thursday in the early afternoon, 1,200 opinion leaders from australia gathered at st. paul's cathedral which was just across the river from the conference center. so that was an important thing to remind ourselves, that in the midst of this conference was this other larger drama that was unfolding. the last thing i will say which chris can add more element to which has to do with putin's actions vis-a-vis hiv/aids. this mh-17 tragedy aggravated and further worsened what was already a trend line in which putin's seizure of crimea, the confrontations over ukraine, and the battles to regain dominant shares over central asia and the baltics and elsewhere which has grave public health implications was driven into the next stage, and we need to think about that.

we need to think about that. i'm not sure there's any near-term solutions to this, but it was another one of those dark, dark and somewhat implicit implications for this terrible tragedy. thank you. >> thanks. i actually want to pick up on one thing you said and then come to a couple of you as well around some of the turning points. i agree, that speech that president clinton made was quite extraordinary and i'm not sure everybody -- it got the attention it needed given how extraordinary it was. but the other thing i wanted to say is that the ias itself in the way the ias responded was also pretty phenomenal because there had been a few calls for should we go on with the conference and the ias came out immediately and said we are going on that, we have to go on. and that really i think just gave a lot of energy to people that people needed and the way you adjusted to the opening ceremony to address it was very admirable. so thank you for that. so there's a lot to pick up on,

and i'm just going to go to a couple places. i don't know, chris, if you want to say anything in reaction to some of telephone pieces that steve mentioned on the conference, or one thing that would be great to hear a little bit about too is the melbourne declaration. >> yes. >> so maybe those things, and then we'll come back to you again. >> so maybe just start with the melbourne declaration. one of the kind of core ideas that we had for australia is, you know, countries now 30 years and more into the epidemic each have their own story and their own kind of national response and what's happened, and part of the story with australia is very early implementation of evidence-based prevention, very early engagement with communities. one of the first countries to really seriously take needles syringe exchange to scale with a big injection drug use problem, and really heading hiv off at the pass in some ways and still having an admirably low rate of

infection, although ticking up in young gay men as is happening virtually everywhere. this was always going to be part of the story, that australia is a place to talk about key affected populations. we are in the asia-pacific region where that is the principal driver of most of the epidemics, and not so much the key affected populations, but the poor public health policies and programs around them and the restrictive environments. that certainly is the case with central asia and the increasing russian influence on public health programming in that region. so we focused on the melbourne declaration to say basically nondiscrimination is totally unacceptable at this point and that if we cannot do a better job of delivering safe and effective programing with dignity and human rights for everybody who needs it, we're not going to be able to succeed

in the hiv response. so the melbourne declaration became all too real and alive during this conference i have to say. vis-a-vis the issue with the russians, we wanted very much to try and have the russians engage in this conference and to have central asian governments as well in the asia-pacific. we tried really an outreach there. organized a special session on the region which we invited russian participation in. they agreed. the head of their federal aids program was the person they put forward. ten days before that conference, that person pulled out and said, sorry, we're not coming. the russian government is not participating. we invited them to put in a report. they didn't do it. and on the day of that session, which was on a thursday, they sent a letter to the international aids society and also to all the media protesting the russian exclusion from participation. so very unhelpful to say the least and put us in a very challenging position.

we tried to respond with the evidence. we laid out what actually had transpired, but as steve said, what is really distressing about this is, first of all, that their own public health programs have markedly deteriorated. the quality of the data and evidence is such at this point that i really don't think anyone knows what is happening with new hiv infections in that enormous country honestly. in addition to that there are also aggressively promoting these policies and practices, blocking harm reduction, pressing hard on anti-homosexuality legislation in their region of influence. and the best example of that, and i'll stop after this, is the occupation of crimea. as you may know, they announced the cessation of the methadone program. ukraine has methadone substitution therapy, on their first day of their occupation of

crimea. so that gives you a feel for where this sits in their priorities, right? you occupy somebody else's country, there's a long list of things you need to do and most people would not put methadone on the day one list, but nevertheless -- so we really do have an enormous challenge ahead. >> thanks. debbie, to come back to you and then we'll open it up, unless steve wants to say another comment, two other things that have come up. one is around this -- i think we all felt around the global consensus about where we need to go, whether it was the geographic focus, the goals, how we get there, how we use existing resources. i was wondering how you put yourself into that dialogue and relate to that dialogue, and then just a follow-up would be related to the africa summit so we get that out. because that's wrapping up and it has consumed all of your time until probably right before you arrived here. what's your read out on that for us? >> well, this particular meeting

