicly available. i have outlined the strategy but there is no secret data file and strategy document under

top-secret thing that we are talking about. this is meant to be transparent. we need to improve upon it. >> the community engagement. >> the cdc is writing the notice of opportunity right now, there are two things, we want to make sure everyone is using evidence-based models and you need to use prep, all the things that we know are evidence-based. we're gonna have them working over the implementation research but there will be parameters that are evidence-based but we really want to bring in a community to tell us what they need and how they were going to do it. the community is going to be very different. it's an overriding strategy for the ministration whether it's the opioid response grant to provide a foundation of what is

evidence-based because we always want to be signs of evidence-based. but in to enact the programs to be sensitive to the particular communities need. in terms of where they are going to be, let me answer that. where they are going to be, i think were in the process of looking right now. some of the parameters that we are talking about is we want communities to have at least a start of a plan to pilot things because when we are starting to pilot we want to learn from that and disseminate the information as well as them working from us. number two, we want to have some hard areas, 52% of the cases are in the south. so i think we want to have a commitment to a couple southern jurisdictions because you gotta do that earlier than later. and we are looking -- i would

love to have a community that primarily has american indian issues who i'm convinced has a related but separate different problem. we would hope that we can get some of that by june or july for some pilot programs. number one, i went to get started. we all have an expiration date whether it's an 18 months or in six years, we have an expiration date so we want to make sure we get as much done as possible. number two, i think it's horrible to have everybody excited by the state of the union and then nothing happens until when you get a budget, potentially the $291 million is weekly until congress allocates that. your question, i don't know how to attack this. those laws are on jurisdictional basis, usually on state bases

and i say in general that criminalization of public health needs are never a good idea. whether you can arrest our way out of the opioid crisis and you can't allegedly arrest your way out of things that are public health and behavioral issues, i don't know exactly how to approach us. i know they will be a tremendous barrier. i know that in community health centers or ryan white programs we intend to take care of everybody. there has to be an overriding goal and perhaps heather can talk about that a little bit more but we certainly intend taking care of anybody in need providing improper providing them services. >> we can talk about helena, georgia experiences that is moving in the right direction on

this. the question. >> over here in over there. >> andrea with the hiv medicine association, i do question about clinics providing prep, are you also considering title x funded clinics which can be an important source and were successful. >> we have integrated a couple more things into her title, number one is fud screening which is not uniform in his last week 3000 centers, title x centers that provide prep that was put on our website so that would be known. the absolutely we have to make use of every encounter to make sure that we take care of the patients. i would also say hpv fox nation is in their because i'm on the bandwagon for that. so yes we have to make sure of

that as well. yes, absolutely in any other opportunity that we have to do we need to make it part of routine medical care. and that is the goal. people need to be tested, screened and if you need on it you need to be product. it's routine public health medicine 101 that needs to be reeducated. i think you can tell me, but if you look at the diagnosis data, that seven out of ten people with hiv solve physician within the 12 months before and were not tested. i think we have complacency among the medical profession because were so effective at treating hiv that that is the urgency has been lost. i think we have to get rid of the complacency on the medical

side and we need to look at other models. i was meeting with pharmacist where there is interesting models of pharmacy and pharmacist providing prep in a non- stigmatizing way. i think we have to open our minds to all the different ways that we can reach people the way they are. >> i'm sorry i should have three questions. >> will do to our questions and i'll put this together. >> jeff from h1 healthcare foundation. can you elaborate when you said leveraging 340b for prep purposes in particular since ryan white covered entities in getting eligibility because of bright white grant. you can't use 3040b related to prep. >> that is one. i think there's somebody. >> niclas from strategist. to follow up on the title ten question. are there concerns that the ministration have concerns about

the title ten taking effect next week ? and basically how that will impact some of the most utilized health centers within the title ten program as well is the opioid disorder and how that plays an important role within the health centers. >> the ryan white funding in am sure heather will talk about this more specifically, it cannot be used to provide prep to prevent hiv. so community health centers can't. they will use the 340 program to provide prep. about half of rain way are also associated with community health centers so it's a left righ poc, use the ryan white funding for

the therapy and then their community health center they can also use the 340b program to provide and how to have her affirm that for me. ultimately it would be a legislative change to allow ryan white to use the ryan white funds for something that can be brought together. this is what we can do right now. you're not assuming any changes to legislation were things in the future. the title ten regulation and of course were all concerned, we wrote the regulations. it is the administrations regulation. let me to it say, i know there will be disagreements but i want to make it clear what the gag rule is and what the gag rule is not. number one i don't think it will affect the hiv program whatsoever. i think there's funded entities that will provide services in a primitive way that they have always been. title ten prohibits the

