obama. hillary clinton started it, i finished it. victory. at 9:00r: sunday night p.m. eastern on c-span's book tv. , talking about the forident's emergency plan aids relief established by the george w. bush administration. this is one of the half hours. >> good morning everyone. i'm the national security director at the bipartisan policy center. it is my pleasure to welcome you here today on a beautiful monday morning after a glorious weekend . it is easy to be hopeful on a day like today.

we are glad to be releasing our paper. paper co-authored by a former senate majority leader dr. bill frisk. our motion is to actively seek the best idea from both parties to promote health, security, and opportunity for all americans. we drive viable solutions through analysis, negotiation, and advocacy. today we will talk about a strong example of bipartisan policy. this is the second time the bpce -- pepfar.at pet far we are returning to it for two

hopeful reasons. pepfar reminds us the u.s. does not have to choose between pursuing a sound interest and helping the world. that pepfarl learn continues to help promote u.s. interests. have include a new about the ebola outbreak in west africa.

pepfar tells us america does well when it does good in the world. ar reminds us about the continued ability of washington to find bipartisan ground. had reauthorization in 2008 20 13. for those counting, we are due for another reauthorization later this year. we hope it will be just as strongly bipartisan. if you missed on the way in, we have copies of the reports available at the front door. being streamed by c-span and a recording will be made available on the website. we invite you to interact on twitter about today's event using the hash tag bpc live

bipartisan. i invite you to turn your attention to the screen for a brief video from the george w. bush institute commemorating the anniversary of pepfar. thank you. ♪ ♪ the pandemic threatens to wipe out an entire generation. in the face of preventable death and suffering my administration firmly believes we have an obligation to act. we launched the emergency plan for aids relief. a work of mercy beyond all previous international efforts to help the people of africa. over the past 15 years, thanks to the generosity of the american people, millions would

have died. on the verge of a regeneration of the people of africa still need our help. the american people deserve credit for this tremendous success and should keep going until the job is done. ♪ thank you to the institute for that video. good morning everyone. i am the chief medical advisor at bipartisan policy center. and with the codirector of the work on strategic health and

diplomacy, we have two excellent panels for you today. the first will feature senator daschle and senator frist as mentioned, the two authors of the report being released by the bipartisan center today. the second panel will feature the general charles and ambassador mark. both panels will be taking questions so please raise your hand if you have a question during the q-and-a period and we will have roaming microphones and we will get those to you. at this time it is my honor to invite senators daschle and frist to the stage along with our moderator for the first panel discussion. michael is the senior adviser to an advocacy organization that works to end extreme poverty and preventable disease particularly in africa and is also a columnist for the "washington post" and previously served as the assistant to the president for policy and strategic planning under president george

w. bush. thank you to all of you and i will let you take it away from here. >> appreciate it. it is an honor to be with you all. pepfar was my bes minus experien government, and one reason the program is exceptional is because of its bipartisan nature. expand the gap between social conservatives and traditionally liberal global health advocates and span the gap between parties and administrations of president obama deeply committed to this effort. so, pepfar has been a haven safe harbor and these men represent how it can work. they turned the idea into a reality and remain its tireless advocate. it's often said pepfar is the largest investment the country has evecountry hasever made in e

disease is one of the most successful global efforts in terms of its scale and impact. ththe program so that his 15th year this may which means that some people in the audience may not know about the pre- pepfar period. can you remind us of what people believdo good things were like r people living in the hardest hit areas? >> first of all, the just compliment you for all of your work and leadership you were one of the inspirations, one of the true organizers have a thing for the record and those that may dy not have history, michael had a lot to do with the fact that it was as successful as it was. it was a pleasure to work with him on that effort going through to your question i would say people started to die of hiv aids in the 60s but by the

year 2000 when the bush administration took office, over 25 million people have lost their lives. there are countries in africa where 20% of those living in these countries had been infected and said it was becoming more and more widespread. there was a stigma attached to the disease so people were reluctant to become engaged and there was a lot of confusion of what was right and what was wrong and what was the truth about the issues and that led of course to an enormous degree of confusion of how we approach the issue. the final thing i would say is how expensive the cost of the medicine was. $125 a month with marginally effective treatments so things

have changed a lot but it was dire and that period after the turn-of-the-century. i remember visiting south africa working with grandparents and grandchildren with an entire generation nearly gone. talk about what you saw during the. >> that is exactly right the image that you just laid out is much to me i think it best dramatizes what was happening. it was a hobbling out of society where you travel around in the '90s and i spent two or three weeks somewhere during medical work during that time and he would see grandmothers and

little babies and you would see no mental image nobody above adolescent years of women, of girls, of men because of this hobbling out. it would create over 11 million coming back to the time of the early 2011 hiv orphans. i first began when there were only five cases in the united states was a resident at massachusetts general in boston at the time. nobody talked about the virus because we didn't know existed. although that seems a long time ago, to me it doesn't seem like it was a very long time ago today. and we still didn't know what the virus was and the next year 2,000 people died and then

