any final comments? >> thank you. >> thank you both. let me see if i've got a very formal closing statement for you to be able to make. that concludes today's hearing. there's my formal statement. i would like to thank the witnesses for their testimony. the hearing record will remain open for 15 days until the close of business on december 16th for submission of statements for the record. with that, this hearing is adjourned. [ room noise ]

friday, former white house staffers and presidential transition teams on how the incoming president governs through the first 100 days. and how the first family prepares for moving into the white house. we are live with the national council for the social studies, starting at 11:15 a.m. eastern here on c-span3. the israeli defense minister and egyptian foreign minister speak friday on u.s. foreign policy in the middle east. we're live from the brookings institution at 6:30 p.m. eastern on c-span2. listen to c-span radio this saturday for historic audio about japan's bombing of pearl harbor, the attack that prompted the u.s. entry into world war ii. you'll hear president roosevelt's declaration of war address to congress.

>> a date which will live in infamy. >> as well as british prime minister winston churchill's remarks to congress. >> the british and american people will for their own safety and for the good of all walk together. >> and interviews with veterans who were at pearl harbor on the day of the attack. the 75th anniversary of pearl harbor is featured on c-span radio, saturday at 7:00 p.m. eastern. listen to c-span radio at c-span.org or with the free c-span radio app. december 1st marks world aids day. next, dr. deborah birx, u.s. global aids coordinator, on funding the fight against hiv/aids. from "washington journal," this is 40 minutes. at our table this morning, ambassador and doctor deborah birx, who is the u.s. global aids coordinator and u.s.

special representative for global health diplomacy. it is world aids day. tell our viewers why it's important to have this day. >> it allows all of us a moment in time to reflect on the epidemic, where we are, where we've been, who we've served, who we haven't served. really look at our progress. also, real time to remember those who we've lost, because that's what motivates us everyday. we know many of the people we've lost. we have to prevent losing them. >> let's talk about we're at with combating hiv/aids. if you look at it in the united states, almost 1.2 million people are living with aids infection. in 2015, 39,000 were diagnosed with the infection. from 2005 to 2014, the number of people who were diagnosed with aids declined by 14%. gay and by sexual men accounted for 82% of diagnoses.

heterosexual diagnoses accounted for 24%. talk about where we are in this fight against hiv/aids. >> that is a critical question. epidemics evolve and move, and change their dynamics, who is being infected, who is infecting who. unless you're on top of that and follow the data, you're behind the epidemic and new infections expa expand. the focus is ensuring we're putting resources where the epidemic needs to be controlled. when you look at the history of two cities, you look at the history of san francisco and oakland, you can see amazing progress in san francisco where they're talking about and counting new infections being less than 100, less than 90, less than 75, with the intent to get to zero. then you look across the bay and you see oakland with expanding

epidemic, young gay men of color, do you have the right messages. it causes us to evaluate how we reach everyone. >> what's the difference between those two programs, those two cities? >> i think the difference is very stark, when you look at where everyone has focused. i know the mayor of oakland is very dedicated. congresswoman lee, very dedicated to the issue there. but the epidemic started to expand in a group where we didn't have focused activities. watching that, finding that, now they're having a huge impact and will continue to have a great impact. san francisco, new york, a few cities, were ground zero a few years ago. so they had a head start really getting the data and the informs from oakland has been key. and many people have participated in that. and now they're matching programs. when you look at washington, dc, ten years ago some of the incidents here and prevalence here was higher than many countries where i worked in

africa. but the community, the government, the mayor, and all the resources together, nih, came together with georgetown university and really said, where inne nexfections are occu where do we get people diagnosed, where do we get them on treatment. and incidence has plummeted in the city. it's taking the parameters frro paper to action. >> is this a federal initiative? is most of this work done on the state level? >> it's done at both, it's also done at the community level. we have to remember how important the local community groups that continue to work tirelessly against this epidemic, ensuring that people in their community are served with health services that meet their needs, in a way that's representati receptive to them, nonstigmatizing, nondiscriminating. i think it helps that the churches are taking this on once again as a real issue to ensure that everybody who is in their