promotion of abortion as a mechanism of family planning. the gag rule does not stop in interaction between the provider in a patient about abortion as an option. it does not prohibit that. what the proposed rule states is there cannot be a direct referral or directive counseli counseling, you really should go have an abortion. or here is an abortion provider. although the clinics can provide names of servicers that do provide abortion. i just want to make it clear, there can be a lot of disagreement about that but there is not a gag rule that abortion cannot be discussed. i think if you read it and you look at what is says, it allows that in a nondirective way and personally i don't think physicians direct people what to do. i think you provide information and allow people to make their own choices but you don't direct

them to do one thing or another. i want to clarify that piece of what the gag rule is and what it isn't. >> i think we have time for one more maybe two more. over here and in the back. >> national back leader commission. you mentioned about the principles and is very noticeable that nobody at the table of people of color or persons living with hiv, i was wondering why was that decision made also going to your community listening and very interested in that because we work a lot on the ground, how do you plan to set up the community and when will they start and how do you implement them because of this stage the input will be important. >> the first question, we are very sensitive to having input from a diversity of groups.

we are also allowing the cochairs of posture to make sure we fill the positions with people who prevent diverse background. it's obvious, i cannot help it, i'm a white male, you're stuck with me to it organize this at that level because i have my position. but i'm committed and we have done many of her actions already to bring people of color, people living with hiv in two very important roles including imposter. we are working to the local community health department. we are very specifically we met with congresswoman barbara lee, congresswoman jackson lee, congresswoman wilson from miami, who are all very supportive and will help us to make sure we get the right people at the table. it really depends.

i think there's a lot of congressional involvement to make sure we get the right people at the table so is working collaboratively in working with the community. when congresswoman lee asked me, how do you know yet the right people at the table? i obviously don't know. i don't know who i am missing in miami or who i missing in oakland, you have to rely on a combination of the congressional leaders from that district as well as the local leaders to make sure people are there. we are starting a listening tour now and we have a couple jurisdictions and that will march on very soon. >> as long as it's quick because a promise to get you on time. >> chelsea, and a consultant in d.c. the local service organization working with people and economies. you mentioned a couple of times to get testing were regularized

in these services, most of the clients we see are actively turned down testing and turning down those types of services because of the stigma and the fear of treatment by the medical professionals and i want to mention that we know there's a strong connection between hiv and internet partner violence, if you're going to be working in native american communities, regularized in this testing, and like to hear you talk about voluntary testing and the work you will be doing to make sure the test and services are safe. >> i think what you said, our principles that we all believe in and i want to get input from you about where the problems are. we obviously actually have to increase the people who are bringing into testing, we have to overcome those barriers as you pointed out. again, i don't know exactly how

to answer your question in a very precise way but i look forward, e-mail me and let's get input and understand where specific issues are and what other services we need to. one thing i've been very impressed with in the ryan white program, every holistic in their viewpoint and if the person needs transportation to provide transportation, if they need housing, they do housing, all the wraparound services. maybe heather might have a more direct answer to that but if not i'd be happy to work with you on that. >> i know you have to leave, i didn't know if you want to take a moment and give the last word. >> personal, i appreciate the opportunity to be here, i really do. i think this is very important interaction in want to make myself as available as possible. i would only say that we are

very serious about this effort, both from people who have done this all their lives as well as people like me who are driven by public health and i've said it before, we have the opportunity to eliminate an infectious disease, whether it's polio, measles or hiv, is not something we should do better to our moral obligation to do it and that's the way i a purchase. i also know there will be differences -- there will always be differences with the ministration policies. i understand that. no matter who they ministration is, but this is something i think we can all get around it's a critically important public health effort. i think it is a once in a generation opportunity that things are lining up even in tight budgetary times were able to get about $300 million of new funds and will need a lot more in upcoming years.

again, i am willing to work with anybody at any time to roll up my sleeves to make it happen, i think of starting to know a lot of people by their faces which is a good sign. really appreciate the opportunity to work on this and so many other public health issues that we can attack and work together. i think there's very little divide on a partisan basis and we need to talk about this critically important public health issues but there's hpv, hiv or exercise. all the kinds of things that we can do together to improve the health and quality of life for everybody here. thank you. >> thank you. [applause] >> as he is walking now we will do a quick set up and i'm going to invite my panelist for that moment.