3 million people died in the world, remember over that period of time africa was especially hit and by the time of the 1990s when i started to go, this virus that has been defined by 1983, ekg and go virus anytime you get the treatment of changes confirmation there for a escapes treatment and to this day we don't have the treatment purportebut for the disturbing s getting the military civil servants ar, hitting the politicians, the people who keep the society safe. without hollowing out that in the 1990s everything up until the 2002 pepfar was the reality that we all have to face. i remember seeing a lot of child headed households. to talk about the villages where there were no village elders left. very extraordinary than the drugs start arriving.

you have at the tim time it is called the lazarus effect. can you describe that period held the hope advanced in the aftermath? >> i did spend two or three weeks as the majority leader when i was in the united its senate taking off my political hat to the omission where we went to about 15 different countries in the period of the '90s and through to 2000 and early on it was voluntary counseling and testing. people said it was impossible but then again going to the story we had some political

movement, we had the industry go,the pharmaceutical companiesl come forward because all of a sudden the cost started coming down. the antiretrovirals started coming in in a place where the life expectancy had been around 60 and then in the 80s and '90s it would come down to 38 years of age. then all of a sudden through the american leadershi leadership ik up and eventually, we will get there in terms of the story, it gets back to about 62 years of age and that is the lazarus effect. >> what did you see in terms of the aftermath? >> the most exciting thing you see is people are getting their lives back. on a personal level, people are actually becoming more optimistic about their life and about their future and their communities. you saw economic growth and prosperity restored as bill was

noting. i think one of the greatest impediments to the employment and economic growth when you see the widespread impact across the spectrum you saw a decimation of the economy and then they resulting stability of the government itself. there was a great deal of uncertainty. it existed as a result of all of this uncertainty. as soon as pepfar came along and we could see real results, but opened up some of them, began to be restored and that had a

catalytic effect on the economy, stability and governance and the capacity once again to restore some degree of normalcy. >> this sense of time and place especially post 9/11 but even the 1990s, part of the hopelessness when you are a 12-year-old or 13-year-old you see no hope not because you are poor or you don't have a home, but you have no hope because of death and destruction and chaos and your father has died i and your mother has died and then all of a sudden somebody comes in and gives you a little element of hope of life, that is

probably one of the best antidotes. remember when it hit terrorism is rampant. when you were given hope of having a family, to put a roof over their head in assent your daughter to school where you didn't have it three years before, that is a powerful antidote to what there is terrorism or a currency for peace which by the way it's also interesting how the treatment of would talk to people who said i know it's not a death sentence now and it really expanded that element which was necessary. treatment was important to testing. i want to get to a point the senator made that is the focus of the report which is the effect on the socioeconomic gains. this hasn't gotten as much

attention on per capita growth in worker productivity in terms of the ability of people to become employed. how does supporting the countries with treatment result in the improved development? >> i would say there are three major components. first as i said earlier the fact that you have such pervasive widespread illness necessarily will go up dramatically. the reverse is true when you find ways to address that illness and make people healthy, unemployment goes down, people are beginning to develop a capacity for work again and that has profound economic consequences so it starts with a realization that there is a direct connection between being healthy and having a healthy and a strong economy, pin it goes

beyond that. you have to create greater capacity to end that can be in the infrastructure that helps enhance the infrastructure within any country to address not only the challenge of the illness but also the concept of making the society more productive again and that is a big part of what i think people fantasy. there are studies done showing the correlation between the presence of pepfar and economic growth and vitality, clear connection between the strength of the program and the economy. south africa in particular but there are many other countries. so, we see an enormous operation nation for what this can do and it has macro economic effects are still today appreciating now 15 years after the fact.

>> africa is a major trading partner of the united states as well. the report points out $40 billion of trade in 2016. four of the top five partners in the region are countries that have been major pepfar partners. ..

>> even his own secretary of health made that statement and then the old bill was passed. but even then in the first report we didn't concentrate on the gdp growth. so that impact is 4% with gdp so if you can reverse that with employment but the other thing that our report does is the impact on trade not just health and productivity but a country had an impact on other countries. so what happens to be our partners moving forward so it

is obvious you have young people that are less interested in then they look to the hopeful future and girls going back to school and you have a country that has shared with the united states to put americans on the ground and to share information with them to build that infrastructure but throughout the whole country were go there are three or four little kids. what your name? they say america. my parents named me america

soul because it is a partnering and resources, one of the things with our military is a degree of transparency and participation and the ideals that are exactly the sort you want the government to have in a trading partner. you don't want someone who you cannot work that is not transparent now this came through government with this legitimacy that meant more and more trade over time. >> so with the expression of american values, this report

talks about to be more positive public opinion what do you think of the attributes of this program? >> if i could start to say first of all the impression people have of the u.s. as a compassionate and generous country that has the capacity to work with people. one of the values while i give great credit to our diplomats they deserve our thanks and praise and gratitude for all that they do. because it is so widely dispersed and it carries to the grassroots of these communities the real values at its best in the church and the

local community centers so that representation of that physical understanding of the generosity is very evident and that makes a big difference one kid was saluted every day and he would think the united states and the other thing that would contribute as well that there is so much local talent. it isn't americans from washington or new york but these are local people helping communities. but given the resources with the technological capacity.