the ias was really helpful for me personally, because it was the intersection of the new gap report really illustrating where we have done well and really recognizing that, but also recognizing where we haven't done well, and then immediately be able to go look at the posters and the plenaries and see whose got something that we can bring back and try to implement in those areas. so where did we -- we looked through everything. where do we still have gaps? tb, hiv. we have patients coming in and getting dot therapy. being diagnosed with hiv, not getting hiv treatment. so we have a gap there and we have to figure that out. that one should be pretty simple because we already see the patients. and we're paying for them to come to the dots clinic. we need to really redouble that effort and really use, again, data for decision making and understand that situation. the other big gap that was clear is pediatric treatment, and so we really tried to respond to that immediately. we sat down with pete mcdermott.

he shares my and everybody else's global concern of the children and the children not accessing treatment. only about a third of the children who should be on treatment are on treatment. this is country by country. even in countries that have been enormously successful in getting adults on treatment where you have adult rates on treatment of 80%, 90%, and children of 30%. so they have joined forces with us, and i think it's really an exciting time not only because of what it stands for, but it recognizes that we and the european community are working together on these issues and i think we haven't really had that kind of alliance with europe during this time and, you know, they feel very strongly about the global fund, we do, too. we're the largest contributor but having that technical dialogue really helps us to have that broader dialogue. we're very excited about that.

that's a gap we all can address. i think the double diagram was important to make it very clear that the vulnerable population in sub-saharan africa is young women. 7,000 women infected every week. if you add up all the other bubbles of all the other vulnerable populations, they fit within the women's circle completely. that size of that group that is vulnerable and at risk. if you walk around to the posters, a lot of people have ideas but none of them have been taken to scale. and young women like young men have their own agenda and their own endeavors and their own belief systems that we have to really discuss with young women. it takes us back to we have to understand what's driving young women's decision making. do they have enough knowledge? do they feel empowered? are they making correct decisions for them and do they have all the correct information to make their own decisions and are we giving them the correct services in a friendly way where an adolescent feels like they

can access a clinic and get advice without someone going why are you here? you mean you're having sex? and we know that happens. it happened in our household. so i think it's happening in others. they're all passed that now. they're 27 and 31, but it was a vulnerable and difficult time. so i think, you know, i recognize it as a mom. i think all of us struggle with this and struggle to figure out the best way to resonate with young women and we have to figure that out. i think it was a great time to really look where we still need to do better and then see if that can connect with science that gives us a road map. and we're excited about those pieces coming together and we're excited about the opportunity to translate gaps immediately into response. but we want your ideas so you know we have put all of our data up on the website. you can go to pepfar.gov. go to data and results. you'll see all of our budget,

all of our results by country. send information back to us and say, well, i'm there, i have looked at this and this doesn't make sense. you can't -- don't try to hold back. we want to really hear where you think we could do a better job and we're committed to putting additional data as we receive it. we're going down to the site level and site level quality data so you can really look at our performance and tell us how to do a better job. because we're all in this together. it's a global pandemic. we're there together. i just want to leave with one last thing, because you did mention it, and i'm sure it's on everybody's mind -- ebola. it's a very big contrast in how the united states has worked effectively in partnership with countries. because the last five or six ebola outbreaks, you haven't even heard about. you haven't heard about them because scientists and clinicians in those countries had the immediate infrastructure, the laboratory infrastructure, the knowledge base so when those patients came in, they were immediately isolated.

the lab was immediately diagnosed them. so there was one case in uganda, or five cases in drc. another one or two cases in uganda. i think all of us should feel guilty in a way that sierra leone and liberia and guinea did not have the resources to really identify that -- those cases in the laboratory and i think it speaks to the pepfar infrastructure in the laboratories that have been built have been really critical to the health system. sometimes we ignore the laboratory and we shouldn't because it's absolutely critical. so i'm just going to one more gap. long act two. long acting prep would be amazing because we have vulnerable young women who may not have the ability to take a pill every day regularly. i see a lot of birth control pills on my counters where there are still pills and not all pushed out, so it worries me. yes, it worries me.

