tech advisor, you are likely to not get someone that is a trusted tech advisor. the more quickly we can do that, the more quickly we can make progress. i appreciate this hearing. i learned a lot. i think all of us are motivated to the if we cannot push this envelope. i thank you for your work. thank you, chairman, for a really good hearing. senator collins: thank you. i think your comments are well taken. we want to make sure that as we start promoting this kind of new technology that can give peace of mind to caregivers that we are not opening a whole new avenue for con artists out there who will exploit any possible opening as we have found in our

various investigations. in our various investigations. i want to thank all of our witnesses for being here today. dr. kim, i love the fact that you are involving the students at the university of maine. it is incredible that there are 50 different ideas that should keep them busy for quite some time. i thank you for taking the time to testing -- testifying for us today. i want to thank senator mccaskill and members of our committee who participated as well as the committee staffs. most of all, thank you to our witnesses.

our meeting is adjourned. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2015]

[chattering} [indiscernible]

>> if you missed this in hearing we will have it for you later in our program schedule and you can find it online at www.c-span.org . loretta lynch will be on capitol hill tomorrow and will justify -- testify at the justice department budget hearing. and also tomorrow, voters in the united kingdom make their choices, parliament tory choices -- parliamentary choices. we will broadcast live coverage and extensive interviews from across the country and analysis of the election.

recent polls suggest that no one party will win a majority and if the outcome is to close to call we will have coverage tomorrow at 4:55 p.m. on c-span. and on mother's day, c-span presents the children and grandchildren of america's first families, painter viewed to first ladies and life in the white house. speakers include the bush daughters and others. here is a preview. >> the first dinner, i will be quick, the first dinner we had is a family and there is this tension. i don't know if you notice when you first go there, you don't know the staff, they have been there for years. and you try to get to know each other and everybody is formal. we are sitting at the family dinner table and it is myself, my sister susan, mom, dad.

my dad is trying to sort of take the edge off and he looks and sees there is a fireplace in the room and he says oh gosh, when we would go to colorado for christmas, we loved to have a fire. one of the people who work there , they thought, must be the president telling us to light a fire. they went over and lit it, it hadn't been used in 10 years. smoke is billowing out. this is your first dinner with the staff. we are coughing. [laughter] i never forget, my dad looked at me and said, sit back down. and he said betty, don't we just love a fire? he had such a good hard to make them feel good. those are my memories of those first days. [applause] >> life inside the white house

remembering first ladies and first families beginning at noon on mother's day. >> and on c-span's q & a --the world of the white house through those who work there. >> who are the pick lens? >> members of a family that have worked at the white house, a butler that i got to interview there, he works every week at the white house. and nine members of his family have work to there, his uncles were head butlers and he told me, that his uncles ran the white house. they brought him in when he was 17 years old in 1959 during the eisenhower administration and he is still working there.

and he described how he would work in the kitchen, he was just a skinny guy and he says they were always getting him ice cream to keep. he got to work with the eisenhower's, a dying breed of person and what i want to do was pay tribute to these people. >> sunday night on c-span's q & a. >> singer elton john and rick warren testified at a senate hearing today on global efforts to fight hiv and aids. the executive director of the global fund to fight aids tuberculosis, and malaria also testified. it is chaired by ms. graham.

[chattering]

>> back in your cages, give these people a break. [laughter] >> you have to pay a quarter internet -- pay a quarter. the subcommittee will come to order, the hearing today on a global health programs and we have a panel of incredibly brilliant people who i am honored to welcome to the united states senate so that you can form the senate and -- in form the people of the world about the good causes you represent. deborah burks. u.s. representative for global diplomacy, dr. mark topol.

sir elton john, founder of the elton john aids foundation. and dr. rick warren. to you to each of you, thank you for coming. you have busy schedules and you made time to talk about causes near and dear to your heart. i will make an opening sent -- statement. thank you for coming. senator lee, it has been a pleasure working with you. as politics change in this country, we are going to make sure that the commitment to this does not change. at the end of the day, i've tried along with senator lee to shine a light on what the 150 count does. it is 1% of our budget and here is what i would suggest. find an account that gives a

better rate of return than the 150. 1% of the budget is it -- that includes all the funding for the state department and our aid to israel and other nations. a small portion of that goes to fighting tuberculosis and aids and other diseases. what i want the american people to know, is an i have never seen a better return on investment. the private sector and other organizations of other governments have been collaborating for well over a decade to take the fight to aids and we are winning and aids isn't losing. at the end of the day, the scourge is being put in a box but growing in some areas of africa for reasons we must address. in terms of future commitment of money, now is not the time to back off.

we are literally inside the 10 yard line when it comes to some of these diseases like aids and malaria and there are thousands if not millions, of young people alive today because of america's intervention and the taxpayer's generosity. it is a national security effort in my view to stabilize developing parts of the world so that diseases like aids malaria, and tuberculosis can be contained and does not create in ability in regions that are already unstable. from an economic point of view we are creating a customer base where american companies can one day do business with millions of people on a continent that i have come to love that has an infinity for the american -- affinity for the american people and our way of life. and i believe we are doing

things that are right. even though we have economic challenges here at home, compared to most we are incredibly rich. but our richness is not in our bank account. i think it is in our attitude and the way the american people engage the world. if i had to give one example to someone from far away to explain america, i would use this account. this account represents the best of the american people. it is transparent, it is well-managed, it is saving lives and changing the world. having said that, this count is at risk. the question budget -- equestrian budget cuts, if fully enacted, will devastate the ability of this account and others to fulfill its promise. we are literally inside the 10 yard line and the budget cuts that are coming under sequestration will destroy our

ability to make progress and we will lose many of the gains we have achieved over time. when you are 18 trillion dollars in debt, you need to evaluate your spending. here is what i can say. this account is not why we are in debt. this account makes us richer. this account, i believe, isn't the smartest use of federal dollars of any place within the federal government. it is my commitment working with my democrat and republican colleagues that we not abandon this account at a time when we are so close to achieving the purposes of this account, which is to change the world in a positive fashion. with that, i recognize senator leahy. senator leahy: we have worked on this committee so many years and we go back and forth sometimes

you are chairman, sometimes i am. but we come out with a bill almost always where we are in total agreement on it, and that is why it passes. this is an issue that should not get involved in partisan politics. can't think of these kind of programs we find that have stronger support van global health. we support investments to combat diseases. i know last night in our discussion, sir elton and pastor warren, we talked about a lot of these diseases that could be prevented or treated or cured for just a few dollars. if it happened to anyone of us we could come up with whatever amount of money it was. but we are talking about

countries where that money is not there. very few americans suffer from malaria, polio, and blindness. can you imagine if they did? you would have people lined out there saying, let's do something about it. when you are in the wealthiest country on earth, we have some moral responsibilities. especially when these diseases affect millions of people, especially children, in countries that have an adequate health services. hiv and aids was identified 33 years ago. aids and tuberculosis continue to be a serious problem not only worldwide, but here in the u.s. we can do better. the rate of infection here pales in comparison to other countries, africa, southeast asia. now the chair man has rightly

pointed out the budget constraints that we have, but that does not mean we suddenly have no money. we have a lot of money to spend as a country and let's pick where we go. we just want to make sure we use our best resources. the ebola catastrophe, that shows how vulnerable we are still as bill gates and others have warned. ebola was a relative -- relatively easy disease to detect and contain, compared to one that is infectious before a person experiences symptoms. so it is not a question whether such a virus will occur, but when and where. if we don't invest in training health workers in countries where such a pandemic can originate, we will be paying millions of dollars and millions of lives lost. these are things that dr. burks

works on all the time. and we want to be here. you have all worked, everyone of you, have worked so hard on these issues. everyone of you could find much easier things to tackle and i applaud you all. sir elton, we have known each other for a number of years and you can sit back and relax. instead, you are out pushing us all the time. i don't want to say anything about pastor warren going after us on a moral issue, but the good pastor has spoken to me about where our consequent -- conscience should be on more than one occasion. that is important. but doctors, the expertise that you bring, we need it.