pews on sunday is aware of their risk of hiv and their need to be tested. so community plays a really critical role. yes, there are federal dollars. yes, there are state dollars. yes, we recently had ryan white reauthorized. yes, we do have programs for the poorest of the poor and safety nets. but it takes everybody together. and i think we never want to lose track, that no federal or state program is going to be impactful without community engagement. >> how much money are we talking about? >> billions in the u.s. it's somewhere between 15 and $20 billion a year of really investments both in prevention as well as treatment programs to ensure that we're decreasing the epidemic. that number continues to depending on the cost of medication and access. but it's really been from the beginning a comprehensive response that really had said we need to have prevention, you need to have treatment, you need to have community, the state, the federal government, and science. and what nih has done to provide

us the tools over the last 30 years is extraordinary. >> where are you seeing increases in infections in the united states? >> when you look across the entire united states and you look across the south, that's where you see many what we call hotspots. we look for hotspots domestically and we look for hotspots globally. it's areas where there's more transmission. over tho often those are areas where people know their status. no one is intentionally transmitting the virus. when you first get infected, you're healthy, and you stay healthy for a long period of time. when you talk about motivating a 16 or 17-year-old to interact with the health system, that's not one of their top three things to do in their daily life. so really finding a message that resonates with them and personally with them, that motivates them to want to know their status and want to know what it takes to protect them

against hiv, that's really key. but those messages have to evolve from talking to a 30-year-old down to talk to a 16-year-old. very different, and very different message. >> what is the president's emergency plan for aids relief, pepfar? >> it is an amazing program that grew out of the durbin conference in 2000, where president mandela got up and talked about the unrelenting playing in africa that was killing 20 to 30% of their teachers, their mothers, their doctors, their nurses, and really saying something needs to be done globally. the congress took this up between barbara lee, senator frisk, senator kerry. president bush, historically, for the first time ever in the history of the world, stood up to say we're going to invest to save people's lives around the globe, we're going to translate the compassion and empathy of the american people and their tax dollars into a program that

prevents, cares, and treats those who have less. and that has now, fast forward 13 years, we're so excited on this world aids day, because for the first time we have data to show that we're beginning to control the epidemic in three of the high burden countries. when you say in 13 years you've gone from -- and we continue to save lives and prevent new infections, but now we have the impact data that said those investments brought us to a place where we're actually changing the very trajectory of this pandemic and dramatically decreasing incidences. if you look at how incidences have decreased since pepfar has started, over 50% in countries where we've invested. >> what countries are you talking about? >> we're highly invested in sub-saharan africa. we have programs in the caribbean. we have programs throughout southeast asia, central asia, the ukraine, and programs, a few

programs of support in south america. >> and we're showing our viewers a map, a 2015 map of those so-called hotspots that you were referring to, sub-saharan africa. there's a goal of an aids-free generation by 2030. i want to show our viewers what the map looks like by 2020 comparing to what they're seeing now in 2015. those red spots become more orange. is it realistic, is it possible to have an aids-free generation by 2030? >> that's what these three surveys in the field were about. these were three comprehensive, done at the community level, so everybody in the community, not biased in any way, going door to door, 25,000 people in each of these three countries, zambia, zimbab zimbabwe, and malawi, and looking at the community level, what services are being provided and are those services having an impact.

the fact that we have community viral load suppression of over 60%, that means you're disrupting the sexual networks. that means we do have the evidence base. we had the scientific evidence base, all the clinical trials that nih supported that said if you do this, you can have an aids-free generation. going from there to implementing these programs in a full community country, county way, is quite extraordinary. but we have amazing government and implementing partners on the ground who have taken that science and they've taken that science to the people we serve in their communities, where they lived, and now we're showing for the first time that that's changing the course of the pandemic. so yes, we can. we need to continue to focus our resources. every single day we get up and say, are we spending the dollars where we need to to change the course of the epidemic and save lives? you have to be attentive to the money, the people, the

locations, every single day. otherwise, you can get behind the epidemic. this epidemic doesn't respect borders or gender or race or any kind of sexual orientation. this is a virus that spreads quietly. and that really takes programs that are comprehensive. >> if our viewers have questions about the virus, about the science, and about this effort to combat it across the world, we invite you to call in, republicans and democrats and independents. we have the ambassador and dr. deborah birx who has been working for a long time, who will take your questions. a democrat from chase city, hi there. >> hi. we should send some aid to indiana, since mike pence defunded planned parenthood, which they take care of all the