prep is important and i think a long acting treatment option so that people get monthly injections, long acting prep could be a bridge for young women and vulnerable young women, and i think good tasting pediatric formulations. i don't understand this frankly. we made dimetapp taste good. we have gummy vitamins, and we can't figure out how to make pediatric treatments taste good. a mother cannot hold their child down every day to give them a dose of medicine. it's horrifying. if your child is already sick and you're trying to do this, it's horrifying. so we do have some still technical gaps that we need help for in a global way. so if you're working in any of those areas, please work harder. please work harder. >> i have one other thing that hasn't come up that was talked about at the conference which is the question of resources going forward and where are they going to come from. part of it, there was a big

emphasis on using the existing pool of funding that we have and using it wisely which is incumbent on everybody but also going forward we know there are still these gaps and needs. we released a report showing donor government convictions are going down. that was an issue but there's other sectors that can help. so that's something we can get into if it comes up. steve, i'll turn to you to see if you want to add anything else. >> a couple quick points. the melbourne declaration, michael kirby, the australian jurist, came across as just remarkably eloquent and powerful at multiple points. from the beginning, then there was a session on criminalization that was a very dramatic session, and the u.s. ambassador, jon barry showed up at that and kicked that session

off. and in his presentation turned the view back upon the united states in terms of the body of law at the state, federal, or local level that impedes a sensible, rational approach on reaching certain populations that need to be reached. and it was a very, i thought, refreshing, a very refreshing self-critical way, and it opened the discussion quite nicely. michael kirby came in and joined it as well. that was quite amazing. it was less clear to me what was supposed to be done. i mean, it was less clear to me after all of the pronouncements -- i mean, the melbourne declaration was great, the criminalization session was great, the appeals were made, kirby's opening address on opening night, but it hasn't yet gelled into a fairly clear set of priority actions that are

supposed to happen to address this surge of homophobia and the proliferation of bad laws that we confront. so i put that out. another problem area that emerged was the fact that there were no serious high level asian leaders that showed up. the president of fiji showed up which was nice of him to do and that was great. there were ministers there, there were ministers there, but there was not a surge of -- there was not evidence of a broad gauged, high level political interest. from the asia-pacific region. and i was disappointed to see that. the world bank had a test run, a study of the financing across the asia-pacific. a paper that will be published that david wilson is working on.

it shows that there -- you know, in this case, the response is overwhelmingly dependent upon government commitments but is very flat and very deficient. so that's something. myanmar, we did a session that chris was very instrumental in helping us organize, a regional session which the deputy minister from myanmar came and presented. this was a bit of a debut. i think the government of myanmar had overcome its sense of embarrassment or discomfort at talking publicly about its programs. it came forward in a very candid, comprehensive, honest and forthright way, and that was so refreshing to see. and the response was great. i mean, you had dozens of myanmar folks come and those from the region and you had the indonesians and thai experts join in that effort as well. so i was really delighted to see that. thank you. >> okay. so let's open it up to questions or thoughts. we'll take three at a time. so just introduce yourself.

there's mics i think on both sides. i will try to facilitate this. anybody have any -- okay. this is not a shy group. okay. you have somebody over there, over here and over here. yeah. so just say who you are and -- >> hello. i'm suzanne la clerk from usc. my question is for dr. morrison, you mentioned that there was near consensus on the five or six things that need to be done to turn the tide of hiv. i'm wondering if you could just review those. quickly. thanks. >> next question. >> mary lynn, creative associates international. i had the same question for stephen. i think consensus at an aids conference is a little frightening. and i wondered what you wanted to see more debate about. but i also wondered what is the explanatory dialogue going on about low treatment for pediatrics.

i worked as a pediatric aids adviser for a child health project from 2005 to '08. and i never thought it was the lack of reagents or formulations. mothers in communities did not know anything about what could be done for their children and the stigma around the discussion of parents being positive were much more the barrier. so what will be the response of sif. what kind of interventions are being looked for is the question i have. >> last question. >> my name is edward green. i'm the u.n. secretary-general special envoy for hiv in the caribbean. i happen to be at the conference and i share the sentiments of the head table. and in fact, i want to congratulate you for making the content, the context so vivid for the audience. i, however, want to add a more

optimistic takeaway. for me, when i reflect on the conference, there was a takeaway which was resolved to end hiv/aids in brackets by 2030. and i believe that this is a momentous opportunity for health and development. one reason is that i think it was embellished by the u.n. aids executive director, the 90, 90, 90. now i want to ask the panel, are you as optimistic about that 90, 90, 90. secondly, an implication as we go forward, where it is we position aids in the post-2050 agenda. one of the takeaways and one of the results i believe from the conference is ensuring that aids is positioned in the post-2050 agenda. i think we were all clear on