so i will hush up. i want to hear from these people. chairman: thank you. madame --, lead us off. madam ambassador: i am pleased to be on the subcommittee today which has provided visionary leadership of the u.s. president emergency plan for all aids relief since 2003. millions of people are alive today because of the compassion and bipartisan commitment of congress. the leadership of president george w. bush and president barack obama and the true generosity of the american people. as you've seen firsthand and asked the chairman mentioned this is not only a transformative global health program, but is an outstanding expression of american diplomacy.

i'm privileged to be joined by three great leaders for the response, ambassador mark diebel -- dybul, pastor rick warren and sir elton john, a powerful advocate for people living with hiv and aids for decades. we have changed the trajectory of the hiv, aids pandemic. it has offered hope, healing and the possibility of prosperity in the place of sickness, suffering, and death. today, because of the group, 7.7 million men, women, and children are receiving life-saving treatments. 6.7 million voluntary medical male circumcision to have been performed. success, as mentioned by the chairman, is it within our grasp

if we all focus, accelerate, and to sustain our efforts. that far, has supported people with hiv and also programs with global health security. yet our work is far from done. every week nearly 40,000 people are infected with hiv, 7000 of them young women. with the youth involved in africa, many women are entering the window of the most susceptibility to hiv and aids infection. we have to work diligently right now to get and stay ahead of this epidemic. according to research, there will be an estimated 28 million new hiv infections by 2030 if we do not act now. that is more infections than any global resource can support. actions taken over the next five years will be critical. efforts could reduce the number

of hiv infections to under 200,000 per year by 2030. as compared to our current trajectory which is unthinkable, 2.5 million new infections per year. so pepfar is pivoting. we are utilizing a transparent data driven approach to target evidence-based interventions to the highest burden populations and geographic areas for maximum impact of every u.s. dollar. making this hit it is not an easy thing, but it is the right thing. it will prevent new infections and lead to control of the epidemic. earlier this year, we watched a sustainability index to provide an annual snapshot of the elements essential to sustaining and controlling this epidemic, including the critical contributions of partner countries and how they are working towards national response.

the program leverages the expertise of the whole of the united states government, civil society, save-based, and other partners. the accelerating children treatment program is a $200 million partnership with the children's investment fund foundation to reach and treat 300,000 additional children living with hiv by the end of 2016. dream is a $210 million partnership with the bill and melinda gates foundation and the nike foundation to prevent hiv infection and adolescent girls and young women. finally, we cannot control the epidemic without putting an end to the stigma and discrimination that force people living with and at risk for hiv aids to the very margins. all people need access to services, including key populations at this critical time in the aids response.

we know what needs to be done we have the tools to do it. the continued leadership of the united states is vital to ensuring we achieve and aids free generation because the alternative is unthinkable. chairman graham, ranking member lay he -- leahy members of the subcommittee, the uncharted terrain we are entering it will test our resolve. but i am confident we will reach our destination. thank you again for the opportunity to be before you today, i'm profoundly grateful for your ongoing and continuous support of the subcommittee. i look forward to your questions. chairman: thank you very much. i wanted to mention that bono could not be here today. he had wanted to. he had a difficult accident, he

is better, but just want to recognize his contribution to this cause. i wanted to recognize the fact that he is with us in spirit. >> could i interject? he has also kept his sense of humor. i called him and he said, the fellow members of the band said it is a good thing he was wearing his helmet so he didn't damage the sidewalks of new york. chairman: well, with friends like that. mark? >> thank you for your leadership. this chamber, this congress and two administrations have reached across party lines to reach those in need. your compassion and insight reflect the best of the american people. you have changed the landscape

from working, to being on the brink of any three plagues to that have been around since record a medical history and the modern black death, on the path to a station. while building resilient health systems, resilient societies and resilient economies. the experience of the investment you have made has put us on the break -- and brink of ending malaria and tuberculosis. and hiv-aids. we are on the path to end these

as public health threats. with your leadership, these have it dropped dramatically. 5500 countries are on the path by the end of next year to reduce malaria by 75%. 26 of them are on the path elimination. there hasn't been a remarkable progress on reducing death. we can accelerate the work or we can risk at the resurgence of these diseases. the global fund has contributed to this progress. we offered billions of dollars per year and have committed to putting many people on the route to new treatment, 12 million have been effectively treated by -- four to be girl -- four tuberculosis.

these efforts are incredibly important. as chairman graham pointed out be on the health of individuals this has an anonymous impact on economic loss in of the global world. it is estimated that nigeria alone loses 3.5 billion dollars per year in its gdp because of malaria. the reality isyou've as we point ud out you've pointed outs by working together we can bring about the best in humanity. we can change the course of history while lifting up human beings. ambassador but mentioned young women young women are often five to 10 times to be affected than

young boys, five to 10 times. with the youth bulge the increase in young people there's a risk of explosion, undermining the progress that's been made. new evidence suggests that if we can work to keep girls in school, h.i.v. rates can drop by 60%. if they stay in school they don't get married early, don't get pregnant yurg. we're working closely with the dream initiative, pepfar, the gates foundation and others to change the course of these girls' history. investments in h.i.v., tuberculosis and ma layer ya are bringing an effect on health systems as well, including the fight against ebola. women trained to go door to door

to fight ebola. how do we achieve goals? we do it through partnership. the global fund is probably the world's largest public-private partnership. we work so closely with ambassador birk's pep far. forever dollar the u.s. contributes to the global fun we leverage $22 from over 25 countries, the european commission, private foundations and the community. requiring countries to match what we invest in and lock the resources. so far we have leveraged $3.9 billion in the past two years in order to increase countries' own contribution to fighting their epidemics. as we know based on reports, countries are investing more in h.i.v. than the external

financing, which is pretty remarkable. that's since twoif and they've long provided the financing for tuberculosis and more for malaria. this up crease in cri contribution is incredible but the private sector is as well. the global fund has had $1.7 billion contributed from the private sector. while bill and ma lenda gates have been the largest bono through his corporate partners have cricketted over $3 million. we're also that high net individuals from countries we have commitments from these individuals and we are working to get more. the faith community has done a remarkable job both as implementers where we fund 73% of them, but also as funder, the united methodist church handed over $5 million.

