an ebola patient comes up to him before he or she knows what he has, he has already been infected. >> mr. isaacs, you ask the question earlier -- where will the money go? in your opinion, where should the money go, and what should it buy? >> i feel that international personnel are needed. i do not think the ministry of health of liberia can fight this. they do not have the case investigation capacity. i talked with a senior person at the cdc. i won't name her, but she is a well-known person who told me that in the united states, if there was one person that had a level four infectious disease, they would have many hundreds of contacts to run down. there are no contacts being run down in liberia. i do not believe the liberian

government, as well-intentioned as they are, and i do believe that they are well-intentioned, i just simply do not think that they have the capacity. i think that there needs to be something to augment their capacity. i think that there needs to be some kind of coordination unit. i've heard here today that the world health organization has the lead. maybe, maybe not. i think something with a bit more of an operational edge to it is called for. that may be some kind of a -- i do not know what that could be, but more is needed. i think that if we leave the situation up to the ministries of health -- when you have a unique situation where you have three poor countries that have a communicable, infectious, and lethal disease, they clearly do not have the capacity to contain it. and is the world willing to allow the public health of the world to be in their hands while they try to contain the disease? that is the essential question.

>> finally, dr. glover, you had worked on the outbreak of ebola, what, 20 years ago? >> actually come at that time, i was in the zaire, but the outbreak was in another place. i was in zaire. outbreakre during the but i was not working with ebola. >> how does this compare to that .utbreak there is no comparison . you have somebody people in liberia that moved to the city. you wonder how you can get some people jampacked in a bus or how many people live in a house. withdministrator came down the virus and he infected his

eight children and his wife and all 10 of them died. the close proximity of people living in the concentration of thisopulation means that epidemic no matter what we do will be a tremendous loss of life due to the nature of this disease. >> i thank you both. is there anything else you would like to add before we conclude the hearing? that -- i amst say sure there is much more, but this concept research and development for a vaccine and a cure is very important. i think we will see death tolls in numbers that we can't imagine right now. also, i will tell you that we are now in the process of distributing ebola-readiness information to hospitals across

africa. >> any final words? thank you. i want to thank both of you for your extraordinary service to fornkind and especially those suffering this terrible outbreak of ebola. least stay in touch with their subcommittee. we are looking to make sure that we are doing whatever we need to do as a congress and subcommittee, and me personally and my colleagues, what we want to do and your guidance is absolutely essential. and you for your wisdom insight. an incisive commentary to the committee. the hearing is adjourned. thank you.

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we have three distinguished .uests with us today and a very large audience. thank you. the i first want to acknowledge this ongoing collaboration. given the large audience that signed up for this and is actually here, i am curious how many people went to the

conference. if most of you did not, it is understandable. it is far away. , i wante serious note to say a few words about the tragedy that befell all of us and that is the crash of , literallyirlines when they were traveling to melbourne. all of us collectively lost six incredible people who devoted their lives to do this very work. want to name them all.

the codirector of the hiv netherlands-australia research collaboration. the former president of the international aids society. also at the amsterdam institute for health development. martin, who is also at stop aids now. and glen of the world health organization. this experience should the beginning of the conference, which was somber and serious and full of a lot of shock and pain. it reminded all of us something really important about our community. it is a community of scientists. many are embodied in the same person. just to remember these individuals, i would like to quote a friend of mine who worked very closely as a reminder of who they were and what it means for our community. and also to recognize the act of violence that occurred. these are kate's words. a tribute that she just gave a

few days ago. "it is incomprehensible that people who work so hard to save the lives of others should be shot down and the collateral damage in a war. each of us needs to reflect on how to celebrate their memories. this world is a better place for them having walked among us. let that be said of each of us too." i want to say a few more words on the conference and where it was in terms of the attendance. not expected to have scientific breakthroughs, but nevertheless, it had an incredible depth in what was resented and -- presented and the come together of communities in what was a consensus on where we need to go from here that has not always been present and emphasizing the importance of focusing on key relations that are marginalized.

transgender individuals, sex workers, and confronting discrimination in all of their forms around the world. the emphasis on the need to scale up treatment and what we know now about treatment and how effective it is, and the power of convention again, some prevention, of again, some exciting new information about rep -- prep, which i am sure we will talk about. for now, i will leave it at that. i would like to ask our three panelists to come up. the ambassador at large, dr. birx. dr. chris beyrer, president of the international aids society. and dr. steve morrison, director of the center for strategic and international studies. so please join me -- [applause]

chris is here. that is my most important job today. [laughter] ok. as usual with our events, we will ask a few questions of our panelists and quickly get to your question. i hope this is a dialogue, especially for those who were not there and want to get a sense of how things played out. we know that the media itself did not cover the conference extensively. that has been a trend that we have seen for a long time. bringing that information here is a critical task. my first question, i will start with ambassador birx to get a sense of your main impressions and takeaways. what were some big themes that came out? >> thank you for having me here again today. thank you for all of your

information that you put on the website about hiv-aids. and every question that i have had from every african press. site.ll referenced this so aids 2014, when you start out with that level of heartbreak, all of us were very introspective the entire week because many of us came from that time when there were so many unexpected deaths among our friends for an unknown reason back in the early 1980's. i think you have to have that reflection at the beginning. every time i heard something, i was able to think about the history of hiv-aids and where we are. to me, it was the historic content of our 30 years together and where we have been. what started out as heartbreak came forward very much as hope