aids medicine and everything. and he cut that off. so -- >> yes, let's talk about what happened in diana and the role planned parenthood plays. >> there are clinics everywhere in these states and counties. these programs are more effective the more local they are to the communities. i don't know of the specific case so i can't comment. but we know through our advocacy and our community work that if people weren't being served, we would know it immediately. >> do you see infections then go up? >> people don't stop their medication. that's the other piece that these impact surveys show, that when you had 86 to 91% viral

suppression, that means that that patient is every day staying on his medication, he or she is staying on their medication. that's extraordinary, that people have that level of dedication, both so they can thrive but also so they don't transmit of virus. >> what is the medication? >> a combination of different drugs that work at different sites of action to inhibit the virus and keep the virus from replicating in your cells or keep the virus from binding to your cells, going what we call inside your cells. these all work in a complementary way. we have a combination of three drugs that we've been using in sub-saharan africa that cost less than $100 a year. those have been extraordinarily durable and extraordinarily accepted by the individuals that are hiv-positive. in the u.s., because we started with what we call one drug and then two drugs and then three drugs, because every time we had a new drug, we wanted to make

sure that every one of our clients had access because it was such a devastating time to have people in their 20s and 30s dying of this plague and not having the medication. so in the u.s., we've had to use more sophisticated drugs, more technically difficult to make drugs, because we have more resistance in the united states because of that, people being on one drug, then two drugs, then three drugs, which in africa, clients, because they couldn't access any drugs until pepfar, less than 50,000 people were on treatment before pepfar, now we have 11.5 million people. that's in 12 years. so they have much more durability to what we call the first line drugs than in many developed world who had access to the drugs. >> let's go to york, grand junction, colorado, independent. york, you're next. >> hello, dr. birx. i've been in the hiv/std

prevention business for you for 30 years. i manufacture condom vending machines. i have them in over 80 countries around the world. i ship 600 just to moscow. but we have noticed, even my competition here, we have noticed a definite decline in condom machines for around the u.s. and i've noticed a definite decline in the offshore. i haven't heard from the u.n. or planned parenthood for quite a while. but anyway, i'm on the web, if you would like to -- i sure would like to work with you. and i'm on the web. you can go there and go to condommachines.com. >> let's have dr. birx respond about prevention. >> thank you for talking about condoms, because they are a critical, critical component in our prevention armentarium. we launched two years ago what we call d.r.e.a.m.s., providing

a program of prevention meeting the needs of the young woman where the young woman is and responding to her specific issues. condoms are part of that. and pepfar continues to procure probably more condoms than any other program in the world. and we continue to do that at a very high level. we have not decreased, in fact we've increased the number of condoms we continue to procure. condoms are part of that. but we have to make sure that we just talked about -- we have know that people understand that they have a risk of hiv. and sometimes, particularly 15 to 24-year-olds, don't believe that they have a risk. so as the epidemic, and you raise an important point with your knowledge about condom availability, when a disease moves into 15 to 24-year-olds and they're not aware that hiv is a risk, they wouldn't be particularly motivated to utilize a condom machine because they wouldn't think that they are exposed or others that

they're with are exposed to hiv. so that's our job, to make sure people understand how this epidemic is moving and how in the united states, it's moved very much into young men of color, 15, 16, 17, and 18-year-olds becoming infected. throughout the world, particularly sub-saharan africa, it's moved into 15 to 24-year-old women who didn't even perceive themselves at risk. you have to constantly pay attention. >> ambassador birx is responsible for implementing the u.s. president's aids relief, pepfar, started under george w. bush, and as you told our viewers, the results that you've seen in the last 13 years to reduce the infection across the world. but the goal is an aids-free generation by 2030. >> and that's not just the united states' goal. that's the goal of the world, because when the world signed onto what we call the sustainable development goals, they said that we will

absolutely end hiv, tb, and malaria as pandemics and they'll be controlled by 2030. that's extraordinarily an ambitious goal. we've shown through pepfar that it's achievable. >> why do you think it has been successful so far? what has led to the reduction in numbers? >> i think there's three components to that. one of them is really utilizing data and information at the very most granular level. in pepfar, if your viewers would go to pepfar.gov today, they would find all our results down to the district level. we have results down to the site level. and we have all of those results age and sex aggregated. we have to know immediately, are young men not being tested, and are there certain areas where they're successfully being tested? we go to those clinics and find