they've done a remarkable job in advancing the fight against the disease. people like elton john get into the community to make sure people in the community are not left behind. coca-cola is working with us to ensure distribution. who better to work with on distribution of drugs and commodities, get to people. we are reducing the price of commodities. in two years through an initiative called an nir active that we've launched, we saved $500 million by better knows. now, that's value for money. mr. speaker, ranking member leahy and distinguished americas you are the members who will make this happen. thank you for your support. we look forward to working with you and fighting these diseases. chairman: dr. warren. >> chairman graham and ranking

members layly and members of the sub committee, thank you for inviting me to testify here today. i have so much respect and admiration for you, i agree that the 150 account is probably the most effective account in the united states budget. and what you're doing matters to our nation matters to the world and it is a matter of life and death to millions of people around the world. i've sent in my own church 24,869 of my members who have served in 197 countries which is 57 more countries than the peace corps has served. by the way, before i address the matter of global health, i just want to say thank you for your previous hearing on protecting religious liberty abroad. it's a big issue and i've spoken on that in my printed remarks.

as you know from your hearings previouslyly, we are making a lot of progress on pan democratics like h.i.v., malaria and t.b. now is the time to move for eradication. a lot of times in the third quarter of a game, people say we know thousand outcome's going to happen, so let's just let off the pedal and thill leave the game. we can't do that now. the super bowl's a good example of what happens in the last second of a game. and i believe that it will take three catalytic factors in order to eradicate h.i.v., malaria and t.b. first we must form a new perspective on foreign assistance. second, we must forge a new perspective -- a new partnership in distribution, and third, we must fund a new priority in the budget which would include ending sequestration.

i've covered this in detail in my written testimony. i want to spend most of the time on partnerships and new distribution. let me just make a combhent on forming perspective on assistance. there are voices who believe we should cut back or eliminate all foreign assistance. this resonates with a lot of voters for a couple of reasons. first, they have no idea that this amount is actually less than 1% of the budget. second they don't realize the strategic value of foreign assistance. they've never considered that the right kind of foreign assistance may be our most effective for security against the next generation of terrorism. this is what i mean by new prospective. in the bible it says it's morally wrong to withhold assistance from those who need

it, as long as we're able. when america saves the lives of dying people from preventable diseases, we make friends. that's obvious. around the world iveb often been told, please thank americans for pepfar. it saved my husband's life, my wife's life, my children's life. we'll always be grateful to america and we pray for you. when we make friends like that potential enemies are turned into allies. if somebody savers your life, you have zero desire to terrorize them. when people are stuck in poverty and they have no capital or create opportunities, they get resentful of countries with resources and that resentment makes them right for angry ideologies. it's far more more cost effective, far cheaper to send

medicine and make friends now than to send troops to fight enemies later. medicines cost less than thanks and the resources we budget for humanitarian purposes can prevent us from spending far far more when tensions boil over. we need to frame that as being strategically smart for america's safety to help people in pain. the second catalyst in eradicating preventable diseases is we have to forge new partnerships in distribution. sometimes you have to team tackle a player on a football field. he's so big, one person can't take him down. this is where i call in to reference what i call the three legs of the stool . one-legged stool will fall over and a two-legged stool will fall over but a three-legged stool

will stand. i've spoken many times at davos. people say we need public and private partnerships. i say you're right, but you're leaving out the biggest sector and that is the faith sector. there are 600 million buddhists in the world, 8 million hindus in the world 1.5 million muslims in the world and 2.2 christians in the world. most people have a faith and if you want to talk about distribution you have to use faith communities. i could take you to 10 million villages around the world, the only thing in it's a church. in much of the world, the church is the only social sector outside of the capital. and even if we have all the medicine for tuberculosis, aids,

h.i.v. and ma area and other diseases the issue of distribution will not be solved unless we mobilize local churches. let me just give you one illustration. at the end of president bush's term of office, he invited me to be the closing speaker at the global sum it on malaria. i said i'll come if i can bring some pastors from africa. and so i did. at the end of the talk i stood up and said i'm going to show you three slides that show you why you can't solve any global problem without the faith community. so i put up -- i said let me show you one example. i've been in 164 countries, but this is just one. rwanda, i said we went there and we said what would you like. they said the western province of rwanda needs health care. we went there and i put up a map of western rwanda and i said here are the three hospitals for about million people.

it's a two day's talk to any of these hospitals. that's not good enough health care-to-to walk two days to get your health care. two of these hospitals are faith based. i put up the next slide. here are 18 clinics. these 18 clinics, that's only a day's walker but if you've been to developing country, a clinic is often a bottle of aspirin on the shelf or even less than that. i said that's better than three hospitals but, by the way only six of those are faith based. i said watch this. i put up the other map and it was covered with dots. i said here are the 600 faith based organizations. melinda gates said i get it, rick, the church could be the center of distribution for health care.

i said melinda, it has been for two million years. the church created the hospital. we've got to do a combination of the public sector, the private sector, the faith sector, the three legs of the stool. i would encourage, if there's any way we could end sequestration, i'm in favor of that. there's a lot of areas that i think we could cut the budget. this is one area that should be increased for strategic reasons. thank you. sir elton john. >> thank you very much. mr. chairman, mr. leahy, and members of the subcommittee thank you for giving me the opportunity to testify before you. it's a task to sit at the table with amazing people people who are in the trench every day, who

do amazing work every day. i'm humbled. at 2003 at the invitation of senator ted kennedy, i had the honor of speaking before the senate health committee in my capacity as the elton john aids foundation. i created the foundation in 1992 to address the dire need to provide basic services and support to those dying from aids. over the past 23 years, we have raised over $321 million to fund organizations that provide direct treatment and prevention efforts in dozens of countries around the globe. the first time i testified before congress 12 years ago, almost no one had access to anti-retro viral medicine in subsa hare an africa, where the epidemic was most acute. people being infected and dying by the millions, even though we very literally have the drugs,

could save their life in our hands. children in subsaharan africa have been or fanned. more than 30 million people were h.i.v. pozztiver. the disease left nothing but despair, ruin, and fear in its wake. i saw it with my own eyes as i traveled to the hardest-hit regions on malaysian of my foundation and our grantees. without the funds needed to make live saving drugs available in after ca, my foundation provided pal active care and a hospice network. across south africa, hew ganda and kenya we give a dignified death to men women and children. we provided food and medicine to more than three million orphans left in their wake.

it was a passionate -- compassionate response but not enough. in a time of great need and urgency, a republican president and a bipartisan majority in the united states congress created pepfar. the president emergencies planned for aids relief. compassionate leaders from both sides of if isle said to the inter-- aisle said america can and america will lead the world in the global fight against aids. today, thanks to the unprecedentsed actions of congress, and h.i.v. positive mother in south africa can give birth to a healthy h.i.v. free baby who she can live to raise. today thanks to the generosity of the american people 9.4 million men, women and children have access to life saving anti-retro viral treefments where there was once depair,

ruin and fear, there is now hope life, laughter, and love. pepfar has done more than just lives. it has provided basic infrastraur and trained more than 100,000 health care workers to prevent outbreaks in places like bats wanna, kenya and uganda. cong's support has enabled it to generate verments from governments and corporations worldwide and leverage $2 for every $1 invested by the united states thrsh expanding its reach and its impact. i'm grateful this has included up to 1 billion pounds in england. from my foundation, too congress' leadership has been transformational. the hospice care has been

repurposed to help for the living. more than 400,000 patients have been licked to lifesaving treatment on the continent since 2012. combined with efforts by the united states we've contributed to reduction of mother-child transmission of h.i.v. in short, we're no longer bailing out a sinking ship. we're helping to steer it into a safe harbor. mr. chairman because of the actions of this congress, the cost of the aids epidemic was am time period for all humanity. because the american people had the optimism, the ingeniuty, the lives of millions of people halfway around the world have been saved. but i'm here today with a simple message. the aids epidemic is not over. america's continued leadership is critical. there is a window of opportunity before us, a window through

which we can very clearly see the end of aids within my lifetime. we cannot afford to let the window close. >> amen. >> if our efforts flag, transmission rates will rise and this disease which knows no boundaries will once again become a ruthless pandemic with disastrous and far reaching consequences. i have stood in -- at too many bedsides in america, england and across africa hopelessly watching people die in pain with the thought of -- the thought of going back to those dark days is unfartherble. if he wonor the lives lost over the past three decades we can and will see the day when aids is no longer a horrifying global killer but a contained and controlled chronic illness.