that but less clear was whether or not we embrace it within the conversion of health. that's what i was not sure about. i think we have to discuss that strategy as we move towards the u.n. general assembly in september and beyond. >> thank you. so we had a few questions here, one on this consensus and what it was about specifically and another one around pediatric -- or low access and what's going on there. and that last one, thank you very much. were we as optimistic and really hard questions i think about post-2015 agenda, 90, 90, 90. are we really going to get there. so do you want to start? >> sure. we've heard from deborah in particular about the fundamentals of the consensus. i would say they are really about making full use of an

expanding and very promising set of prevention tools including treatment to prevent in prep. you know, there's a sense that in the last several years there's been dramatic improvement in expansion of tools and those become central in moving forward. a sense of the need to systematically retool approaches from the general to more targeted investments at local and subregional areas. where the epidemic is most intense. and that includes geographic as well as targeted populations. dramatically the need, the imperative to improve the use of empirical data to guide investments and track and prove impacts that will guide our future investments. the shared common view around girls, particularly rural girls in southern africa obviously key

populations as high priorities. i would also put as the broad frame of this a shared optimism, a pragmatic approach, a forward looking approach, a data driven approach, and that -- i was being only facetious really in saying that it bothered me there wasn't a more active debate. there will be more active debates but i found this broad consensus quite reassuring. and the last thing on this is the whole question around criminalization, surge of homophobia, proliferation of bad laws. that was a prominent portion of all argumentation across the board. i think those were the major elements. >> do you want to pick up on that? >> i want to come back to the community piece because it not only relates to the children. it relates to all of the mothers

and fathers in these difficult countries being further stigmatized, being afraid that they'll be -- when the perception is that hiv/aids is only in the vulnerable populations, then it becomes fingerpointing. we had it in the u.s. we have to make sure that our responses are comprehensive and comprehensive at the community level so that the community understands that there is a compassion that needs to go with public health. we talk about a lot of technical details but there has to be a sense that all of us are vulnerable and all of us need access to services and no one should be stigmatized. what has happened in uganda, what's happened in nigeria and what's happened at isolated cases in tanzania, kenya, the drc, very difficult and will only drive people away from service because no one wants to feel like their life is in danger while you're seeking life-saving services. and people believe their lives

are in danger. and they are. they are in danger. so this has to be addressed. so it's a matter of criminalization, but a matter of the community accepting that criminalization and actually even turning each other in. so we can't -- and we need to work in that more comprehensive way. i do believe that there are mothers, both mothers accessing option b and b plus and mothers who are not bringing their children into the clinic for diagnosis for the very reason that mothers found it so difficult when we only had single dose noverapine where we mothers to come out of their villages and people to come out of their villages when they are hiv positive and save their child when there was nothing for them. we didn't have any other options then, but imagine the break of trust with that mother when there was nothing for the mother. so i think option b and b plus are going to help us there where mothers feel like they're being cared for, where they feel like their children are being cared for, but we have to overcome

that 10% or 15% that we know are throwing away their pills on their way home because they can't confront the stigma in the community. and i think involving the churches who are a very important fabric of the community, involving the community leaders, involving the local chiefs to make sure that no one is turned away from services and becomes more vulnerable to disease because of what we're doing ourselves. so you're absolutely right, the community piece is essential and remains a barrier for both mothers and baby. >> so the last question on -- >> optimism. >> optimism, and also a little about the post-2015 agenda. just to start it off, i am an optimist. i always approach it very optimistically. but that was a feeling at the conference. so if we didn't convey that, most of us felt it. i think what's changed from my

perspective is just in the last four or five years we can actually say now we know what to do and the fact that there is more of a -- or is a consensus on those things. so a few years ago we both didn't necessarily have all of the evidence and the tools, we did a lot but not all that we have now and there wasn't this consensus around doing those things. those are two things that have come together that i hope will get carried forward in the next few years to really reach those goals. anyone want to add on optimism or post-2015? >> let me just say that in my incoming address at the close of the conference also tried to share in that optimism but also back away a little bit from putting ourselves in a position where our concerns are 2030 and saying really what do we want to do by durban, which is two years from now.