incredibly innovative solutions in the field. but every time i go and say, this is amazing what you're doing, they say, doesn't everyone do it this way? people in general are so humble in their new ideas. but what we've been able to do by utilizing data in a very clear and disaggregated way is to find the areas of success and then find the areas that are lacking in success and improve those. we talk about the starbucks model. it's a little bit like a starbucks store being open and never selling a cappuccino. is that because that community doesn't like cappuccino or is that because no one knows about the cappuccino? so what we do is we look at data to really see, why aren't young men accessing treatment, why aren't they being tested, what age groups are we missing, what genders are we missing? that's how you stay ahead of an epidemic. more importantly, that's how you make programs effective, so that every dollar goes to a highly

impactful program. >> what are your questions about the epidemic? start calling in now. republicans, 202-748-8001. independents, 202-748-8002. we've got several callers lined up. david in gatson, alabama, a democrat, you're next. >> yes. i would like to give a big shout out to c-span and dr. birx, i think her work is great. i'm a 54-year-old white male, i have a modest income. what would be the best way for somebody like me to give to this foundation and to get involved in it? because i have kids and grandkids coming up, and i'm going to try to really educate them on it. but i would really like to help, you know, support the cause. what's the best way of doing that? and thank you for your work.

>> david, thank you, because that's what pepfar really is, says the translation, and you're doing something every day, because you're paying taxes that make this program successful, and we're deeply grateful to you, we're deeply grateful to the american congress, and we're deeply grateful to two administrations, a republican and democratic administration, who continue to support this program. i think that represents the best of all of us. what you just said represents the best of all of us. the best thing that you can do is what you talked about, educating your grandchildren and your children about hiv/aids. and then looking in your community, because i'm sure there's a community service organization within your community that is doing outreach into the communities that really are most affected by hiv/aids. thank you for your compassion, and thank you for being an american that has made this program successful. >> here is a tweet from a viewer, urban dweller. the difference is color of one's

skin. nonwhites were marginalized during the early days of the hiv/aids epidemic. would you agree with that? >> i think that's a very interesting perception, and i think the fact that someone feels that way means that we have to look at how we're working. we hear this all the time in sub-saharan africa from young women who said, i went to a clinic to try and find out how to protect myself and they turned me away and said, you don't belong here because you shouldn't even be thinking about having sex. this is a 17-year-old. until we really look at ourselves and we look at ourselves at the communities where we're providing services and saying, are our services open to everyone. i think the other piece behind that tweet that has worried me both here and around the world is, are the churches helping and are they part of the solution now. are the black churches talking about hiv/aids?

i think they are, and i think they're part of that critical community that can outreach. we talk about the churches in africa and we say are the churches in africa reaching out to the individuals in the churches every sunday morning and really ensuring that they have awareness of hiv/aids, how to protect themselves, how to keep from getting infected, and how to get tested to find out if they are infected. >> stan in broad brook, connecticut, independent. thanks for holding, it's your turn. >> yes, deborah, i would like to know why you and the government help spread the aids by allowing men to have sex with each other, by having this -- making it legal for same-sex marriage and all this stuff, you spread it -- you give aids a chance to spread across the country doing that. >> let's get a response, stan. dr. birx? >> i think we have to really be aware of the data. that's why data is so important. so when you start to look at the data, and as we opened the

segment, we talked about -- greta talked about how 25% of hiv/aids in the united states is heterosexually spread. we also know hiv/aids is spread among people who inject drugs. we also know hiv/aids is spread in prison. if you look around the globe, the primary, the absolutely primary mode of risk of spreading hiv/aids is in hetero sexual couples. so that's what's putting young women at risk, that's what's putting people at risk around the world. we don't have to be very careful that we don't use language that further drives people away from services and keeps them out of the health care system when we need them to access services and become tested. >> here is a question from jim buck on twitter. given the difficulty creating a vaccine to a retro virus, what is the current status of an hiv vaccine? >> well, thank you for mentioning vaccines, because there's two things that nih and the scientific community around the world are working on right now.