>> in o'shea some data on the kaiser family foundation. i will start doing that while we wait. in the moment those theaters come up in our panelist will come up and they will turn on their microphones and will be ready to go. because so much. just a little bit from us, setting the stage, one of the things that's important to recognize about the initiative being out now is united states is not performing as well as it could if you look relative to its. countries. comparing the united states to other high-end countries that we are often compared to, we looked at viral suppression, the u.s. is the lowest all the way on the right, 54%.

this is viral suppression of all people living with hiv. this is not where you want to be. i think the united states can aspire to be where the united kingdom is. but it's going to take a lot to get there. also, as we know from cdc hiv incident which has been going on is no longer going down. we are plateaued and not of concern. of course in this country the epidemic is concentrated. the epidemic is affecting people on certain groups in certain locations much more than others. this is a current state of her epidemic. last on this, federal funding discretionary funding, this is the funding that congress appropriate every year has been relatively flat for the last several years it is not been increasing. while funding is not the only part of the equation it can help jumpstart and get things to a new level. the new initiative comes into that moment. as he talked about it would mark

new funding in this shows you two of the key programs that would get new funding is approved for 2020, that the ryan white program on the left and seated d.c. prevention on the right. these programs have been flat funded for many, many years. they have not seen an increase. if the budget request is approved ryan white funding will go up 3% over fiscal year 19. it is definitely relatively speaking a change. and particularly cbc, these two graphs are not on scale with each other. that is important to note that ryan white is over $2 million program, cbc, hiv prevention in the u.s. is funded under a billion. this would bring it closer. with more significant increases. we just looked at the jurisdiction that have been selected for the 48 counties, d.c., san juan and understand

who they are, what they are and what we know about them. this is something that we at kaiser will be tracking going forward. this is basic demographics, how many are in the south, 23 of the counties, 60s in d.c. in terms of the share that are uninsured that is greater than the national average, 31 of the counties and three of the states. in terms of the share that are greater than the national average of poverty, 30 counties in six states. in terms of targeting it's reaching far in reaching communities that are in greater need. it's not that the others are not close to the average and challenges but it's an interesting and important metric to look at. in addition, looking at policy and problematic variables, about 30 of the counties are in states that have expanded medicaid into of the seven states, d.c. and san juan of course, almost all of them have part a programs and

we might hear a little bit more about that from heather, and community health centers in all of these communities. that is one of the reasons that community health centers were selected. your bid with us around the united states. in terms of data on which of these counties and states seven of the counties are in states that have prohibitions in six states. it seems to be where of an issue for the states that have been targeted but is still want to pay attention to. lastly, we recently released polling data and something we have been tracking for many decades. just to highlight a few, there is concern which i think is important people still see hiv is a serious issue in the u.s. and what is happening is for series of people that they know and they have the data broken down and you can see where concern is highest.

but also, this came out right after the initiative was announced, most have not heard about it which would be expected, but were optimistic, have you heard about this, many hadn't but we said, here are the goals, what do you think, people were optimistic. there is an openness that this is something should be pursued. we also found there is still significant gap in the public knowledge and prevention. this is a general public but not people that necessarily would be targeted with this information but i think it's an interesting metric to look at. most people are not as aware as how effective in both treating hiv and preventing the spread of hiv. on the bottom is prep, what is interesting, we don't have a trend data, there's been a tremendous increase in the share of people who know what preface and know that there is something like that. it is still not where we wanted to be but it's a sign of education has increased but there's more to go.

these are just some things that without wheelchair to get started and now we will go to our panelist who i will call up. i will introduce him really briefly. heather hawk was a deputy associated ministry. kendra johnson the director for mississippi, one of the seven states that will be targeted initially by the initiative, michael who is a senior director from d.c. one of the jurisdictions that is being targeted by the initiative. jesse who is the president of age united. thank you and welcome everyone thank you everyone. i hope you can see and hear us. sorry about you over there.

i want to start with heather. thank you. i made my fought really big so i actually do not need my glasses today. that's metri my tricks. i'm going to turn to you first and when we talk about the role of ryan white and some of the things we heard already. first of all, thank you very much for the opportunity to talk about that. >> and epidemic initiative. i thought it might be easiest for folks if i walked through the pillars of the initiative which hopefully many of you have heard the admiral discussed. and how we are collaborating across cbc and with her colleagues. the first pillar diagnosed, which is the effort to rid nice hiv testing and make access to hiv testing much more available

than is now. so we can address some of the specifics that the admiral mentioned this morning. in addition, to expanding access and a variety of initiatives, we will also be working in the community health center program to expand access to hiv testing as well. it currently does around 2 million hiv test a year but there's a lot of opportunity to do more in the community health care program and to reach more than the 27 million people that they care for as well as working incriminating as they are doing outreach efforts to bring people into the door of the community health centers give them access to hiv. the second one is treat, we are working in collaboration with our partners including cbc were often doing partner services in identifying people who need to