if we just keep the pace we're going at, we should add at least, you know, 4 million or so more people on to treatment between now and then. that would be actually where we are plus a little better. and it seems to me that what we need to do with this every two-year global convening is to start to use it more as an accountability tool and really to use it more as a formal way to measure where we are and what we've achieved. i feel just for myself the new goals, the 90, 90, 90 is laudable. it makes sense. 2030 makes sense. that's a long way off. and i think we're right now at a place where we have i think the community that cares about hiv, this consensus that you've heard about, about now we really know so much more about what to do. probably the single biggest

change in that is the recognition that treatment is prevention and that by getting folks on therapy, we really are impacting the dynamics. but there are notes of caution there for me. one of them is key populations, the homophobia, the bad laws that go in precisely the opposite direction. and the second is a geographic one which is eastern europe, central asia, which we know the epidemic is expanding with what little data we have. and it's a very, very tough challenge. i would say one bright note of optimism there is that al alix sheshan is africa's representative to the think tank on the brics, and working

closely with the brics. that's brazil, russia, india, china and south africa. so maybe there's no hope that that form which will not include us, the u.s., it maybe is a place where the hiv issues and the global health issues and public health practices can really be brought to the fore in a different and new form. that maybe will be something of a way forward. i know that we've already discussed that in some detail and very committed to it. so i think that's a stay tuned. >> just one quick comment. if you look in the gap report again, there's this great diagram that shows if we continue to do what we're doing today at the rate at which we're doing it today, the number of new infections creep up. and what's missing in that is where you end up at 2030 is 80 million people infected and a treatment gap of $31 billion, $31 billion every year. so there is this imperative for us to take the tools that we

have, all of us in the room, and accelerate that in all our programs. because treading water gets us to twice as many people infected. by 2020 it gets us to another five or six or seven million people infected but an $8 billion treatment gap. these are not small numbers. these are not numbers that we could make up. they're numbers that any country could make up, that pepfar could make up, that global fund could make up. but look at that diagram and count out the number of new infections there are per year and realize the cost of only doing what we're doing. we're doing a lot. but we're not going to be on the right line unless we do more. and i think that's the call of action to all of us that somehow we have to do more with what we have. we've done it before and maybe we'll get some additional funding, but we can't wait for that. we have to figure out now how we can get more control now rather than just doing more of what

we're currently doing at the rate we're doing it. so i think that diagram to me is one of the most telling diagrams in the gap report. and i think we should all look at it and study it and understand it, and understand what those differences and lines really mean, how you have one case maybe 43 million total infection patients. another you have 80. we can't afford another 80. we've already had 75. to then put on top of that another 200 million, 250 million people that have been affected with hiv, that's too many. one's too much. that's truly too many. >> okay. let's go to some more questions. someone back there. you have somebody back there, katie? okay. and over here. >> thank you. my name is sister veronica. i worked in tanzania for many, many years. and i worked for 12 years hiv/aids program.

and we were very grateful when pepfar began in the early 2000s. and what is happening today, i've received two e-mails today, one from kenya and one from tanzania. and they are saying that, because pepfar is being lessened, their funding in kenya and the funding in tanzania now will go down quite a bit, i understand. they're saying who can we pressure, how can we start to get that funding back again to a level? because now the incidence, they're afraid the incidents will rise again. so thank you. >> yes, over there. >> hi there. i'm julia hotz from

international press service. i apologize. i spoke with ambassador brooks earlier this week about this. but i'd like to ask the question to the rest of the panel, which is about especially in terms of educating these populations about the need to seek treatment and diagnoses and whatnot. i'm wondering how, if and how you've utilized the extension of social media and internet and mobile technology to help raise awareness and about proper treatment and just even correcting some misinformation about hiv/aids. so thank you. >> hi, my name is anna forbes. i'm an independent consultant working primarily on women and hiv prevention. i wanted to thank all of you for a very helpful discussion, but i particularly wanted to thank you, dr. bayrer for editing the lancet series on workers and hiv. i think it's a brilliant issue

for those who haven't seen it. seems to me that the empirical data in that issue particularly by the study of kay chen and her colleagues, is sort of equivalent, the empirical data showing the connection between decriminalization of sex work and reduction in hiv is sort of equivalent to the data tipping point that we reached in 1996 with syringe exchange, where it really became irrefutable that these two things were connected and that we couldn't achieve hiv reduction in the way we want to without syringe exchange in the one case and decriminalization of sex work in the other. what i'm wondering is what kind of political response can we expect to see based on these data and even more how we can expect the community to step up and use its cloud to advocate for decriminalization. we saw with syringe exchange after the 1996 data came out there was increased pressure not