mr. chairman, this is the most powerful legislative body in the world and this congress has the power to end aids. you have the power to lead the global campaign against this disease. i'm here today to ask you to use that power to seize this window of opportunity, to change the course of history, and one day soon, i hope to extend my thanks to you, to this congress, to the united states of america not only for fighting this disease but for ending it once and for all. thank you. chairman: and ended right on time. that's amazing. after this, how would you like to vote against this account? what would you say? the terrorists want you to vote no. that's the only thing i can think about. anyway, mark, main countries

that could do more that are knots. >> thank you, mr. chairman. it's a long list and i just came from one actually, china arriving last night. they not only have received funds but now are giving it. >> what about the gulf countries? >> the gulf countries could definitely do considerably more in the fight against these three diseases. parts of southeast asia, thailand is transitioning into -- >> we've not asking people to give who have their own problems. we're asking people who have the ability and are not. >> these are people who have the ability and they are stepping up. >> what about europe? >> europe is doing quite well in a number of cases. the u.k. sir elton john mentioned. >> what about germany?

>> germany is currently number five -- number six. japan is number five. >> in terms of economic power in europe how do they rank? >> they've increased their commitment to us and made commitment to do even more. >> thank you very much. rick, these churches and their new distribution network, will you take anybody that comes? >> absolutely. absolutely. in fact, after i made that presentation at president bush's malaria conference, i said i'm going to prove that i could do it faster than any n.g.o. or government entity. so two-point that area of rwanda and i asked pastors, would you be interested in training your people in health care, because you'll never have doctors in

your area. he said yes. i said give me two people. we started training them in health care. the muslims came to us and said would you train us? this is not a religious issue, so we trained them. that group grew to 60 and we trained them to 120 340 and on and on. this last august i went to that area of rwanda and did a rally for over 3,000 trained health care workers who each visit seven families a week. they make hospital calls they make house visits and we did it with little, very little money. and these people are saying -- we started off with simple stuff like wash your hands and hang out the sheets to dry and how to do sanitation and dressing a wound, stitching a wound, but they can learn things like how

to administer a.r.v.'s arched how to do peer -- what's the word i want -- you know, peer coaching to make sure that they do -- they're compliant with the drugs. it can be done and now we have many other countries asking for the same model. >> madam ambassador, what will sequestration do to our ability to get this thing put away in terms of aids and how would it affect the pepfar program if we fully implement sequestration? >> i think you heard from my testimony that we're doing everything that we can to focus every dollar we have, because there's always more need than there are dollars. so we take a very strong responsibility ensuring we focus the dollars we have optimally. any cut in those dollars would be -- >> do you have any idea how much

would be cut by 2021? >> you have mentioned it would be -- >> you need to go find a number. i want you to go find a number and tell me. if you don't know the number you need to get it. >> we have that number and we will get it. >> the global fund, i want you to tell me the numbers. i want to tell my colleagues, you have x dollars today and you will have y numbers tomorrow. you need to know these numbers. they're dramatic. sir elton john, you've been fighting this battle a long time. what's your worst fear? >> the worst fear is stigma, to be honest with you. we are seeing, especially in african countries, the lgbt community suffering under draconian laws. when people like that who are suffering from h.i.v. are penalized, they go underground and the disease is spread even further.

stigmatizing people because they have h.i.v. is the wost thing one can do. that's for me the biggest problem that we face. once we get people on drugs, it's fantastic. but getting people to feel unashamed, to feel that they're ok with this virus and not to feel as if they're being threatened by their own government because they maybe have a sexual orientation that maybe the government doesn't approve of, it is astonishing. le not only is it a human crime it is a medical crime as well. there's two sides to that coin. one, you're telling people that they're worthless, and you're telling sick people that you're not treatable. you're driving them underground you're making them feel worthless and you're -- the thing with my organization is nobody should be left behind. we live in a world that is so

materialistic and so narcissistic, we need to have compassion. the pope, i have so much respect for him. this is vital to the recovery of self-belief, self worth in this world. if people are told they're worst -- worthless and they're unliked, where would be as human beings? if christ lived today -- and i believe in christ -- he would be appalled. we need the people to feel love and compassion. without that ingredient in this whole mix sure of medicine and everything else, we face a huge battle. i encourage people in the world who say that homosexuality is a sin and all that, they are making their disease worse and the long consequences, their economy will suffer.

it's inhumane and it's inhue main from suffers of this disease. >> have you been able to raise adequate amount of funds, even though the economy has been crippled throughout the world? are people still giving? >> they are. it has treated malaria and tb. the more unique people and train people to train in countries where they haven't got enough medical stuff, in africa for example -- people are not used to taking a pill. they are not used to that. they are used to a traditional healer. it is a matter of education. once you tell people, i have an event and tell people, this is what we are doing. this is to educate people. you can see this is improving the knowledge of the disease and

the treatment you are going to give people, then people will get into their pockets. when we started off with this disease, there were so many different foundations. we all work together and i think we are a strong force. i think we are a force for good. and i think -- we had a meeting last night. the camaraderie and the feeling i get from an active people is so touching. i'm british and i came over in 1970, and this country gave everything to me as a professional musician and a human being. the strength and the willingness to help people and the rest of the world has touched me so much. it was ryan waite who pointed out to me that my life was out of disorder. i was a drug addict. i was a self obsessed asshole.

and ryan white and his wonderful family turned my life around. he had a young boy who is a hemophiliac and treated very badly by people who are ignorant. he never got angry about it and he forgave. we have to have compassion. we have to have forgiveness and inclusion of everybody, whether it is drug users prisoners people who are gay transgender people. we are all human beings and children of god. if we throw that away and we throw everything down the drain. when i explained this to people, people are good people. i believe in the goodness of the human. . this room for example. long-winded answer to your question, but no, people are very generous. if you explain where the money is going and show them what they -- it is doing, it will go into their pockets. senator leahy: i think this is

something should be heard over and over again. one thing, a question has been asked on dollars. it would be -- please be very honest and direct in what of some of these sequestration things would count. in my office, someone has worked on this. he's probably more knowledgeable than i am. the numbers i am seeing are devastating. devastating. they are not anywhere near that number senator graham and i have supported in the past. don't sugarcoat it. please make it clear. sir elton, you talked about how

much less expensive it is for prevention then care after the fact. while i'm aware of that, i know maureen and i have talked about this before. you were mentioning about wealth when you spoke last night. i grew up with a dear friend from vermont. when he was diagnosed -- he was a public figure in vermont. rest his soul. when he was first diagnosed i remember being ostracized, my wife and i came to a large gathering and people were trying to avoid him. this was some years back. my wife is a registered nurse. she walked up and gave him a