receive hiv care. really in the treat pillar we are trying to focus on the 40000 individuals for newly diagnosed individuals each year but equally and partly we estimate there are over 400,000 people diagnosed with hiv but not currently in care or achieving viral suppression. we really want to engage the 400,000 of the nearly diagnosed. we want to make sure that they receive access to services either the rain right program for community health centers and achieve suppression for all of the public health. . . . third pillar is protect or prevent. that is the power that is really one. the discussion this morning about the role of the program. want to underscore the program

will be largely providing this for the uninsured, for folks who don't have other resources to access prep. who will be starting the community health centers because we know is a cultural issue that needs to be addressed in a number of programs. we want people to talk to a center where there's cultural competency because of the fact they have that program. ultimately, we will extend it through all programs across the country. many of you may know there are over 12,000 programs throughout the country. we have an opportunity to use that system, to increase that to the 50 or 60% that he mentioned. terms of the last pillar, response, that is where cdc is working actively with local committees to protect and

response to the outbreaks. we see our role in that as being there for the folks who identify. somebody identifies as living with hiv not yet been with care, we want our services to be the door they walk in. those who identify not as hiv-positive, to use the program to provide access so those who need services either because they are positive and need care because they are at risk and need services. those are the fill four pillars and how they are working on that. each of the federal agencies had a lead more cold feet role in it. we are also working across all agencies treatment number of times, admiral alluded to talk about how they can use their

science foundational network to help bolster the efforts and the innovations we know to happen in order to reach the 400,000 as well as those who are in need of services. we are meeting with ih s to talk about how we can work with them around there plan we also work closely with santa to talk about how we can support their efforts. we talked a lot this morning around the community engagement and plans efforts that they issued a number of times. we know in the community planning is a statutory requirement. there be local planning that involves a number of different committee members from various walks of life as well as agencies at the local level.

we have really been focusing on the epidemic of unity plan process to build on this foundation that has already been established through the program or hiv prevention program, all of these restrictions submitted a plan to both tdc and herself in the last couple of years. those to be the foundations to end the epidemic plan. people have been engaged, many have done and ending epidemic plan so we don't want them to have to redo work is already done but at the same time, in order to do this, people have to come to the table. we need different partnerships in order to accomplish this. we see this as an opportunity to bring you and different partners to the table and work with the local jurisdiction to figure out what it is you all need that we

can support and bring together to end this. i think i'll stop there, i was a very quick overview. i'll be happy to answer questions. >> they expectations is a question we have and i know it talks about this a bit in the budget but assuming the budget request for ryan white is approved by congress, how will the funding be distributed and what's the time like? >> personal, the admiral said it does not exist. i'm talking about is our plan for how people do this the funding is appropriated. in addition, in order for the program to direct the funds to these counties, we need for stability in our authority to be

able to direct the funds. the purpose is because there's an over way in all jurisdictions in the part a program. each one of them has a part a. each of the states went through the part b. our intention is to disturb funding to the existing comprehensive service delivery system in each of the jurisdictions through the program. obviously we will need to see what congress does and what they appropriate for us. >> once the payment is permitted, the like. that gets rented out, so that could be anywhere from -- >> 2020 funds. we would hope that if there's a budget, it's only happened once in the past 22 years, we would plan for a january 1 start date

for the initiative fund cdc is also aligning their start date for generic first so it may start in the calendar date. it is entirely appended on that. when we have a cr in the past, that shift the timeline for all of the planning we spent doing. that's our hope and goal but until we see what the timeline is from congress, we cannot definitively do this. >> thanks. thank you for being here. he's the ceo of the organization with over 240 and 30 states and territories. also a person living with hiv and living in this area for years. what is your initial reaction where the questions used to have? what are your members saying?

>> thank you. one of the most great people in the industry. thank you so much. i had to reactions. as a person living with hiv, to see this president even mention our existence in the state of the union address from got to tell you i had a similar reaction when bush did that. with regard to the prep announcement. i thought my gosh, he just put all of us in front of the entire population. that is one i am still living with. i hope the reaction is that it's a bit more complicated, we know this is a unique opportunity, almost a cataclysm opportunity with a have come together to make it truly clear epidemic can be ended and i think the study is really the question, that's what they are really dropping. what is the strategy?