only from the advocacy community but also from the research community for syringe exchange to reduce hiv. now we have canada on the verge of possibly changing and decriminalizing its hiv sex worker laws, or possibly not. we have the south african national aids council pushing its government to decriminalize sex work. i'm sure the discussion is coming up even more strongly in other countries. how much can we expect these scientific community to step up and make an issue out of what we now know is true? >> thank you. great questions. one was around funding concerns focused on tanzania and kenya, but i think it was larger question. the second was on social technologies and the last very important question is what's the role of science now on the political on the issue of sex work and the relationship with incidents and criminalization. who wants to -- would you like to start? >> yeah, i can talk briefly about the budgets.

i think we had tanzania come back for a week of discussions with us last week. very important discussion because we're not cutting the budget in tanzania. the budget hasn't been cut. and the budget isn't being cut in kenya. they're total funding envelope is the same. it's the mix of how it's old and new money and creating that total funding envelope. but i think what your question is do you have enough resources. and so what we're doing right now is trying to look at how to get to 90, 90, 90 in high prevalence areas. and that will mean that there will be areas that don't have hiv and don't have hiv cases, but we had service provision there, that we may not be able to support any longer so that we can move that human capacity and the funding to where hiv positive patients are, where they can be found, and to the communities that surround those patients. so we're looking very carefully at the geographic analysis and using data down to the site level of every single site

showing how many positives they have for every six months based on the number of tested. so we're going down to a very granule level so we can make public health decisions based on the funding level that we have. i think once we do all of that and see what can be done, i think your question begs that bigger question of do the countries have enough resources between pepfar, the host country, and the global fund to meet the demands of controlling the pandemic. i think that's the very question that is on the table. when he says there's consensus, there's enormous working relationship between ambassador diebold, michelle sidibe and myself because we've known each other basically since we were babies. we've grown up together. we've done nothing like this. we've only done hiv/aids. we're passionate about turning the tide of this pandemic. so i think there is consensus of how we utilize every dollar we

have collectively to have the biggest impact. i'm reassured by that. i have one social media thing i'll do quickly. i saw this incredible work coming out of in cambodia, i'm not sure, on different internet communication strategies that resonate with not only different age groups, different sexual practice so that everybody can click on a site and find a voice that resonates with them and gives them the knowledge that they need. so i think it was just incredible. they had 40 or 50 different individuals talking and you could click through them and decide what voice resonates with you based on some profile that was done anonymously. i found that so incredibly powerful. if we could figure out how to do that and how to get broadband through sub-saharan africa, it would be terrific. i'm sure you saw more, though. >> well, just quickly, it's interesting. i was on a conference call with

our tanzanian colleagues today. and of course they dropped off and all the connectivity problems, right? just remains a reality that we all have to deal with. i think there's a lot going on in terms of innovations in technology and not only in mobile technology and internet-based technology but also in some other domains like self-testing, home testing, getting testing out of clinics, getting it to people. so lots of effort around that. point of care, cd-4 and other point of care diagnostics where now again the technology is moving to a place where there are much more local kinds of facilities that can actually do staging. you don't have these big problems with people waiting professor get a cd-4 and being told to go somewhere else with their cd-4 results and all of those challenges. that area which broadly is in the implementation science arena is, as i said, now the largest area of scientific endeavors.

really very striking at least for what we see coming to the conferences. and i think, you know, part of what we're learning is one size doesn't fit all with these innovations. it turns out that, for example, and there were several studies on this looking at interactive supports for treatment and prep adherence and use that there are very age dependent differences. even among one population, like men who have sex with men, men under 25 really like interactive sms messages and want to be notified all the time. older men, no thank you, leave me alone. so it's very age specific. and we're going have to get that right. i would just say as something of a plea, i think one sector that hasn't engaged very much in hiv has been the social media sector, facebook, google, all of that silicon valley and we need them. and we would love them to be way more engaged.