great big hug and kiss. until the time he died, that changed his life, because after that people would not avoid him. they knew my wife. she is a lot more popular in vermont than i am. [laughter] they saw her do that and -- so keep pointing that out. it is not long-winded, it is important even today. people need to hear that. we have known about hiv and aids more than 30 years. but it is still a huge task even in the united states, there are parts where it is growing. you would think with all the education, it would be cutting back. the things we should be doing differently in combating this, i

we focusing on the right countries? we know we are going to have a finite amount of money. how do we spend it best? dr. dybul: well, --elton john: you still continue what you are doing. giving drugs to people that have access, getting the infrastructure in countries where there is no infrastructure. so people can receive drugs and get them on a daily basis. a lot of people live in rural areas where it and you have to educate. you have to educate. education is very important. prevention is very important. you heard earlier some young juvenile women in africa are accounting for -- juvenile women now is the second cause of death in the world, young juvenile

women through eighth. this is catastrophic. you have to educate them and spend the money very wisely. that is all i can say. senator leahy: we are seeing increases in parts of this country. i mean -- you would think it would be decreasing everywhere in the world. when sir elton talked about the young women in africa, we are seeing men and women in this country. where are we missing the point? elton john: and the rural south it is a very big problem. young gay men having sex with men it is a big problem. they feel they are not going to die.

this disease -- we mentioned this disease can be manageable and you can live with it. in this country with sophisticated medicine available, people are having unsafe sex and thinking, i'm going to be ok because there is a pill i can take. not really knowing or understanding the consequences of what that might do to their body in the long run. but in africa, they don't have that option. they just want to live. over here they are able to live because they have medicine available. in africa and asia, they don't have that option, some of them. they don't have the medicine. i think you've seen a rise -- it is cyclical. every 10 years it starts to rise again.

i'm at a loss to explain it. everyone knows the consequences of being hiv-positive. as of now, you can live a self -- safe and healthy life. that would be my explanation why. in the rural south, it is also a huge problem as well. again, a lot of it is stigma. a lot of people not wanting to admit they have the disease. not a lot of people are being tested. a lot of people are walking around not knowing they have the disease. there is still a lot of fear. even in a country so sophisticated as america, and my country, great britain. senator leahy: thank you. dr., last question.

in the fiscal year 2016, $300 million impact fund, to take steps to realign the national programs to combat hiv aids in areas most severely affected. you are implementing a similar realignment of funds. now, some who challenged that say there are areas that are going to receive less funding and that is going to be severe impact for them. would you like to explain what is happening? dr. birx: thank you senator. two things that we are doing -- we are fortunate the way congress set up pepfar, we have granular data. we know where there is hiv and

where there isn't. what we found is a real evolution of the last 10 years in areas where there is very little hiv, there is excellent coverage of all services. sometimes over 100%, because people come from over the border. in areas where hiv is the most prevalent, where the incidence are the highest, say in kenya service delivery is that 30%-40 5%. we have created in equity between areas we over serve and areas we substantially underserved the population. we are working with government to go through the information so what you just described does not happen. we are committed obviously to maintaining all of the services in the areas that are very low burden. and i working with governments and global funds to ensure there is a safety net. we are also working in geographically mapping sites down to the absolute process gps

coordinates -- precise gps coordinates, within a half a kilometer. it will be much more effective to have two sites in walking distance, less than half an hour walking distance. and increase the number of bases in the very high burden areas. what is happening -- if you are a pregnant woman in consumer -- you have a much less chance of being diagnosed then you are in the capital in kenya. this is the type of work we do. sen. graham: thank you. senator? >> i want to think the passion and compassion today. we thank you for that. i was struck, sir elton john via statement you made. there is a window of opportunity

to which we can very clearly see the end of aids within my lifetime. what is the greatest barrier i use the to accomplishing that goal? elton john: a reduction in funds, would be a huge blow. the world has to step up. and keep funding going. the more funds we get, the more medicine we can get people, the more we can educate them. let me put this bluntly. we have talked about sub-saharan africa and asia. we have not talked about russia or the middle east. countries that don't even talk about -- and we have no idea what the epidemic is like there. what i have is this is -- i have a suspicion it is not great. they don't talk about it. the more money that is given the more -- once those figures are released -- and we don't

know anything about china either. we have to maintain funding. that is the biggest thing we have to do. and we have to educate people. and we have to stigma again. we have to make people feel they are loved and not shamed. that is a big issue. and i think rick would agree with me. what he does with his church, the church preaches love here. along with funding which is so essential, we hope the united states government and congress will not cut funding at have far -- pepfar because it will be a complete disaster. it is a mixture of coming together everybody. other countries has to step up to the plate. america cannot do this on its own. i don't think that eu is doing enough or china or japan.

as a panel of people we have to say, what can we do here to make those people step up to the plate and make sure america is not the only country in the world doing this. it can only provide 33% of global funds. as a panel, we have to go away and say, you would need to step up to the plate. but the funding is so important. the more money, the more we can stabilize the world from suffering of aids. and the more compassion we show people with aids, then i think that is the way to go. it is a mixture of both. it's not an easy solution. senator: thank you for that very thoughtful response. i want to pivot and ask dr. warren. in your testimony you called religious liberty america's first freedom. you made opening remarks thanking the panel for the protections. it is the first phrase in the

first sentence in the first amendment of the bill of rights. our founding fathers cared a great deal about this as you do as well. in your view, what is the state of religious liberties in this country today, and are we doing enough to protect it? rick warren: as i pointed out religious liberty is what america was founded on. it is first freedom. the first phrase of the first sentence of the first paragraph of the first amendment. it comes before freedom of speech, before freedom of the press, the four freedom to assemble, before the right to bear arms. if i did not have the freedom of conscience to believe what i want to believe, i don't need freedom of speech. i don't have the freedom to practice my believes, i don't need that freedom of press. that is very -- extremely

important. it is all part of what i call holistic assistance. that kind of assistance that is needed around the world is not just -- men's are not enough. -- meds are not enough. the whole reason we have a peace plan is because when we deal with aids, we notice, they need education. they need training. there is poverty issues. all of these things are holistic. at the church, all the things elton was just talking about we have a saying. there are six things the church can do. care for and support the sick we remove the stigma, unleashed army of volunteers, we champion healthy hater and we help with

nutrition and medicine. it is a holistic approach. you can't do one thing. religious liberty falls into that. it is just one of the other factors. i have actually had debates on this in china with the chinese bureau. senator cowan back to a comment elton john made about the need for funding. what do you do of the importance to fight aids, and people health issues in the u.s. and overseas? rick warren: as a pastor i'm interested in personal growth and character. if you tax me and use the money to help the poor, i don't get credit for it. if you incentivize my generosity , and i am generous -- i

actually grow in character by being generous. i'm obviously and they broke the government funding increasing funding for these things. i think there are a lot of things we could cut, and this should be expanded. i believe the line item does need to be expanded. it is so miniscule. i also believe and this is probably not the committee, we ought to incentivize generosity. the tax code should reward generosity rather than tap it. americans are the most generous nation there is, that we could be even more generous if we created a system that encourages it. what ever is a repeated. thank you. -- whatever is rewarded is repeated. thank you. >> thank you, i want to thank you for your bipartisanship, compassion commitment to the