when they released the global report. i believe you all have seen it. it is a return to fundamental data reporting from u.n. aids with clear analysis that we can all understand. it's the first time we look at the graphic without a lot of subtext. you only have to look at the pictures, which i really appreciate, and you get a sense of where we are around the globe. to me, the last thing was renewed commitments and the beginning of the week -- when things happened and advocates and activists spoke, there was a true resonating theme from all of us. when they were talking about they want to be undetectable, we all agree to that. it is so important. i think there is consensus. my final impression, probably the biggest impact on me personally was a session done

with individuals who have lived with hiv-aids for more than 20 years. it was really -- i had somehow, in my years of travel, lost track of how those days felt and how sick those patients were. hearing them relive the number of days they spent in the clinic, in the hospital, throughout their 20's, 30's, 40's, they were unable to work, unable to access effective treatment. we had monotherapy and then bi-therapy. fortunately, all of them in that room made it to combination. hearing about their life experiences and the impact it is making in their 60's and 70's having lost their most productive work years reminded me why the united states turned to a huge epidemic in sub-saharan africa and said we cannot stand by this.

25-30 losing all of the year olds. hearing their stories and understanding that their life journey had a tremendous impact and we all need to resonate with that and understand that we have a lot of patience now who live successfully with hiv but do not have the wherewithal to retire successfully. it renewed my commitment to understand all of the stages of a life experience, from prevention of mother to child to transmission to treatment that we are approaching and being able to understand people's life is princes. -- like experiences. >> chris, i think this is your third of these that you have done. >> yes.

>> just put it on your calendar for two years as well. >> two years from now, we will be talking about -- i will come back to that at the end. i just want to add to those reflections. the mh17 tragedy changed all of our experiences, had a huge impact on the conference. summarizedword that the response of our community, by midweek, we heard it repeatedly, unity. it just draws people together. i think this will be remembered as one of the conferences where the divides that we sometimes see in our community really got dissolved. -- truly got resolved in some way. there really was a unanimity of

purpose and engagement, which i know we will need for the next phases. big picture messages that came out of the conference were certainly -- and debbie's talks on the u.n. aids data, there is a's -- a consistent theme on using the data that we have more consistently and focusing on better quality, focusing on the people. the human age report showed that 50% of the new cases -- that is an incredibly important thing. they are predicted to be in key populations. they are relatively small portions of our community but bearing this burden. that is a combination we have to change. so that refinement of the response was a theme that occurred. if i might just go through a

couple of highlights from each of the tracks. we have five tracks now. while there was not any one or two single big studies, there was a number of advances in each of the tracks that i think are important. particularly because so many of you will not be able to attend, hopefully this will be your 10 or 12-minute go through the signs. there were a couple of key talks to her example, with track a, there is a lot of focus on the cure. the big news was the breakthrough after 27 months of the functional remission of the mississippi child who is now four years old and doing well on therapy, but unfortunately was unable to us -- to stay off antiviral therapy.

and the curing plenary on the opening day is a masterful summary. she managed to do both things. not dumb it down and keep us all appraised. the big news from the focus on cure is the concept that you try and get hiv out of the reservoirs it is hiding in and use immunotherapies or gene therapies or drug therapies to try to go after that reactivation of the virus. quite a lot of information on that and early studies that suggest this may be the way forward. there is clearly a consensus emerging that the best thing from make your perspective and probably also from a clinical perspective is earlier initiation of therapy is better and the people who are likely to

be the most to benefit from fewer strategies -- cure strategies are the people that start in the very near term. this includes a large pool of children worldwide. so that is going to be a very important area. the clinical track him the great news is that basically 13 million people worldwide are on antiviral therapy at this moment. with the new w.h.o. guidelines, another number the will to that are now eligible for therapy. there is an enormous still untreated population. more people have started than at any other time, partly due to the global fund.

in terms of treatment areas that emerged, there was a big focus on tuberculosis. there was a great summary with very important findings. there are some new combination therapies that looked quite promising. there is an emerging area related to clinical care and smoking, particularly thinking about chronic obstruction pulmonary disease. probably the next tier. there is a lot of action on that front. and then probably track c, epidemiology and prevention, the area where there was the most action because there has been the most news and trials out. a couple of things to highlight.

first of all, new w.h.o. guidelines were released just for the conference. i should say that i cochaired the guideline process. the dean of the university of the medicals cool -- the medical school in malaysia. those guidelines made one of the strong recommendations for more consideration of the use of exposure prophylactics for men who have sex with men as an additional prevention option. some of you saw that this got very misconstrued in the media,

saying that all gay men should be on prep. please do read the guidelines. i think they are a real advance. in addition, there is the recommendation for community distribution. in companies where there is good coverage of a.r.v.'s, it can replace hiv as the leading cause of death. there was also good news on prep with transgender women who have sex with men. iprex was the critical trial that came out in 2011. this is the open label extension. this is really the question of the effectiveness of the prep where people know what they are taking and can choose to take it or not. the good news is that the

effectiveness was higher in the trial, about 50% overall. looking at blood levels and people who took the drug, it turns out that the efficacy was 100% as measured in people who took it every day. but it was just as good at six times a week, five times a week, four times a week. while that is a difficult message to put out there and we are not backing away from daily prep at this point, the adherence does not have to be perfect. that is a real advance. the other thing that emerged from that study is that people had a good sense of their own risk. taking the drug daily was more common for people who had a high risk of exposure.