one of them is a cure. and that's extraordinarily exciting and they're making progress every day. the other one is hiv vaccines. i think that was the world i came out of about ten, 15 years ago. there's a really critical trial that just opened in south africa and really shows how vaccine development can work in partnership between the south african government, nih, and the community. and that is just being launched. that will be a critical trial. and i believe that we will have a vaccine. i hope we have a vaccine in the mid-20s, hopefully critically by 2030, because we will be able to control this epidemic with the tools that we have now. but we will not be able to end aids. i want to make that very clear. we're talking about 37 million people thriving and living with hiv/aids because they're on medication. they stop that medication, they once again can transmit the virus. so we have to ensure that those

individuals stay on treatment. and we have to ensure that we have a vaccine that's protective of all the rest of the individuals, while we work on our prevention activity. we're excited about the progress nih is making, and dr. fauci. >> let me give our viewers your background. dr. birx, military trained clinician in immunology, focusing on aids vac even research in the department of defense in 1985. assistant chief of the hospital immunology service at walter reed from 1985 to 1989. director of the u.s. military hiv research program from walter reed from '96 to 2005, rose to rank of colonel during that time and helped lead one of the most influential hiv vaccine trials in history. and then the director of cdc's division of global hiv/aids from 2005 to 2014, led the implementation of pepfar programs there, around the world, and managed the annual budget there of more than $1.5

billion. why did you start this work? >> you know, i went into medicine -- and thank you for going through that, because now you know i'm very old. >> sorry. experienced is what i was trying to get at. >> when i started in medicine, i was trying to decide what i wanted to do. i was so intrigued by the immune system, because it sealed like everythi seemed like everybody came to that, whether the inflames that leads to cardiovascular disease, auto immunities, immunological abnormalities. i studied immunology. in the middle of studying immunology, i got a call about -- and i was working on primary immunodeficiencies in the military, young children born needing antibiotic support, like the boy in the bubble, that didn't have t-cell function.

then i got a call about patients coming to walter reed, young, men, young, vibrant, amazing soldiers in their late 20s, coming in, dying from a mystery illness where their immune system has collapsed. in talking to those patients, they knew they were dying, yet they stood up to say, fight for the ones behind us, because although there might not be anything for us, please ensure there's something for those who come behind us. i have any seen that in medicine. i felt so disempowered. and they were so empowering, because they believed, if we worked hard and we got the scientific break throuthroughs, could make a difference in the future. that level of unbelievable selflessness when you're dying yourself, to be concerned about the others, was so inspiring to

me that every day i remember their faces, and i remember the sacrifice that they made. and their only request to me was help those who are behind me. >> let's go to jason in san diego, a democrat. good morning to you. >> good morning. i have a question and a comment. first of all, i would like to say that the affordable care act states that no one can be turned away for a preexisting condition. i would like to know if aids, cancers, devastating diseases, can be covered by the affordable care act. also there was a guy dealing with junk bonds who got control of the aids pill that cost $15, he changed the price to like $5,000 a pill. how can we -- and i would like to know if the affordable care

act can give assistance to aids. >> great question, jason. the united states, before pepfar was even created, very seriously responded to the epidemic in the united states. and ensured that everyone had access. the ryan white act, and i'm just so pleased that we still call it the ryan white act, because ryan white represented really what some of our problems were. they represented -- ryan white was discriminated against every day. he wasn't allowed to go to school. his mother -- he wasn't allowed to go into grocery stores. people shunned him because he was a hemophiliac who got hiv/aids from a blood transfusion. he stood up and asked, again, while he was dying himself, that we have a service for others, that we don't discriminate against each other. he really called for us to have access to the lifesaving treatment for everyone. and that's what ryan white is

about. that's -- there's a lot of acronyms in this, but those are all safety nets to ensure that everyone who has hiv in the uses has access to the lifesaving drugs they need, and it's also available on aca. there are safety nets below safety nets for hiv/aids in the united states. it always has been that way from the moment we had available drugs, and we had a really effective drug combination in 1996. >> what are the costs of drugs for somebody who is using them to prevent aids? >> that's a difficult question, because in the united states, where we've had to go to stronger and stronger and more different and different combinations to really combat resistance, the drugs in the united states do cost much more. but we're using drugs in africa that we used in -- basically that were the concept of them was available in 1996.