fact that we have thoroughly and productive hearings and look hard at human suffering and the opportunities we have to do good in the world and do it well. and do it in a while -- way that is sustainable and bipartisan and effective. i think your issues -- your support of the issues. i want to thank the panel for what it means to be american and what we can do when it means doing the best. and we bring our best capabilities. reverend warren, i thank you for reminding us we had an injection to not withhold goods. and south and john, i appreciate your compelling and testimony and the dramatic impact you have made across the world. and how the two of you really are helping demonstrate what it means to accept, without them love and celebrate a wide range of people who are otherwise suffering. i agree with you that fighting

stigma against lgbtq community in africa is one of the most important things we can do to avoid marginalization and the spread of the disease, and show humanity. in my limited opportunities as the africa subcommittee chair visiting 15 countries, i have tried very hard to press that point. the human consequences of ongoing oppression based on orientation are very real. this is a very real threat. if i could to dr. dybul:, thank you to your leadership of the global fund. i introduced a maternal and child health bill and last congress. that would get access to innovative financing techniques to strengthen the amount of resources available for maternal and child health. that is the core issue we are talking about. have to sustain a budget in

these investments. what are the opportunities here for innovative financing and what if anything, do we need to be doing legislatively to help facilitate that? dr. dybul: innovative finance is a big field. one of the most important things to do to get other countries to contribute, and as we are actively pushing that, not just from traditional donors per from others. i recommend germany's actually number four. i got that wrong. the innovative finance field, i give you some examples -- is an extraordinary opportunity. we are working now in nigeria. we are forcing matching, they have $100 million gap to meet needs. we have incentive funding. we will give you 50, if and only if you are the other -- other 50. they will float a bond in order to cover activity.

that is one opportunity. another is by high net worth individuals. we understand all accounts are constrained, not in the u.s. only. high net with individuals have enormous wealth. as i mentioned, we have already raised $100 million, working with bill gates and others. we see huge opportunity. not just money how we can use it here it built --. build trust funds. it puts more money in. high net worth individuals in countries like korea or china or vietnam are among the most influential people in those countries, with the billions. they are putting pressure on the government to increase their contribution. the third is around innovative implementation. if i'm going to put money in, want efficiency. let's work together on supply chain. on recruitment systems --

procurement systems. these innovative trust funds are huge opportunities for us as we are moving. countries are finding more and more of their own programs. there are many other opportunities around innovative finance we are asked learning. -- exploring. senegal and kenya have some of the most innovative programs where they do special tax schemes and special funds internally to raise money in their own country. it is a huge opportunity. >> i just visited senegal and kenya last month. as both of them john and reverend warren has shown, the capacity of the private sector in charitable individuals to make a significant impact is impressive, and we need to employee further. as we saw the response to ebola there were americans and folks around the world who stepped forward making individual

contributions to help accelerate eu engagement. and multilateral engagement. one lesson was that pepfar resources and training were identified with nigeria being able to rapidly identify and contain the outbreak. what is the path for integrating investments into a process of building broader health systems to prepare for the next pandemic? tell us a little bit more about two programs accelerating children's hiv-aids treatment and the dream treatment. dr. birx: thank you. we had intentionally strengthen health systems. without a health system that can provide commodities or that can diagnose disease at the laboratory level or that has actual health providers, it was not going to be functional. it has been very deliberate and

matched the services we provide. a nurse at a health center, although she is providing tests and treating patients, she is treating all patients in the community. although they may be trained they are there for the community. we have seen in every other ebola outbreak in the drc and uganda -- a rapid community response and rapid medical and scientific response. because of the infrastructure from the pepfar countries. in nigeria, they trained individuals therefore polio. trained by pepfar, but underneath that you have a global health core funded and build by pepfar around the world. thousands of individuals and countries art of the u.s.

embassy deployed to these countries and were immediately responding. now you have highly trained public health individuals. and dreams are to exciting things. it illustrates when you see private sector engagement around a core program. having children's investment fund foundation come forward with a few million dollars needed possible to achieve the goal of doubling the number of children reached by pepfar. only 24% of children in need under the age of 15 are receiving treatment. so this was a key initiative. the dream initiative was to empower young women to remain hiv free. the statistics are overwhelming. 5%, 10%, 15% 30% prevalence in areas of south africa.

this is a program i have to tell you, when i said this was high risk and we were entering into unknown territory, this is a program we are relying on a completely different approach. ground up planning, bringing everything to the table from social structure to the community structure, to the only structure to the school structure, to figure out what the most disadvantaged young women need in order to remain hiv free. we have a lot of what we call monitoring and evaluation around , so we can tell what is working and transport -- transported to other countries. >> thank you. i appreciate the very hard work you are doing with the global fund to make sure we have data, doing analysis, delivering more effectively. i'm sure elton john's foundation has demonstrated that are testing, as reverend warren's community health training in

rwanda and elsewhere has demonstrated. we have to do it in different ways and sustainable is if the end of eighth is to be achieved -- the end of eighth is to be achieved. -- aids is to be achieved. >> i refer to call you colonel. when we first met i told you the story how we took the initiative in 1986 to start this program. unfortunately senator leahy was not here. as a staffer, i went to congressman arrested of new york and we started at $25 million earmark to start the global poor -- program. the reason why we were leaning to do that is the first diagnostic kit was produced by abbott laboratories, which is

from illinois. we got the results from avid -- abbott. they had a positive rate that was very high according to the models. the epidemic had been going on for about 50 years. we got very brave by verizon to go in to see dave ovi, and he said something like i will be dammed if i'm going to start a foreign aids disease account with an earmark. luckily, dave changed his mind, to his eternal credit. dr. jonathan mann who unfortunately we lost in the swiss air crash with his wife -- he told us the need to have a multilateral and bilateral program.

i want to just put before you guys -- pepfar started with bilateral roots, and because of those old roots, it doesn't really work massively enough in mexico, a country we should be concerned about. i think that shows the advantage of the global fund to make sure we are working in all countries of great concern. i went to school in mexico. we have a longtime historic problem of mexico taking direct foreign aid from big united states and i would say it's very important we have the flexibility. you've got to start a bilateral program. don't work with who.

i would say that deborah you represent the u.s. side. i would say to this committee you never know what you are working on. this thing started out as a $25 million earmark. we spent a total of $57 billion on pepfar.i sit back thinking about how we've got to remind the public about how the aids epidemic is very much with us. that warms my heart to think of all the positive work. never in the history of mankind has one country given such an investment to health care internationally. sen. graham: that was a wonderful question. [laughter] the stenographer has their work cut out for her.

thank you for your years of involvement. senator shaheen? sen. shaheen: thank you all very much for being here this morning and for the wonderful work you are doing around the world. i want to start with you well -- you all. i find the statistic of over 80% of new hiv infections in young people are in young women.i wonder if you can talk to why that is. i think the dreams partnership is very exciting with nike and the gates foundation, about can you speak to what the solutions are as we think about how to prevent young women from being effective -- infected? ambassador birx?