it was helpful to hear from doctor that the strategy still exists and this is just a subcomponent of that. it has not been articulated well. our community, particularly public policy and largest community has worked much of the last year end a half on community map that we created and submitted to all five of those on that day. roadmap looks largely at the larger epidemic nationally and what is needed to ensure getting to the end of the epidemic in five years. the president has the initiative for ten. sti's, hepatitis as well as tepee and opioid epidemic, how all of them work together. i think we heard the sti and hepatitis strategies are still

to be defined but they are still important issues that help drive the hiv epidemic. on the other part of structural issues including criminalization and stigma that are still very prevalent but the larger question is access to care has to be addressed. it's very disturbing for many of us to hear the administration have this initiative but also working so hard to destroy the affordable care act and i can tell you i was invited to be with admiral and the other architects of the plan and they said exactly what he said here, there's no assumption that medicaid would be expanded but the opportunity for the president to use that, should be extended could be very helpful particularly in the south, particularly the south.

we know the epidemic there, not only for people were hiv positive but those were negative, they need the access to care. those are the things we are talking about and concerned we have, larger issues and structural issues around criminalization, stigma and answers to care and how they will be rolled out. >> thank you. we asked two different jurisdictions to be here because they are both in the first initial wave and also different from each other. to help me and you get a sense of what someone would be thinking, this will happen, what i need to do? first, i would turn to johnson, the director for the state of mississippi. one of the seven states we chose because of the largely well but has hiv in different parts and the challenges we know, we love

to hear from you about what some of those are, what your hopes are and your questions about it. >> wanted to announce, wasn't a surprise mississippi was listed as one of the seven states. to me, it was something i was happy to hear because we have known for a great deal of time that hiv is on the forefront in mississippi. i think this gives us the opportunity to put on landscape and get people talking about it. i'm excited because there have been so many organizations and those who have reached out for support one of the challenges we face is manpower so this will give the opportunity to work

with organizations must be able to work toward the hiv epidemic. there are challenges. mississippi is a largely rural state, located at the bottom fell. there are challenges on the pillars that are mentioned. the biggest challenge is state law. no one wants to talk about anything related to hiv, i'm hopeful that we'll begin to have those conversations but because of stigma, we have challenges to face, getting people to feel comfortable, the health the permit and in their area where their families work. they don't feel comfortable getting tested. also, sippy has a large portion

of individuals who have food insecurities so i'm excited about the epidemic work i think in order to make it susceptible to place like mississippi, we have to think outside of the box. looking at medicine, prep and person, as a whole person. not necessarily focusing on getting people to get tested but seems like you're not getting tested. maybe they are worried about food for the family. offering opportunities to provide other resources to encourage individuals to get tested and once we do identify individuals with hiv, being able to link them to needed services. think we have work to do, i think that one of the things

will be a priority for us is to bring everybody to the table, those living with hiv, to determine what it is we can do to make this accessible. we have work on integrative plan, we are still working on that but i think it will be a starting.back. it will create roadmap to getting to those. >> one follow-up, if somebody want to prep in mississippi, but what they do? >> prep is available, i think we will now focus on providing more information about prep education. there are still gaps, there are folks who don't know about prep in our great candidates. i think it will start with

education campaign about what prep is. we do have providers located in the state, however, we have a different approach to being able to provide prep. i think as we continue to have conversations with providers as well as working with the community health centers, that will be able to provide better opportunities. >> let's switch gears a bit, remember those days when d.c. was in the news about the hiv epidemic? often ranking at the bottom in terms of other restrictions and cities and d.c. really has turned away, turned around in many ways. you can apply the public health

tools and evidence to make a difference in the community. many things you hear about today. if it's over here already, what do they need to get that? really, a place like d.c., where you need to go? so, thank you. >> thank you. thank you for including me in this. welcome to our nation's capital. for those who are visiting, yes, we have come a long way. in ten years, we've made tremendous advances and a lot of that has been because of a collaboration with our communi community, with new partners such as epidemic community, we formed a unique research here that has multiple institutions, the only one like it in the

health department as part of that. we've been able to leverage innovation and as a approach of community participation and that led to 75% reduction in hiv diagnosis, probably advancing along any different just actions. yet, we still have more work to do because we've seen like some of your maps actually, a bit of leveling and the reductions and to get us to the next level, we've been concentrating and prioritizing what we need to do. we did a prevention plant that had a whole portfolio but then we also did not epidemic plan to prioritize the key strategies we needed to get here. some of those are reflected in this initiative, so that was reassuring to hear, we're all on the same track. some of the key pieces to me, to fill that are about making sure

people were newly diagnosed are getting treatment right away. we don't want to leave a gap between somebody being able to start that treatment and achieve the suppression as quickly as possible. we've been piling that year end we've been seeing improvement, one of our partners went from 50% of newly diagnosed persons getting same day start to 80%. want to meet that standard. as well as understanding transmittal standard of care. both reducing the stigma that has been barriers for many. access to prep is reassuring to hear about health centers being partners with this and we have a lot of overlap here in d.c., providers in our community health centers that we have more to go there. we've not seen the same uptake that they have been doing as