less common among men and transgender women who did not. people are smart and they know what kind of behaviors they are engaging in. nevertheless, important. there has been all kinds of concern about people being on this drug and using condoms less. lots of science around this. turns out it is theoretical. condom use is better in couples where one of them is being treated there was great data on that from zambia. no evidence of behavioral -- there was also encouraging news on: terry male -- on voluntary male medical circumcision. the first trial showing the benefits for women of male circumcision. that is the data we have been

waiting for. it is very encouraging. i would say on track d, our human rights policy and law, there was an enormous amount of work. michael kirby let us all -- off with that theme. also some empirical data from the special issues that have been happening regularly at these conferences. this one was on hiv and sex workers. i also edited that. full disclosure. it is a wonderful group of young investigators who wrote those papers. i am very excited. there is strong human rights evidence for potential benefits of reducing hiv incidence. and also on decriminalization as

hiv prevention. finally, the implementation track now has the largest number of abstract submissions of any track. those of you who work out there, you are an enormous sector. there was great science so very encouraging outcomes. also one or two warnings. good news that earlier disclosure turned out to have adherence to therapy. that is an important finding. happily, in africa, many of those kids are surviving. a challenging issue with plan b, occluding the hiv therapy which looks like their retention is not as good as we had hoped. they are falling off and that is going to be an important challenge.

so i would say that finally, the other thing that emerged was how much more granular -- you are talking about the data and the strategic use of data, the importance of targeting resources to where the virus is, to where people need treatment. where transmission is ongoing. given what the global funding climate looks like and given the fact that we are beginning to bear down on this. >> i have to thank you, because i was at many of the sessions and have read so much that has

come out of the conference. that was the best summary of everything that happened. you got the best summary right here. >> thanks jan, and baxter kaiser incurred for hosting us. and congratulations, chris. you're a sent to being president for the next two years and working with -- and moving towards durban, which is very exciting. i was really struck by the emergence of opinion. -- the convergence of opinion. in sitting and listening to deborah berks, to michelle sidi bay. degree to which is a very mature in advance consensus around what needs to happen is remarkable. this is not a community the set in deep controversy and division. i was at times a little irritated. this is really a sign of success.

there was embedded within it, a palpable realism and focus on results and implementation. there was a spirit of constructive forward-looking progress to this. and a sense of advancement and a sense of realism that all came together around those five or six key things. i didn't fully appreciate the degree to which that convergence had happened. is a real testimony to the maturity of the leadership and the continuity of leadership when we look at the people that were up and eloquently making the case. you realized how long they had been in leadership positions. it is a very unusual -- that we have. i'm going to say a few words about the implications of the m h 17. i think this is truly extraordinary. i'll explain a bit more about

that. i think we need to tease out a little bit of the implications. first of all, we have never had a conference in which a geopolitical global crisis sucked the conference in and sucked the host country. australia suffered the loss of 28 citizens. 18 citizens from victoria state died. this became a geostrategic top priority, pressing, urgent matter for the australian government, as it did become a pressing and urgent human matter for the organizers in the aids conference. there's no escaping the reality that this was going to become a dominant factor going through the week and beyond.

thinking about what that means in the immediate and longer-term, i think is important. one is, the mh tragedy will become a signature frame for this in the future as we talk about this conference. secondly, as it triggered a massive spike of media coverage. bear in mind, going off to melbourne was to push the aids conference into the periphery. lowering the numbers and lowering the presence in a world in which the global media is shrinking in terms of its willingness to deploy to this kind of conference. the media presence was a lot lighter than it was two years ago. that tragedy spiked the media coverage in a. period. the storyline was a human tragedy and impact there and what that meant.

for lesson that has been in the past of the sort of programmatic developments that chris and deborah -- i do agree that the immediate impact was a slightly disorienting and dulling effect upon the population for the first couple of days. there was a somber nest that that hung over the opening ceremony. the delegates themselves individually and in early panels and events. what was interesting was that there was a rebound effect that began soon thereafter, in which you saw a community that had an unusual resilience to it. it had an unusual capacity to absorb and process this tragedy. some of that is due to historical -- of hiv/aids. this is a community that is familiar with loss. it is familiar with the rational alliances.

violence.rational it was a reconciliation of a kind that happened slowly. one of the key moments, i would like to have from jen and devon chris on this. i thought one of the key turning points on wednesday. this was not a conference that attracted a lot of big celebrities. it attracted bob geldof as a faux celebrity, but only really attracted one global personality and that is bill clinton. clinton came in and the media intention -- attention intensified. he really was quite deft at

lifting the spirits of the conference and defining the moment. he was particularly humble and eloquent in the way he went about doing that. he talked about mh 17 emanating from the dark forces of her injured -- of our interdependence. he reminded everyone of the 2000 people there in the room not to weaken their resolve in the face of this. he supported the dutch and australian and american positions that there was no excuse. then he segued to talk about the vital point of appealing to the assembled community, that it had an obligation to honor the service and lives of those who were lost and the children were lost. he said we have to remind people that the people we lost gave their lives to the proposition that our common humanity matters a lot more than our differences.