dr. deborah birx: i think this level of statistics, which nih really helped out with -- it was there studies that pointed out the highest rate of new infections that we have seen just about anywhere on the planet, 4% a year, 10% a year, and all of us started looking at this in a detailed way. mark will talk about how we've been working collectively. it will take a community, and it will take a village. what puts young women at risk is a whole series of factors. if there was a silver bullet, we would have already achieved it. there are probably 10, 15 things that need to be done together. a lot of studies have done one thing. they have either done education or cash transfer, or they've done family strengthening. we believe if you put it together as a combination prevention activity, like we are

doing for many other parts of the hiv program, so that it will become synergistic so one plus one is now 10. that is what we need with the number of young women. south africa alone, 3 million young women in the vulnerable age group. sen. shaheen: what you are saying is like so many issues that affect young women in developing countries the status of women in those societies contributes to the tremendous effect from a. -- from aids. >> i often get in trouble for saying young girls should be considered a risk population. it has to be broader than saying we have services available because often they can't access

those services. girls outside of school are disproportionately more at risk. it's a lack of legal status. it's not even being registered when a girl is born. it is a full series of issues. there is no silver bullet, just like there is no one asked nation. you can go toe -- 10 kilometers apart, and he will see a different reason why a girl is vulnerable. you will see a 10 to one differential in the vulnerability. we have to be very careful and go community by community. we have some indication of things that can be done, like keeping girls in school. it will have not only an hiv impact but little impacts on culture, so that the girl is expected to go to school, expected not to get married early or pregnant early. these are the things that would begin to change. perhaps just getting people focused -- even if we don't know the solutions, what are the solutions so we can come up with them.

we are working on them collectively, because it has to be a collective effort. it is a group that has been left behind that we have not served properly. sen. shaheen: i'm working on legislation to try to make sure we can get countries to register when girls are born. reverend warren, i want to go to your comments about the importance -- they were similar to the chairman's -- about the strategic impacts in investing in these efforts. they are not just important to the health and welfare of people in these countries, but they help us in america. i certainly agree with you about the influence of the face sector. i wonder if you could talk about how we can get the faith sector more involved in helping to educate and encourage americans

to support foreign aid. you mentioned that many american people don't understand, don't support foreign aid, because they think it is much greater in terms of the dollar amounts than it is. how can we get the faith sector more involved, and what do you see that is working in that way? rick warren: i go back to this idea of assistance and aid being holistic. a lot of people don't really know what we do when we give money to other countries. they don't know what it is going for. usually about all we know it's going for is when we hear we have funded so many jets for a country, or so many arms per country. that is what is in the paper. you don't hear about what america does for other countries outside of arming them, and that's a big issue.

one of the things that ambassador birx mentioned was having the right information. i have noticed that countries are hungry themselves for data collection. when i travel to other countries, i would advise us to fund data collection in other countries. that would be a wise use of american assistance dollars, because without data collection you can't have a national plan for aids reduction, malaria reduction, tb reduction, things like that. i would say that what we need is smart aid, and smart aid is true accountability on both sides that the donors are accountable to do what we say we are going to do, and the receivers are accountable on what they receive . smart aid has in alignment with national plans. smart aid has good

accountability. smart aid has these data collection systems in place. believe me, the poor countries are not going to be able to afford data collection. sen. shaheen: can i ask a follow-up to that?i think you're absolutely right about that. i guess, can you talk about how we can get the faith sector more involved in helping americans understand why these efforts are so important? rick warren: it has been my experience that the faith community has been more willing to partner than the government has been willing to partner back . the government is more afraid of the faith sector than the faith sector is afraid of government. if somebody raised up the flag and said, we are truly talking about partnerships -- i have been on the hill now off and on for 20 years, and i have heard so much about partnerships, but nothing ever happens with it unless someone on my side takes

initiative. i think if there were others who took initiative on the other two legs of the stool and even called some symposiums together to say, how do we actually do this -- the government is good at this, business and health care is good at this, and what is church good at? it is good at distribution. in africa, they say, the pastor sleeps in the same blankets as the community. i keep going back to rwanda, because i have had 1200 people in rwanda. when the genocide hit in 1994 every single ngo three. it was unsafe. who stayed? the church. the church is the country. in most other countries, you can't talk about committee development without talking about the church. it is there. i think they would step up to the plate instantly if there was a little love on this site.

sen. shaheen: i would suggest we try to work with reverend warren as we are thinking about how we make sure we continue to fund the pepfar program. sen. graham: how do you brand this program in a positive way with american taxpayers so they read -- understand the return on investment? i've been thinking about that a lot. senator langford? sen. langford: let me finish up that conversation. have you seen effective outreach, government reaching out to the faith sector in any particular country you have been around that your church members have worked with that you've seen that connection, whether it's the united states government or other governments? rick warren: i have found it quite easy to work with other governments. they are not nearly as afraid of the church as the american government is. we work with governments literally all around the world and they are very friendly. they realize, we are not trying

to do their work. everybody has a different role to play, and the church's role is not government. the government's role is not church. on health issues and education issues and development issues, you can team tackle. i have found it easier to work with governments overseas. sen. langford: it is ironic we have distributed around the world this concept of freedom of religion and disconnect between government and faith, and to say government doesn't oppose faith but now to become afraid of faith and unable to partner -- it seems that is an obvious area of partnering when talking about the number of hospitals clinics, churches. i hear our experts on the medical side who say, one of the key things we have to have is a distribution center. how do we get that? we can't be afraid here of saying, there's an obvious connection, and where we can connect and can find good

distribution and relationships let's do it. it seems to be one of our greatest challenges of getting to these areas with a relationship that is a trusted relationship, to say, this is a way to deal with this disease or deal with this cultural issue and let us engage with you in a relationship. i appreciate all that you are doing. let me shift a little bit. i am a little concerned -- this is one of the things we deal with all the time, dealing with the funding side -- the global fund receives $1.3 billion in funding in fy 15. we have $4.3 billion in our state department's hiv-aids program. $128 million for hhs aids and hiv programs through the cdc and $451 billion for nih global research. how are we doing on coronation?

how is everyone doing talking to each other to make sure everybody doesn't raise their hands and's day, there's a problem, and we agree, there's a problem -- does everybody have their lane, or do we see duplication? anyone who wants to jump into that, have at at. dr. deborah birx: mark and i can answer that together. it is interesting how you put it together. you talked about our boss because we both were in tony's lab at one time. then the way we work with both the nih and global fund and how we leverage -- we work very closely with nih. they support scientific development and capacity development in africa with us, as well as key research that we need. they are working on an hiv vaccine and have a meeting this week on that. we are excited about the progress they are making. i think what was missing -- the level of absolute working together at the global fund, and over the last 18 months, that

has really transformed into an almost daily texting unfortunately for mark. we are in constant communication, but we are at -- in constant communication at every level of the global fund. sen. wynford: how did that happen? dr. deborah birx: we just committed to it. dr. mark dybul: part of it is relationship, but part of it is evolution. we have no in-country presence. we are a financing mechanism. we are leveraging mechanism to make sure people come together to finance. we raise money for the -- raise money. for the $1.35 billion you put in, we raise $4 billion a year. i have to say to the chairman's comments -- without that leadership from the u.s., it will unravel. it's the u.s. that does it. on the country level, we work as a partnership.

we bring also the multilateral partners, the u.n. institutions, the other donors to work collectively. we have forced ourselves together for impact and to get you value for money. we can't achieve it any other way. sen. langford: there are the obvious issues here. we do the emergency funding for ebola. $2.7 billion. we send 3000 folks to that area to build 11 different ebola centers, and if i remember my number correctly, we had 28 people we ended up treating with $2.7 billion. uncorrelated, too late, massive response delayed. we can't have that in a disease like aids. we can't not have coordination and make sure every dollar is spent wisely. should we have responded to a bola? yes. did we do it in the most

efficient way? time is going to tell us, no, we didn't. i want to come back on that again. is there a structure in place -- i am proud of the to review that you are working on making sure there is lots of communication -- is there a structure in place to make sure this is ongoing? i hope y'all stay at it and worker sells out of a job quite soon. that would be terrific news. how is it going building the structure to make sure that is maintained? dr. deborah birx: there is a structure at every level, and i think part of it has to do with leadership and sending that signal down clearly to every level that we will work together, and we will work together not only in concert at the head porter level and at the implementation level but at the principal recipient level. the global funds money goes through a principal recipient. it makes the principal recipient sometimes nervous how close our dialogue is about what precisely the global fund is doing and what precisely pepfar is doing.