having a national directive of sorts to say that nadine to get on board with this. we need to find other access points, community access points, clinical programs great location for that. we call hours health and wellness center, not about disease, it's about improving one's overall health. the next stage to me is also dealing with equity issues associated with them and audience members who talked about that is, we can't just deal with as well as an port and this is, offer testing and treatment and prep and also to deal with the issues the persons are living within the community. stigma is still an element the there, where if you are a young person, you may be hesitant because you can't use your parents entrance or you are living in the economy and

therefore is the difference between where you sleep at night and where, are you going to have food that evening as well? we need to make this call for us, making that hiv help force, a part of community. those are the presence with that. along with dif were important elements, thinking people, newly diagnosed in the partners. the community itself as well, are our two workforce, their living it in day-to-day life and can be a tremendous asset for getting us back. >> if new funds become available, or be here next thing? i heard you say national directive, health centers do more, i'm curious, what's the choices that could push them to that level? >> to me, the most -- one of the most important choices is

getting medication in people's hands right away. so there's not a delay in order to do that. there are some structural barriers to do that and we are medicated expansion and that's a tremendous benefit and losing that could jeopardize all of the offenses but still, the could be days before somebody can actually get the pills in their hands. to me, there one of the highest priority and resources they would go, to make sure people would start treatment right away and health centers who can work with other health centers that don't. and those who want to get on prep. the others is building the community workforce in order to do that. we've done a model here, has to permit self, hiring people from the community who are living the same lives, the focus population in that. a strategy to engage more people.

one of the things we are experiencing in this comes first hand drawn to those who come in to our health and wellness center, a young gay latino man who we talked about prep with him and he thought about it and he wasn't ready that day for some reason, he came back two months later. that can't happen again. we have to be able to say, how can we take it even easier for that person to be able to get on prep? >> i think the reason i thought you would be here is because you bring a lot of perspective. you are one of the people we look to about how do you do that? had to get other physicians to do that? i work in atlanta and i love

your thoughts on adventure as one of the areas that will be targeted and georgia in general. >> that's a lot. [laughter] first, or to say thank you for having me here. i am excited about this initiative for one reason, if not for many others, that this is more conversation than i have heard in years about this topic and i didn't think any of us expected that to happen at this time with this administration. i think that is terrific. now the hard part is how do we make it work? we've done the easy part, i think. i think the easy part, we haven't done it perfectly but the easy part is behind us. now this will be harder.

it's going to be more expensive, more frustrating. when i look at this from sitting in georgia, the state was among states, the highest rate of hiv diagnosis. it tends to be overwhelming. yet, i think there's a real opportunity to have concrete planning. what we did was go to county, the largest county in atlanta, several years ago worked to capitalize on a bit of political will that came from a county business news planning, we said it's a terrible situation, we presented data and they said, what should we do? we said, take leadership. they did that and over about two and half years, we created the strategy to end aids in the county. that's about 120 people working very hard, it was highly

community driven. we went all over the county, have listening sessions, yes, we really this and. it was not a talking session. that's how we built this plan. yet, now we have the challenge of fragmentation of our help systems in georgia because we have four counties in atlanta that have been identified so these counties haven't really worked together. there are 159 counties and everyone has their own health department. having these for mitchell counties work together to take one county strategy and expand it to a metro strategy, i think it's going to be but i feel people are really interested in doing this work. i have a sidebar, the comment

about the integrative plan. the integrative plan, which integrates cdc funding, it's not an epidemic plan. it basically integrates two extremes, but it doesn't deal with things like comprehensive sex and for schools, it doesn't deal with some of the problems we have without transportation and so on. i think we have to look at these broad epidemic strategies. i think georgia will have challenges in terms of ordination and the right people at the table, the community driven and when i say community, i mean more than people living with hiv. obviously people who are highest risk for hiv but let's not forget about the healthcare workforce. it is the people who are working

in the trenches who also really have a sense of what is not working in our community. my community and atlanta, half the people living with hiv are not in care. what does that mean? say to this initiative, we could get those people back. who will take care of them? we do not have the workforce to take care of all of these people living with hiv. you're going to have to have policies that encourage loan forgiveness for people working in the healthcare workforce, hiv medicine, subsidies that will help but then also the money. it really has to ratchet up. we are in a place where we don't have a safety net so we are not expansion state.