this is the kind of speech that was quite unusual and obviously driven by this tragedy. two other points about the impact. one is just really government. government was an exceptional host. they were cordial, there are gracias. it was very well organized on their side. this was a national tragedy for them. i think it completely consumed this government and in a way stole any serious high-level attention away from them. they were absorbed in the security council and getting forensics into this crash site and they were rallying in mourning and grieving their own population during the conference on thursday in the early afternoon. 1200 opinion leaders touted at

-- gathered at st. paul's cathedral which is just across from the conference center. in the midst of this conference was this other, larger drama. the last thing i'll say has to do with vladimir putin's actions. this mh 17 tragedy aggravated and further worsened was already a line in which putin's seizure of crimea and ukraine and the battles to regain dominant shares of asia and the baltics and elsewhere has great public-health applications, was driven into the next stage. we need to think about that. we need to think about that. i'm not sure there are any easy solutions. it was another one of those dark and somewhat implicit applications for this terrible tragedy.

>> thanks. i want to pick up on one thing you said. i agree. that speech was quite extraordinary by president clinton. i'm not sure it got the attention it needed. the thing i want to say is the ias itself, anyway responded, it responded, was also pretty phenomenal. there had been a few calls for if we should go on with the conference. the ias cannot read away and said we have to go on. that really just gave a lot of energy to people that people needed. the weight you adjusted to the opening ceremony was very admirable. thank you for that. there is a lot to pick up on. i'm going to go to a couple of places. chris, do you want to say anything in reaction to some of the pieces that steve mentioned on the conference? one thing that would be great to hear little bit about is the

declaration. >> maybe just start with another declaration. one of the core ideas that we had for australia is that countries now, 30 years and more into the epidemic, each have their own story and their own national response to what is happening. part of the story with australia is very early implementation of evidence-based prevention, very early engagement in the communities. on the first countries to really seriously take needles exchanged to scale with the intravenous drug use problem. and really heading hiv off at the pass and still having an admirably low rate. it is taking up an young gay man as it is everywhere. this is part of the story, that australia has a place to talk about key effective populations.

we are in the south pacific asian. poor public health policies and programs in restrictive environments. that certainly is the case for central asia. and increasing russian influence on public health programming in that region. we focused on the melbourne declaration to say basically nondiscrimination is totally unacceptable at this point. if we can't do a better job of delivering safe and effective programming with dignity and human rights for everybody who needs it, we are not going to be able to succeed. the melbourne declaration became all too real and alive during this, i have to say. vis-à-vis the issue with the russians, we wanted very much to

have the russians engage in this conference and have central asian governments involved as well. in asia-pacific we try not we tried ana-- outreach there. we organize a special session on the region in which we invited russian participation in. they agreed. the head of the federal aid program of the person they put forward. 10 days before the conference that person pulled out and said sorry, we're not coming here to russian government is not participating. we invited them to put in a report and they didn't do it. on the day of that session, which is on the thursday, they sent a letter to the media protesting the russian exclusion from participation. it put us in a very challenging position. we try to respond with the evidence. we laid out what actually had transpired, but as steve said, 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 that it on think anyone knows what is happening in that enormous country. in addition to that, they are also aggressively promoting its policies and practices, pressing hard on anti-homosexuality legislation in their region of influence. the best example of that, and i will stop after this, it is the occupation of crimea. as you may know, they announced the cessation of the methadone program. ukraine has methadone substitution. on the first day of their occupation in crimea. that gives you a feel for where their sense of priorities is. you occupy some houses country with a long list of things you need to do. most people would not put in that -- methadone on the day one list. but nevertheless, we really do

have an enormous challenge. >> debbie, back to you and then we will open up. two other things that have come up. one is around this -- i think we all felt a global consensus about where we need to go. whether it was the geographic focus, the goals, how we get there, how we use resources. put itself into that dialogue. a follow-up to the africa summit so we can get that out. i notice consumed all of your time. what is your readout on that for us? >> this particular meeting, the ias was really helpful for me. it was the intersection of the new cap report that really illustrated where we have done well and really recognizing that, but also recognizing where

we haven't done well and immediately be able to go look at the posters and the planners and see you as got something that we can bring back to try to implement in those areas. we looked through everything and where we still have gaps. tb/hiv. we are patients coming in and getting therapy. being diagnosed with hiv and not getting hiv treatment. we have a gap. we have to figure that out. that one should be pretty simple because we arty see the the patients.see we are paying for them to come to the clinics. we need to really redouble that effort and really used data for decision-making and understand that situation. the gap that was clear is pediatric treatments. we really tried to respond to that immediately. we sat down with pete mcdermott. he shares mine and everyone else's global concern for children and children accessing treatment. only about a third of the children who should be on treatment are on treatment.