>> on the special issue. >> oh, yeah, yeah, on the sex board question. thank you for that. you know, when we -- when you do one of these kind of comprehensive reviews and really try and look at the field, you have an army of graduate students harvesting publications. one of the things that really is striking is that basically for the last ten years of innovation in hiv prevention and other domains of hiv, sex workers have not been a part of the research agenda. none of the trials, prevention trials in men, women or transgender people have enough strata of sex workers in them to be able to do independent analyses the way that sex work is assessed in the research agenda is inconsistent and unhelpful. there's a lot of confusion about what is transactional sex, what is survival sex, what is sex work. sex workers themselves have been

reluctant, many of the organizations to engage because of feelings of mistrust, of concerns around coercion. and the whole issue of the legal and the policy environment that has been seen quite rightly as hostile to their interests and needs. so one of the things that really came out of this series was -- and we hope that this will really resonate with the research community, is that, you know, we need to be done prevention, research studies with this community very much in a new way of engaging, or communities, that includes them really in meaningful assessments. because right now we don't have an answer about prep for people who self assess. right now we don't haven't assessed bedroom herbicides. and that in 2014 is a real gap so absolutely we sister-in-law hope that that happens.

i have to say that on the issue around decriminalization, obviously that is going to be a government by government, country by country element. but certainly the communities and the people who work with them and the community-based sector, cbos, ngos really have embraced these data. they're taking and running with it. as a researcher, that's what you always hope, that people will find what you do useful and go with it. so i think you'll see hopefully a lot more evidence-based activism now that the evidence base is a little better. >> i think we'll take two more quick questions because then i want the panelists to talk -- sort of look forward on durban a little bit and what that means, and we'll have to wrap it up. now i see a lot of hands, of course. one over here and one in the back. >> all set?

and a third over here. chris and i are conversing. we'll take your question too. but make it quick, please. >> great. i'm andrew forsythe. i'm here from the office here that is charged with implementing the national hiv/aids strategy. one of the things we've learned is that to make the most of the dollars means we have to reallocate to maximize those dollars. it means that we won't be able to do everything. part of our decisionmaking depends on the cost effectiveness of new interventions, the efficacy of them. can you say a word or two about how that process is informing what you think is going to need to take place through pepfar and other international donors? what will not continue to be able to be supported in order to have the greatest impacts on terms of prep or home test organize whatever those new innovations. >> thanks. second? >> hi.

i'm angeli and i'm from interhealth international. you mentioned that a central consideration in the future global hiv/aids agenda include ensuring treatment, follow diagnosis, you have technology like therapy and how can we know having a well staffed work force is also essential to delivering these services. and with the current enormous shortage of global health workers, even if new treatment and prevention options were developed, many countries would lack the capacity to administer these services. so i wonder where health work force strengthening fits within this global hiv strategy going in the future. >> and our last question? >> my name is mike. i'm a fellow with the international -- commission. my first question is during the

conference we had the youth action plan. i'm looking at how pepfar and global fund is looking to engage youth more now that the data is released. and secondly, regarding the aids conference, we had several panels on discrimination and one of the key at risk populations adolescent transgenders. there is no research. i'm looking at how are we engaging the stats having promise to address this population. >> thank you. anyone want to address those? then you all have the last word. steve? chris? >> well, so thank you, michael, for that question. i'll just say that happily we now have an adolescent trials network that is also expanding its footprint in trying to do meaningful research and is going to look at adolescent key populations. the other i think really

encouraging thing is it relates to the w.h.o. guidelines. the w.h.o. guidelines for the first time address key adolescent populations, really included them in all of the recommendations. and in some countries w.h.o. guidelines don't necessarily mean so much, but for many they play an enormative role that really allows them for all kinds of activities to occur, and for people who want to do more of this critical work with adolescents, including lgbt adolescents and adolescents who are selling sex and who are using drugs. they are empowered by having those guidelines and being able to say this is w.h.o. standard of care now. we have to do this. >> let me quickly address the strategy and the great work you've done realigning and congratulate them on their line of programs to really have a

bigger impact on maternal and child mortality. extraordinary work. we're learning from those groups. that's why we have the 12 countries coming back emergently before we release the '14 money. we know we can't do everything everywhere, but what can we do in certain places, what are the right things and the right place at the right time? and getting that right will be absolutely key to either going on this line or this line. and we feel such a strong moral imperative to do the hard work that you did and do the hard work that u.s. aid did, we're running as hard as we can. because i also discussed those gaps. so it's not only a matter of doing what we have been doing, but it's also finding out how to do that cheap sorry that we can address young women, so we can deal with the issues of stigma and discrimination and the training at the community level. there's all of those pieces that we feel like we have to respond to at the same time that we're trying to focus the programs both geographically and in this