as i said at the beginning, those drugs have been 96 -- 86 to 91% effective no matter how long people have been on treatment because they're completely virally suppressed. we're still in most countries, 91% of our clients are on first line drugs. the cost in the united states is different because they've had to go on newer and newer therapies. we've not seen the same thing in sub-saharan africa. >> robert, rock falls, illinois, republican. >> if you go to a different question, and you go to which of the countries can you have or can you get to take with you, is there blood testing for hiv? >> yes, great question. so we are so privileged, and i didn't really get to talk about how much technology has improved and how much that technology has been made affordable to us, to

utilize around the globe. so for the last almost a decade, we've had what we call rapid test. we can diagnose someone within less than five minutes, no matter where they are in the world. and now we're working on a new concept of self-testing, where we can actually give a patient or give a community a series of tests where people can test in their households and then come to the clinic to receive lifesaving treatment. so all those options are available. the hiv/aids field has really bend from scientists and pharmaceuticals and generic companies working together to really bring to the field really new technology that really helps us test individuals so they know their status. last year, pepfar tested almost 75 million individuals. and all with the rapid test. that shows how people brought new technology to us but they

brought new technology at scale. because to do 75 million tests, that is an enormous amount of commodities and supplies. >> capitol heights, maryland, tony, independent, hi, tony. >> good morning. >> your question or comment this morning. >> yes. i just think this is rational to take a -- take a rational position towards solving the aids virus problem, to find out where its origins came from. any time you want to solve a problem, you have to get to the origins. i notice that the history of aids hasn't been discussed so far. and it only took me one minute to pull up an aids timelines by this doctor named dr. reyes. one thing i noticed in this timeline, in 1974, henry

kissinger released his ss 200 to a population in romania, as a program to secretly cull or to reduce the african population. and then in 1975, president ford signed the national security defense memorandum 314, and the united states implemented henry kissinger's -- >> okay, tony, let's have dr. birx tell us about the history. >> yes, no, thank you for bringing up the history of aids. the one thing that hiv has been enormously studied, so we really -- we have blood samples going back decades in different repositories that have really pointed out -- and i'm glad you talked about the history of aids and where the virus came from, because like ebola, hiv virus is a virus that came from animals

and adapted to humans. that's what ebola does. that's what hiv does. that's why we have programs now in global health security to really look for viruses that are making that jump from animals to humans. hiv is one of those viruses that jumped from primates and chimpanzees to humans. humans that were involved in bush meat and bush meat harvesting in the rainforests of cameroon. they were constantly exposed to blood from primates and, you know, when you use machetes, you get cuts in your hands and cuts on your arms and the virus was transmitted from animals to humans and has adapted to humans with each cycle of replication and with each transmission. so both ebola and hiv are viruses that we call zoonotic viruses. it's our responsibility as epidemiologists, as infectious

disease and viroligists, to look for those viruses and find them quickly and prevent an epidemic. ebola kills patients very rapidly so it can't cause the same level of epidemics that hiv was able to do, because it was silently spreading for decades before we recognized it, because people's lifespan with hiv without treatment is nine to 11 years. and they were healthy for the first eight or nine years. so this virus spread without anyone knowing about it for decades. and that's why we're much more focused on global health security and identifying those issues. >> let's get in shirley in south boston, virginia, a democrat. good morning. >> good morning. i'm calling because the caller previously touched on my question of origin. back in the '70s, when i was in the health care profession, i noticed the gay pride parades in new york city and it was absent of a lot of people of color in those parades.

she keeps talking about africa. i don't feel that this disease started in africa. it started to me in new york with unprotected sex with white gay males. >> shirley, i have to leave it there because we're running out of time, i want you to respond. >> thank you, shirley. this is why it's important to look across the history of the epidemic and really understand the epidemiology. and i think you point out a very important concept and perception, because we only see what's around us. and when we see what's around us, we make assumptions about how the virus came and how the virus is transmitted. yet that isn't consistent with all of the data we have now on what we call the epidemiology of this virus and the scientific evidence that we have of where the virus came from and how it spread. and i think we always have to go back to the data,