this is country by country. even countries with an enormously successful in getting adults on treatment. we have a big announcement at the african summit yesterday. not only because it stands for, but it recognizes that the european is working together on these issues. we haven't had the kind of alliance with europe during this time. i feel very strongly about the global fund we do, too. we are the largest contributor. having a technical dialogue really helps us to have a broader dialogue very we are very excited about that. there's a gap i think we can all address. i think the bubble diagram in the cap report over the continents was very important. to make it very clear that the vulnerable population in sub-saharan africa is young women. 7000 young women infected every

week. if you added up all the other bubbles of audio vulnerable populations that fit within the women circle completely. the 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 have been taken to scale. 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 is driving young women's decision-making. to have enough knowledge, are they making correct decisions for them and do they have all the information to make your own decisions? re: giving it to them 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 about someone going, why are you here? do you mean you're having sex? we know this happens. it happened in our household. i think it is happening in

others. they are all passed that now. there are 27 and 31. it was a long and difficult time. i recognize that as a mom, i think all of us struggle with this and we struggle to figure out the best way to resonate with young women and we had to figure that out. i think it was a great time to really look where we stood -- where we still need to do better and see if we can connect with science that gives us a roadmap heard we are excited about those pieces coming together. we're excited about the opportunity to translate gaps immediately into a response. we want your ideas. to put all of our data up on the website. you can go to it and see all the budgets and results by country. all of our investment strategies by country. send information back to us and say well, i am there, i have looked at is and it does make sense. don't try to hold back. we want to hear where you think

we can do a better job. we are committed to putting additional data as we receive it. wriggling down to the site level to there going down level and site level quality data so you can really look at our performance and tell us how to do a better job. we are all in this together. this is a global pandemic. i decide to leave it one last thing, because you didn't mention it and i'm sure it is in everyone's mind. ebola. it is a very big contrast in how the united states has worked effectively in partnership with countries. 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, a laboratory infrastructure, the knowledge base. when those patients came in, they were merely isolated. the laboratories diagnosed them. there is one case in uganda or five cases in drc. another one or two case 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. i think it speaks to the 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 is absolutely critical. one more gap. long acting prep would be amazing. we have vulnerable young women who may not have the ability to take a pill every day. i see a lot of birth control pills on my counters where there are still pills and they're not all pushed out. it worries me. prep is important and i think a long-acting treatment option. it could be abridged for young women and vulnerable young

women. i think good tasting pediatric formulations. i understand is, frankly. -- i don't understand this, frankly. we made dimatap taste good. we have coming vitamins, and we can't figure out how to make the gesture treatments taste good day at a mother cannot hold the child down every day to give them a dose of medicine. it is horrifying. if your child is artie sick and you're trying to do this, its horrifying. we do have some technical gaps. if you're working in any of those areas, please work harder. [laughter] >> have another thing that wasn't talked about. it is a question of resources going forward and where they're going to come from. there's a big emphasis on using the existing pool of funding that we have and using it wisely, which is incumbent on everybody, but going forward we know there are these gaps and needs. note government commitments for

hiv are going down. that was an issue. there are other sectors that can help. that was something we can get into. >> just a few quick ones. the melbourne declaration, michael kirby the australian jurist came across a remarkably -- as remarkably eloquent and powerful at multiple points. from the beginning, then there was a session on criminalization. there is a very genetic session. and the u.s. ambassador john berry showed up at that. it kicked that session off. in his presentation, he 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. it was a very refreshing self-critical way. it opened the discussion quite nicely. michael kirby came in and blended as well. >> i was quite amazing. >> what is less clear to me is what was supposed to be done. it was less clear to me after all the pronouncements. the melbourne declaration was great. the criminalization session was great. the appeals that were made, kirby's opening address on opening night. it has not yet gelled into a fairly clear set of priority actions that are supposed to happen, to address this urgent homophobia and the proliferation of bad laws. i put that out. another problem area that

emerged was fact that there were no serious high-level asian leaders. the president of fiji showed up, which was nice of him to do. there were ministers there. there was not a surge -- there's not evidence of broad gauged high-level political interest from the asia-pacific region. i was disappointed to see that. the world bank and the study of the financing across asia-pacific, a paper that will be published at -- that david wilson is working on. it shows that in this case, the response is overwhelmingly dependent upon government commitments.

it is right flat and very deficient. that is something. in myanmar, we do a session that chris was helping us organize. the deputy minister came and presented. there's a bit of a debut. government of myanmar has overcome its sense of embarrassment or discomfort at talking publicly about its programs. it came forward in a very candid, calm transit, honest and honest andnsive, forthright way. that was so refreshing to see. the response was great. you had dozens of myanmar folks come and those from the region. you have indonesians and tie experts join in that effort as well. i was really delighted to see that. thank you. >> so, let's open it up to questions or thoughts. we will take three at a time. just introduce yourself. there are mike's on both sides. i'll try to facilitate this by pointing. anybody have -- ok, you have somebody over there come over here and over here.

you say -- just say who are. >> hello, i am from usaid. my question is for dr. morrison. you mentioned that there was near consensus at the conference on the five or six things that need to be done to turn the tide of hiv. i'm wondering if you could review those quickly. thanks. >> next question. >> mary linfield with creative associates international. i have the same question for stephen. i think consensus at an aids conference is a little frightening. i wondered what you want to see more debate about. also wondered what is the explanatory dialogue going on about low treatment for pediatrics? i worked as a pediatric aids adviser terry child health project from 2005-2008.