i quoted heather a minute ago, shortchanged in the plan. don't tell anybody. i really think for us, we are people not being in care, this is driving our epidemic, we have to put more money in to helping people and i want to say that this doesn't mean those people are at fault. i think it is a system view about helping people getting care and realize that in my neck of the wood, the health system is broken and not providing what people need to be able to get care. i think this tapestry of these issues and social determinants is going to have to be addressed if we want to be successful. i do think we are at a time where if we see it how it is,

eroded by policies in the administration, we have really sunk. there's no way we can and any epidemic. to be sure that doesn't happen, there's a -- this is a time i thank you can make a difference, i think we can grasp onto it, i think we had to get our leaders guidance about community engagement, having community at the table, having frontline health care workers at the table who are not at the table. these are things that i think would be really important to make this work. >> did you want to add something? i'm looking around, i push it ten minutes to get these questions out to all of you. three questions, same system. over here.

>> i'm from new york city. you most spoke to my question but the social determinants health, i think aside from the lack of medicaid expansion, and stigma is probably the issue. security, lack of transportation support and stability, just a three, the cuts in the budget, including two factors. i'd love to hear, i hate to land this with you but even where congress to appropriate dollars to talk about appropriating, is that enough? what will it take? is that enough to do this job if we're talking about health?

>> , butler, i work across the street. my question is -- first of all, thank you. the question is, how young people particularly those with hiv, in this initiative and thinking about cdc data, which that 40% of young people are currently impacted? >> thank you. i work primarily in the global hiv space. those that were mentioned not easy to the u.s. wondering what lesson can be applied from our experience back to the u.s. strategy.

>> i'll be happy to start. i do appreciate the issues around structural intervention think we've all been disturbed about the cut and i think it may have been a shocking one. it needs to be corrected. i think we expect leadership from the department of health as well as integration across the agency's think that's important. double was in the details, i think providing the greater information and education for the health care work so we have state-of-the-art care particularly in the south but if the details are only funds going through, the education centers are, we may have a significant

problem for me may not have been able to address the opportunity. i do think we have to look quickly across all the details about how this will get out. what impact it can have in the different gaps we know. >> want to go back to dan's comment. there is a recognition and commitment need to provide and also technical assistance to the jurisdiction as well as workforce development. for us and the community health center program, we are working on that to figure out the work force capacity. only because we need more providers to do office work but also because we do need providers to understand the impact of discrimination and work for some of that. we will provide technical assistance to workforce as well as jurisdictions on how to coordinate that. i would say the admiral gave

administrations response in terms of when the modeling was done, there were sections kept constant in terms of changes in the system, their proposed changes in the system but the way the modeling was done, they were not considered terms of dangers in any other funding. i think that is part of moving forward, i also heard admiral they publicly, this is just the first year of the five and ten year plan. there is the modeling done with increase in resources over subsequent years in order to address all of the people we will bring into the system and the people we need to scale up to four prep. >> dan, your point, we have worked closely around some initiatives using the funds to look at how to build strategies. we live in a very expensive

housing environment in the washington d.c. area and we've also worked closely with our planning commission, which is our regional body, we collaborate very much with virginia and maryland. being able to strategize across the region has been a key piece to us. one of the initiatives innovations we've been working with has been looking at lower level rental subsidies for temporary at the time because we know there are limitations with proper funding and hopefully the reduction won't be in effect for to other strategies to be able to meet the gaps people have by providing that lower level of assistance and to be able to afford to stay. and we've also started initiative around how to

integrate workforce development with housing and living with hiv, to no there are people who want to proceed with their independence so we come up with that strategy. also for young people, we also worked with our regional planning commission and is a whole initiative around people living with hiv. we look at statistics across the board, young people have the lowest rates of suppression among the hiv population. we started youth reach, to better provide support to young people. knowing they are starting hiv career, we hope one day it could be a cure for hiv and in the meantime, to make themselves be able to self manage and be able

to get the support they need to be successful. particularly in the transition from adolescent care to adult care because we see a lot of young people drop out at that time because adolescent providers have been terrific working with young people and adults don't always do so well about it in the adult care system working with younger persons. that's a key area we need to resource. >> let me add, when you look at the program, international think, we see many of the same trance. young people do not have the same suppression outcomes as a overall. is been great progress made the still a lot to do. i think in this initiatives, you need to focus on operations where we see they continue and they will work with the

jurisdiction using local data storage and five those operations and work together to figure out how we can address this. >> i would add, i think it's an opportunity given limited funding, even if we got all of it there are a lot of services in our community that are not directed specifically for people with hiv and i think this is an opportunity for us to get out of our silos and try to work with others in the community who are doing good work thinking about people living with hiv. this is where the epidemic plan is important because it takes into account all of the determinants and thank you for bringing that up because this is an area that is the toughest to get out. i think we have institutionalized racism, all of