we can marry that information in a clear and transparent way and that is what is new. it is what the reverend talked about. data and data collection and transparency that is what will ensure that there is not duplication, because we now know down to the site level where his dollars are going and where our dollars are going. sen. langford: you all are doing some great work in raising funds and raising awareness. we appreciate it. we will try to help in what we can do, as well. sen. graham: senator merkley? sen. merkley: thank you for your leadership on this issue, this challenge, this world challenge. there is a modest group of leaders who have had an impact on millions of lives and mr. chairman, you are one of those leaders. all of you on the panel, you are part of that group.

huge thanks to you. i think of some others who have been part of this conversation paul farmer who definitely laid out -- there were three pandemics, tuberculosis, malaria, and aids, and we must take them on. bono who took paul o'neill over to africa in 2002 to connect on economic development and the need to address aids. you are all absolutely marvelous , and sir elton john, as you spoke, you spoke in poetic terms compassion and love and connection. i was really struck and taken to think about the parable of the good samaritan, the story in which the individual goes on the road from jerusalem to jericho which was known as the blood road because it was so common for people to be robbed and beaten, and the priest comes by

and sees the individual who has been robbed and strict and beaten and left for dead and keeps going. the levite comes by, same thing. then the samaritan. we have kind of forgotten this in modern times, but the samaritan, the samaritans and jews or at odds with each other, but it was a samaritan who stopped and helped upout. the lawyer questioning jesus says, who is your neighbor? that is why he tells you this story. it's the one who reached out and had compassion and got involved when others didn't. you all have done that. thank you so much. the piece of this puzzle that i'd like to ask you to add some additional comments on is this challenge of stigma. back in the 1970's, misses ford, first lady ford, after her

mastectomy, proceeded to talk about breast cancer in the way that opened the conversation in america for something that was hidden and wasn't talked about and wasn't explored. in your work, i'm sure you've connected with certain leaders who have changed that dynamic of stigma in different countries or among different groups. can you give us some examples as the type of path they have gone down to try to find ways to encourage others to follow? sir elton john: it's very important, as you stress, for people to come out and say misses ford, you had a mastectomy, and it helps him in a million -- so many women. when magic johnson said he had hiv, it helped tremendously. when arthur ashe was diagnosed. if anybody comes out, even if they are gay transgender

whatever if people who are out there feeling alone, feel that they are suffering because they have hiv, because they are gay or any other disease they have -- when someone else they identify with comes out and says, listen, i have this, and it's ok, it's an incredibly strong thing to do. it's a necessity. not enough people who have hiv who are well-known have come out to say, i am hiv-positive. it saddens me. it would help so much if more rural models, more famous people, more sportsmen -- in africa, they love sports, and their heroes are sportsmen. there are many people in this world who have hiv who are famous and are too scared to come out. it would help us. the whole thing would be so much easier. that stigma would be lifted if

only more people would come out and say, i'm living with this disease. i'm not dying with it. look at me. i'm fine. that adds to any circumstance. angelina jolie has had a double mastectomy. it all helps. people who look up to people, god knows why sometimes, but they do, and especially with aids, it's very important for more people to say, i'm hiv-positive. i'm living with it. because it is a sexually-orientated disease for the most part, it's not something -- you don't come back from the doctors and say i have aids. there is no reason why you shouldn't.

you don't talk about it because it is a sexually transmitted disease for the most part. if marvin's people came out and said, hiv is ok, then it would help so many. it would make our situation so much easier. sen. merkley: if we extend that conversation to nations where the conversation is far more oppressed or underground than it is here, and dr. morin, you indicated you might have something to add to this. are there some spiritual leaders or governmental leaders or medical leaders who have taken bold stands and helped change the course of policy and dialogue in countries that we can try to encourage and other places? rick warren: whenever i find a pastor who has aids, i say telling everybody may be the greatest thing you do in your life. we help people more out of our weaknesses and out of our strengths. if i tell you all the things i'm good at, you say, goodie for

you. if i tell you the things i'm struggling with, you say oh, maybe god can work in my life, too. most people know 18 months ago my youngest son who struggled with mental illness through his 27 years took his wife. it was the worst day of my life. kay and i decided we would be obviously open about it. i went on cnn, and we spent an hour giving testimony to piers morgan. it opened the floodgates wide. if don't help people with your strength. i used to think that aids was just stigma. i think mental illness is a bigger stigma. more people are afraid of that. it is not a sin to be sick. your illness is not your identity. your chemistry is not your character. when leaders stand up and say i'm struggling with this, aids or anything else, it allows

other people to make progress. we help people more through our weaknesses than through our strengths. sir elton john: one of the great things in south africa when i went about 12 years ago -- i saw women had been widowed because their husbands had died, and i was sitting in one of the hospitals. there was a roundtable with about 15 people. the women were wearing t-shirts that said, i have aids, and i am proud. that was the start of a movement where the women in south africa in that area felt empowered. he hit it on the head. our weaknesses are our strengths. i'm terrible at asking for help. i would rather suffer in silence than say, can you help me with this? it's ok to be human. it's ok to be a failure.

it's ok to have a weakness. our weaknesses are our strengths. when you empower somebody by saying, listen, i'm not as strong as you think i am, it helps a lot. it really does. sen. merkley: that example shows the power of grassroots action. it isn't just about leaders who helped drive policy or change but citizens standing up and saying, we are changing how this is done. sen. murphy: what an impressive panel. what fantastic testimony. dr. warren, thank you for raising the issue of mental illness. this is not something we tend to talk about on global terms. we tend to talk about communicable diseases primarily but the reality is is that the stigma is not domestic. it's international. the good news on this issue hopefully, there is more bipartisan agreement.

we need to think about this globally as well. hopefully, it becomes part of the conversation. senator langford had an interesting line of testimony. one of the things he talked about was the response to ebola. i don't want people to get the impression that the only thing we did was build facilities. we did that in part because there were estimates there were the one million cases by early this year, but we also put a lot of work into our local partners everything from the right ways to quarantine, to the safe practices for those that perished from the disease, and it was a lot of that work that made an enormous amount of progress. i want to ask about this question of how we work with local governments to improve governance, to improve their local public health system so we are ultimately noxious reliant on the generosity of the united states and the church community and international philanthropic

community. the reality is, global surveys suggest that one out of every five people in this world have actively paid a bribe to get a health service. a 40% of people view their health care service as utterly corrupt. we know where those survey results are even higher. how do our public health officials -- i will ask dr. dybul first -- how do we make sure our public health dollars are intersecting with the other pots of money we use to improve governance, and are we doing that in the right way and with the right level of coordination? dr. mark dybul: i think the most important word is the last one. i don't think we were there 5, 7 years ago. we have a ways to go, but the progress has been extraordinary. the way the global fund functions, we fund many governments directly.