i never thought it was the lack of free agents are formulations. mothers in communities did not know anything about what could be done for the children. the discussions of parents being positive are much more the barriers. what would be the response and what kind of interventions are being looked for is the question i have. >> last question for the strong. >> my name is edward green and i and the u n secretary-general's special envoy for hiv aids in the caribbean. i happen to be -- i happened to be at the conference and i share the sentiment of those of the table. in fact, i want to congratulate you for making the content dust the context so vivid for the audience. however, i want to add a more optimistic take away. for me, when i reflect on the conference, there was a take away which was a resolve to end

hiv is by 2030. i believe that this is a momentous opportunity for health and development. one reason is that i think it was embellished by the unh executive director. not want to ask panel, are you as optimistic about that? was the position of aids in the post-2050 agenda? as a result of the conference, i believe it is ensuring that aids is positioned in the post 25th teen agenda. agenda.2015

i think we're all clear on that. less clear was whether or not we embrace it with in the conversion of health. that is 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. >> so we have a few questions here, one on the consensus and what it was about specifically. another one around low access and what is going on in pediatrics. this last one is will we be as optimistic. does your all hard questions about the post-2015 agenda. >> we heard from denver in particular about the fundamentals of the consensus. i would say they are really about making a full use of an expanding and very promising set of prevention tools, including treatment. there is a sense that in the last several years there has been dramatic improvement and

expansion of tools and those become central in moving forward. the sense of the need to systematically retool approaches, from the general to more targeted investments in local and sub regional areas. where the epidemic is most intense, and that includes geographic as well as target populations. to medically, the imperative to improve use of empirical data to guide investments and track and prove impacts that will guide our future investments. improved assessments. the shared common view around girls, particularly rural girls in southern africa, obviously, key populations as high priorities. i would put us a broad frame of this, a shared optimism, a

pragmatic approach, a forward-looking approach, a data-driven approach, and i was being only facetious really in saying it bothered me there was not a more active debate, there will be more active debates, but i found this broad consensus quite reassuring, frankly. the last thing on this is the whole question around criminalization. proliferation of bad laws. that was a prominent portion of all argumentation. i think those are the major problems. >> i want to get back to the community peace. it relates to all the mothers and fathers in these difficult countries being further stigmatized, being afraid that they will be -- when the perception is that hiv aids is only in the vulnerable

populations, then it becomes finger-pointing. we had is in the u.s.. we have to make sure that our responses are less -- that our responses are comprehensive. the community must understand there is a compassionate 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. 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 is happening uganda and nigeria and what is happened at cicely's case is intense media, kenya, the drc, very difficult, and will only drive people away from services, because no one wants to feel like their life is in danger while you are seeking life-saving services.

people believe their lives are in danger. and they are. they are in danger. this has to be addressed. it is a matter of criminalization, but it is a matter of the community accepting that mineralization and turning each other in. we can't and we need to work in that more comprehensive way. i do believe that there are mothers, mothers who are not bring the children into the clinic for diagnosis for the very reason that mothers found it so difficult when they only had single-dose medicine.

we asked melissa camargo communities and other villages and identify themselves as hiv-positive to save a child with there's nothing for them. i think in a way we didn't have any other options then. imagine the break of trust with that mother when there was nothing for the mother. i think option b and b plosser going to help us there were mothers feel like they're being cared for, what if you like the children of being cared for. we have to overcome that 10 or 15% that we know are throwing away their pills on the way home. they can't confront stigma in the community. i think involving the churches, who are a very important fabric of the community involving the community leaders and 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 are doing ourselves. you're absolutely right, the community peace is essential and remains a barrier for both mothers and babies. >> last question is an optimism. also the post-2015 agenda.

to start, every one has heard me speak. i am an optimist. i always approach it very optimistically. i do think in general there was a feeling at the conference. if we didn't convey that, i think what has changed is just in the last four or five years, we can actually say we know what to do, and that there is a consensus on this things. a few years ago we didn't necessarily have all the evidence and tools. read did a lot, but we have now. there is an not this consensus around doing those things. those are consensuses that have come together. i hope we get carried forward in the next few years to really reach those goals. is anyone want to add an 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 the position where our concerns are 2030 and saying really, what do we want to do by dermot which is two years from now. if we just kind of keep the pace that we are going out, we should add at least 4 million or so more people onto treatment between now and then. that would be actually where we are plus a little better. it seems to me that we need to do with this every to your 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 have achieved. i feel its just for myself that the new goals, is a long way off. >> i think we are a place where we have the community that cares what hav, this consensus that you've heard about, now are really know so much more about what to do. probably the single biggest

change is the recognition that treatment is prevention and that by getting folks out there we really are contacting the dynamics. but there are notes of caution there for me. one is these bad laws that actually go precisely the opposite direction. the second is a geographic one which is eastern europe and central asia. we know that the epidemic is expanding, given the little data that we have. i will say that one bright note cochair for the 20 16 conference is south africa's representative from the think tank and is working closely with them, of course that is there a result, russia, china, and south africa. maybe a hope that that forum, which does not include us, the a place where the hiv issues and global health

issues and public rack kisses can really be brought to the fore and will be different in a new forum. know that we have discussed that in some detail and are committed to it. that is a stay tuned. >> one quick comment. if you look in the post that report there is a diagram that shows that if we continue to do what we are doing today at the rate that we are doing it today, the number of new infections creep up. what is missing is where you 2030, 80 million people infected with the treatment cap of 31 billion dollars, $31 billion every year. there is this imperative for us to take the tools that we have, all of us in the room, and accelerate that through our programs.