core areas to control the pandemic. it's an exciting time. it linked to that and we start an entire program of high level program of hrh and health system strategies, we have gone to every one of the agencies where we know there's incredible talent and we have stayed give us your talent, we have. we have gotten janet timberlake looking at the nrh strategy. the nurse -- we need to bring them to the children's world too and to other worlds. so i think we are looking at each of these aspects. we know they're all interconnected. but the human rights piece is such an important piece to us also. and we're trying to weed that

through this whole health care worker piece because that's where people come, and that's where they get stigma and discriminated against. so we need to also cover those areas and make sure we have funded that adequately. >> we only have a few more minutes and i would love to hear from each of you, your concluding thoughts and forward looking thoughts of durbin, which is where the next big conference will take place, the next two-year conference, after being there for 2000, for those of us who followed it, it was quite a turning point. so what are your hopes for getting there. so you're really the person who's going to take us forward, you can use this opportunity to give us input. >> i think coming back to durbin, coming back to the

epicenter of the global pande c pandemic, coming back to others in south africa, that's just an exciting and buoyant opportunity for us, and the memory of 2000 will be very much there, i would say a couple of things could be done that have been -- to address recurrent problems. one is to work really -- if you go into durbin and you don't have them it's going to be yet another sort of sense that the leadership has won, so addressing that problem frontally is a top priority. second is to figure out in

practical real political materials, and who needs to be there that is not there this time, who needs to be there that is credible and can be empowered and come out of the woods and talk about this problem, and not feel threatened and be able to put forward a concrete agenda. if you do those two things, you will have advanced the agenda very dramatically. south africa's transition, of course many of those people that need to be brought on treatment that both chris and deb referred to are going to be south africans. and the u.s. will also be in the midst of its own transition towards lowering it's support in handing that off to the south f afric africans. the fact that you're coming into a zone where our own program mattic achievements and engagements and partnerships are so rich and so deep, gives us

much more tungt to -- in the way that congress is used to build congressional support, to get other people excited. it's a very promising set of opportunities. thank you. >> i love the way you talked about the road to durbin as a way to really mark our progress, and i think if we reflect back to 2000 and that very difficult time between then and about 2007 in south africa, where there was difficulty with even awareness of hiv/aids as a -- putting road blocks down as a -- south africa has some of the most progressive and some of the most important laws and working with our south aftrican colleagues, to say working with other -- accelerate south africa's leadership in this area. celebrate their leadership and

investment in hiv/aids. they stood up like botswana and investing the billions of dollars. and they have identified the young women issue, so getting them to have that discussion now, so that that leadership exists and the role up to derbin will make it such a much more vibrant conference on a report card on did we deal with the issues we identified in melbourne and as a continent. >> all three of you are going to be part of this effort, please, your engagement really matters in a big way. i'll say a couple of things, one is of course, we have not had or won't have had an international

aids conference in africa in six years. so it's been a very long time. and of course south africa's story and trajectory from 2000 until now, is just beseeching, and an extraordinary transform mags, and that obviously will be a huge part of this story. we always try and have the conferences in places where we hope it will make a difference, so people don't know this, but steve does, when the president lifted the hiv travel ban and we could in fact come back to the united states, many of you were there in d.c. in 2012, we have made the decision to come back to the u.s. and we had to choose cities and we ended up choosing washington.

architects of south africa's national health system is really a leader in how you integrate hiv into a health system, that's one of the reasons why we asked her to do this. she will be the first woman in history, the first woman in africa to chair an international aid aids conference. when i brought this up to her and said, of course you're going to focus on women and girls, she said, well, i think it's very important to focus on women's rights in south africa. i said, all right, you're on.

we're going to do both of those things and all the other things that need to be addressed as well. finally i would say that the bis is a member organization, i hope all of you are members, if you ear not, please, join us, you actually do have quite a lot of input, it's an elected -- your new regional executive for north america is professor kim mayor in harvard, so please go on to the is website, join if you're not a member, get involved, we think that durbin is probably we hope going to be the same kind of land mark that it was in 2000, but in a very different way, right? there we were trying to prove a point, a rather simple one, that hiv is the cause of aids, this time we're really going to be --

we hope, a real turning point where we can start to say, all right, we have the measures, we have the deliverables. >> yes, july, the third week of july, it's always during that time of year, it comes out to 22 to 27, 2016. >> thanks, chris and we're here to help you. >> thanks to all of you, please join us in thanking our panelists. and thank you, everybody, for joining us.