the tough issues created inequality and created these social determinants, income inequality stigmas. there is, we can not address that. there are partners other we haven't connected with yet. >> we are pretty much at the end of time but i want to do one questions. >> i think it's helpful, i'm a temporary advisory along with you jen. i do think this is an opportunity for us to put a model of building political will is a local level. we know through prep, the state department has worked closely with the executive branch of the government's that opportunity to work with governors and county executives in the jurisdiction

is right so we create an end of the epidemic plan is owned politically by that jurisdiction. it's a great lesson that we can apply here. >> going like this, we need to ask a lot of questions. [laughter] make it quick. >> good morning. one question i have, we talk about ending the epidemic, we have to make sure we look at, before anything happens, we have to look at the overall, how are we going to have early intervention services? you have to teach people how to make sure to not have an epidemic, not have anything happen before we get into the

pool. let's take care of the person, now that they have hiv, no, let's take care of them and let's take care of it before. 300 million, that's not much at all. to do all that, to have that, how will we do that? at the burning question i have. i look forward to hearing what you have to say. >> i'll ask kendra and michael to answer. they are going to have to do that. let's look at your perspective and how you would do that. >> for mississippi, going back to the basics and having conversations about as ti's. doing a better job, engaging medical providers, sexual health risk histories and determining

ways to better inform and educate the public about sdis as well as hip. really it's going to take a lot of conversation. we still have a ways to go with bringing on additional testing sites as well as hiv providers i think it will be a great opportunity. educating and doing the best we can to get additional people on board for that. >> i would answer that in the, i think we need to as melanie was saying, start with silos, often what we get is somebody walks in the door, they get tested and they find out they are negative and then sorry, i can't talk to

you. i have to send you to somebody else or you're positive, i can't talk to you, i need to send you away. we have to stop breaking down the systems and integrating the systems in a way that have the whole person. it's one of the initiatives that we are trying to launch, to look at a model of how you create a neutral status approach to care and the systems themselves. i also think we have to start moving upstream as well, to talk about sex itself. you have to be much more positive. without that, it's part of the whole, some of the stigma and barriers to getting, even walking in the door because of one's sense of their identity and sex itself is natural and we have a lot of cultural unpacking to do that.

as we as a health system and health providers have to start conveying that message, that sex positive in a way that can help, particularly for young people, be able to say i control my health, i manage my health because i have confidence in myself. >> we went way beyond time. because of this important conversation. we are committed to continuing this conversation, who will look at the initiative and surrounding policy issues, we will do this again in a year end see where we are in. join me and thinking the panel. [applause] thank you for being here. [inaudible conversations]

>> today at 7:00 p.m. eastern, c-span, live coverage from george washington home, mount vernon talking about c-span's new book, the presidents. noted historians america's best and worst cheek executive. saturday 2:30 p.m. eastern, booktv has live coverage from the museum, historian ackerman and david. talking about the president, noted historians like america's best and worst chief executive. presidential leadership, today 7:00 p.m. eastern on c-span, saturday 2:30 p.m. eastern on c-span2. from the museum. >> on c-span2, booktv and prime time, discussions on the american dream, 8:00 p.m. eastern, we'll hear from timot timothy.

kyle on her book american spirit, julie albright, author of their own devices, and james on debra. prime time all week long from c-span2. >> three giant networks of pbs. then 1979, small network of an unusual name about a big idea. let viewers decide on their own what was important to them. she's been opened the doors to washington policy making. bring you unfiltered content from congress and beyond. the age of power to the people, this was true people park. the 40 years since, it was clearly changed. broadcasting, youtube stars, c-span's big idea, more relevant today than ever. no government money supports

c-span, cable or satellite provider. online, c-span is your unfiltered view of government. so you can make up your own mind. >> congress is out for a two-week break but they are returning monday april 20 that. when they return, has plans to climate change legislation in the senate will continue the process for judicial and executive branch nominees. you can see live coverage from before and companion network c-span, but the senate live right here on c-span2. >> before we move on, topics of what you really need to know. here we go. write them down. federalism, public opinion, participation, political parti

parties, interest groups, campaign elections, congress, president and court. the entire cast covers those ten topics. >> are you a student preparing for advanced placement in the u.s. government politics? don't miss your chance to be a part of washington journals annual exam program. saturday may 4, 9:00 a.m. eastern for this discussion high school government teachers, and daniel. >> our question is about what is significant. >> it's one of the words our students, at the concept, the idea if you try to get a good bill passed, a lot of times it helps to have good ones for that. yet this writer, or this project, or if you had that your mark, you will get more supportive.