treading water gets us to twice as many people. by 2020 it gets us to another five, six, or seven million people infected. these are not numbers that we could make up for that any country could make up. look at that diagram and count out the number of new infections that there are every year and realize the cost of only doing what we are doing. we are doing a lot. but we are not going to be on the right line unless we do more . that is the call of action to all of us. that somehow we have to do more with what we have. we have done it before and maybe we will get additional funding, but we can't wait for that. we have to figure out right now how we can get more control now rather than just doing what we are doing at the rates we are doing it. to me that diagram is one of the

most telling in the report. we should all look at it, study it, and understand the differences and what they really mean. how in one case you have 23 million and now you have 80. we cannot afford another 80. we have already had 75. on top of that but 150 million people infected with hiv and that is too many. one is too many. that is truly too many. ok, let's go to some more questions. someone back there? >> thank you. in tanzania for many years. i work for 12 years on the hiv-aids program. we were very grateful when they began in the early 2000's.

what is happening today, i have received two e-mails today, one from kenya, one from tanzania because it is being listened, the funding in kenya and in tanzania will go down quite a bit, i understand. they are saying -- who can we pressure? how can we start to get that funding back again to a level? they arencident, afraid, the incidence will rise again. so, thank you. >> over there? >> my name is julia hotz. i apologize, i spoke with the ambassador earlier this week about this, but i would like to ask ashen to the rest of the about-- it is especially

educating these populations about the needs to seek treatment, diagnosis, and whatnot. i wonder if and how you have utilize the expansion of social media, the internet, and mobile technology to help raise awareness about proper treatment . even just correcting misinformation about hiv. thank you. >> my name is anna forbes. i am an independent consultant working in hiv prevention. i wanted to thank you all for helpful discussion, but particularly you, dr. baer, for editing the series on sex workers in hiv. it is a brilliant issue for those of you who have not seen it. it seems to me as though the imperial cold data that we have is sort ofue

equivalent -- empirical data showing the connection between the decriminalization of sex work and the reduction of hiv is equivalent to the tipping point we reached in 1996, where it really became your if you double the these two things were notected and that we could achieve hiv reduction in the way that we wanted without syringe exchange in the one case and sex work any other. i am wondering what kind of political response we can expect to see based on this data and more specifically how much we can expect the research can -- community to step up and use political clout to advocate the criminalization. with syringe exchange after that data came out it was a significantly increased amount of pressure not only from the advocacy community but from the research community for syringe exchange. now we have canada on the verge of possibly decriminalizing its

sex worker laws -- or possibly not. the south african national aids council is pushing its government to decriminalize sex work. i am sure the discussion is coming up even more strongly in other countries. how much can we expect the scientific community to step up and make an issue out of what we know is true? question. one was around funding concerns focused on kenya. i think that is a larger question. the second was on social media and mobile technologies. this last very important question is what is the role of science now in the political sphere on the issue of sex work and on decriminalization. talk ruefully about the budgets. tanzania came back for a week of discussions with us last week. very important discussions. we are not cutting the budgets.

the budget has not been cut and has not been cut in kenya. the total funding is the same, it is the mix of old and new money and creating that total funding. question is --ur do you have enough resources? what we are doing right now is looking at how to get to 9090 90 and high prevalence areas area there will be areas without hiv or hiv cases, but we had service provision there. we may not be able to support them any longer. the human capacity and funding to where hiv-positive patients are, to where they can be found, and to the communities that surround the patients. we are looking carefully at the geographic analysis, using data down to the single site level showing how many positives they have for every six months ace on the number tested.

we are going down to a granular level so that we can make public health decisions based on the funding level that we have. i thinkdo all of that that your question begs the bigger question of do those countries have enough resources for the host country and the global fund to meet the demand of controlling the pandemic? that is the very question on the table. when he says that there is consensus, there is an enormous theing relationship between ambassador, godfrey, and myself, we have known each other since we were babies. always done hiv-aids work and are passionate about turning the tide of this pandemic. i think there is consensus about how we utilize every dollar we collectively have to have the biggest impact. i am reassured by that.

i just saw this incredible work on different internet communications strategies that resonate not only with different age groups and sexual practices so that everyone can click on a site and find the noise -- voice that resonates with them. it was incredible. or 50 different individuals talking, based on some profile that was done anonymously, i powerful. so if we could figure out how to get broadband throughout that would africa, be terrific. >> interestingly i was on a conference call with our tanzania and colleagues today and they dropped off, with their

connectivity problems. so much reality that we have to deal with. there is a lot going on in terms of innovation and technology. not only is it an internet aced technology, but it is another domain like self testing, home testing, right? getting it to people. lots of effort around that. diagnostics where they are moving to a place where they are much more local facilities that can do staging. no big problems with people waiting for ever to get the cd for and going somewhere else with their challenges. that area is, as i said, the largest area of scientific endeavor for what we see coming.

part of what we are learning is that one size does not fit all. it turns out for example that there were several studies looking at interactive supports for treatment, adherence, and use. even among one population, men under 25 really like interactive messages and want to be notified all the time. older men, no thank you, leave me alone. one sector that has not engaged much in hiv has been facebook, google, all of them in silicon valley. we need them. >> on the special issue? >> thank you for that.

when you do one of these comprehensive reviews and try to look at the field, you have an studentsraduate working on it. sex workers have not been a part of the research agenda. in men,the trials women, or transgender people have enough strata in them to do an independent analysis. the weight is assessed in the research agenda is inconsistent sex workersl themselves have been in to engage because of feelings of mistrust and concerns around coercion.

they are seen as hostile to their interests and needs. one of the things that came out is that we need to be doing prevention research studies with this community. right now we don't have an answer about prep with people. in 2014 that is a real gap. i have to say that in terms of the issue alone -- around criminalization, that is an idea from government.

community-based sectors really embraced this data. they are taking a run at it. what youarcher that is always hope, that people will find what you do useful and go with it. i hope you will see a lot more evidence-based activism. two more >> i think we will take two more quick questions, because then i want the panelists to talk about, to look forward under been a little bit and what that means. and we will have to wrap it up. nice a lot of hands, of course. one over here and one in the back. and then -- oh yeah.

and a third over year. chris and i are conversing. make it quick, please. >> i am from the office here at hhs to discharge with implementing the national hiv strategy. one of the things we have learned is that by making the most of existing dollars means we need to reallocate to really maximize those dollars. it means that we won't be able to do everything. part of our decision-making depends on the cost effectiveness of new inventions and the efficacy. can you say word about how that sort of process is informing what you think is going to need to take place through pepfar and other international organizations. >> thanks, second? >> hype, i'm from into health international. are you aware that essential

considerations in the future agenda include in treatment, diagnosis, advancing technology like early initiation therapy and long-acting prep, etc. never having a well-stocked, well-trained local health workforce is also essential to delivering the services. with the current enormous shortage of global health workers come it even if new treatment and prevention options were developed, many countries would lack the capacity to administer these services. i wonder where health work fits specifically within this global hiv strategy in the future. >> that question. >> i'm a fellow at the international gay and lesbian rights commission. my first -- i'm looking at how the global foreign is looking -- form is looking how to engage. one of the key populations is -- [indiscernible]

how they can engage in the stats that [indiscernible] . >> anyone want to engage that yak are you all have the last word. >> thank you, michael, for that question. happily, we now have an adolescent trials network that is also expanding its footprint and trying to do meaningful research and is going to look at a lesson for key populations. i think one of encouraging things relates to the who

guidelines. guidelines for the first time address adolescent key populations and has really included them in all of the recommendations. in some countries, who guidelines don't necessarily mean so much, but for many they play a normative 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 using drugs. they are empowered by having those guidelines and being able to say this is who standard of care now. we have to do this.

>> really extraordinary work. we are learning from those groups. that is why we have coming back. before we release the 14 money to really work with the countries to see we know we can't do everything everywhere. what can we do in certain places? what are the right anxiety right place at the right time. getting that right will be absolutely key to either going on this line are this line. we feel such a strong moral imperative to do the hard work that you did and do the hard work that usa did -- that u.s.aid did. is also finding out how to do that cheaper so we can dress down women and deal with issues of stigma and discrimination and training at the community level. they're all of those pieces that we feel like we have to respond to while at the same time where

china focus the programs geographically and in these core areas. it is an exciting time. we have started an entire program of high level hr age and health system strategy. we've gone to every one of the agencies where we know there is incredible talent and we have said give us your talent. every agency has come forward with 5-10 additional people to send to work on these core strategies. we have gotten janice timberlake team coming over from usaid really helping us look at the hr age strategy, what has really worked her task shifting has worked extraordinarily well or itcrabbers are among the best positions i've ever seen in botswana. we need to bring them into the children's world and other worlds. i think we are looking at each

of these aspects. we know they're all interconnected, but the human rights pieces is such an important piece to us also. we are trying to weave that through this whole health care worker peace, because that is where patients come and is often where they first get stigma and discriminated against. we have to ensure they are -- that our training also covers those areas and that we have funded that adequately. back tonk that coming durban and the epicenter of the global pandemic, come back to fromrt airship issues others in south africa, that is

just an exciting and grand opportunity for us. the memory of 2000 will be one of a couple of things that could in order to address recurrent problems. assiduously to recover high-level leadership into this. if you go into durban and you don't have them, it is going to be yet another sense that the leadership has walked. addressing that problem frontally is a top priority. second is to figure out in practical and real political terms how to address the homophobia and who needs to be there that is not there this time. who needs to be there and is credible and can be empowered to

come out of the woods and talk about these problems and not feel threatened and be able to put forward a concrete agenda. if you do those things you will have advanced the agenda dramatically. the south africa transition, many of the people that need to be brought on treatment that both chris and deb referred to are going to be south africans. the u.s. will also be in the midst of its own transition towards lowering its support in handing that off. thatg to highlight some of . the fact that you are coming into his own where our own programmatic achievements and engagements were so rich and deep gives us all sorts of opportunities in the way that to buildrence is used congressional support, getting other people excited. it is a very promising set of opportunities.

>> i love the way that you talked about this as a way to mark progress. if we reflect back to 2000 and that very difficult time between then and 2007 in south africa, where there was difficulty with even awareness of hiv and aids as the agent, i think that putting road marks down about each of these things, stigma, discrimination, south africa has some of the most progressive and important laws. working with our south african colleague to say that in the next 24 months let's work with other countries on the african continent to move towards your vision and really accelerate south africa's leadership in this area. to celebrate their leadership and investment. like botswana, they stood up and invested aliens, which it will take to control the pandemic i