>> why is it important? >> there is a great question that going back to those days in 2003 with our discussions on the floor it really was a global calling of society. it was a moral imperative. or south africa but if you were struck down then you should be lifted up and never live in fear. because of a lack of attention. but the impact ultimately has

been just that with that so she oh economic impact. with our ambassadors one of the things that we take credit for that our team did was to talk to the ambassadors. but then you hear this broad power not just the industry or the diplomats they have people feel the caring and compassion. it was a global effort with the global fund but there were 30 or 40 other countries that participated so it was caring and compassion of humanity. so using medicine or health or

diplomacy is a real thing. i've always said medicine is a currency for peace. but the military might is absolutely protective of our freedom and democracy. but the cost of success of this broad bipartisan people supported is that caring and compassion and health can be a true currency for peace and understanding. but on the ground you have some type of aid coming into save the life of your child $1.50 that breeds faith in humanity. so you don't go to war with

someone who just saved the life of your child. to use that his strength just like we use military. >> letter some of the other public health threats? >> i would say we have already seen the impact of this extraordinary effort to deal with ebola. not is what we were challenged by. we can also see that hepatitis efforts especially in africa to be more successfully addressed with this effort

even noncommunicable diseases like diabetes. even cervical cancer problems because of the early efforts to detect and treat hiv-aids we can detect more capably those afflicted with cervical cancer so there is an enormous array of illnesses we can address because we have the infrastructure to take the lessons learned and applied them to other instances as well. >> but cap far mom --dash.

>> that is why this analysis is so important. we came in because you are constantly changing. and the goal is to continue that. that is what we are doing. we started with a virus with pepfar $60 billion. that the global fund through president bush began with the largest single gift and that expanded to hiv-aids, malaria, and tuberculosis. but now with hiv-aids we have cut aids-related death at

50%. but when you have the anti- retro viral that cost one dollar to save the baby you have to set up a system of delivery or compliance you don't take it one time and go away there is surveillance the whole testing was revolutionizing because $300 was taken at about two dollars to set up the infrastructure and those that would give birth to a baby with hiv-aids that somebody has to identify the mom to set up the community and while you are there you have other maternal and child health maybe breast-feeding or early detection of other disease or -- diseases so there is a huge infrastructure built

expanded to others that saves countless other lives. between five or six times of that with that broad infrastructure. so that diagnosis and delivery and treatment. >> and those cases used to be overwhelmed. but from the senate appropriations bill there is still strong bipartisan support from state and foreign operations appropriations and

said this bill makes america safer by supporting those diplomatic efforts around the world to provide assistance for our allies and assisted for conflict and lifesaving for those in dire need. now is not the time for retreat it is not backing away from its role in the free world. why does that remain important? >> it is even more important because the world is in such chaos. you have the innermost challenge especially in this context has never been more critical. secretary mattis said if you

cut back on funding for programs like this and that is a sustained way to say there is a direct correlation with good health and economic growth and with the national security perspective and what we have seen for 15 years. or with overall stability worldwide we don't have a strong military. >> you opened with that it has been bipartisan from day number one. >> in our early years it was partisan or stigmatized with

the condition pushed off to the side that basically said this is what they need to deal with initially but then after the american people spoke or the faith-based community came on board to say 3 million people dying, 11 million orphans we have to act. but then he played a huge role to say america is great. and this is the single greatest thing this country has ever done but to put that in perspective, this is the budget, we talked about everything all global health is 1% of the nation's budget.

gdp, reputation, national security america first meeting those core principles that are outlined we need every one of those principles coming forward. but it does boil down to this. one quarter of 1% that goes to all global health it really is a currency for a national security issue. and then to provide for their children and give them hope in 20 or 30 years. why is it our administration comes out right now? and then let's cut that by 12%. so congress has come back it

is good in this environment but now is not the time to step back are to have the administration cut global health with positive and constructive global benefit to cut the death related to hiv-aids in half in 15 years. >> ask your question in a form of a question. [laughter] >> first of all thank you for being here. i was the senate foreign relations committee. i am wondering how pepfar dealt with former presidents

opposition and the denial? >> yes. so at the time we had countries and recipient countries who basically from a standpoint that narrative was the antiretrovirals don't work then hiv-aids is not caused by a single virus they didn't say what it was nobody knew what it was at the time they call that wasting disease so at the time what we did michael is the expert up right away. he wrote a lot with the president to articulate this but what the president did before is he sent our head

scientist for infectious disease but even before that announcement he sent him to africa and said what is the science? and then he came back before the state of the union and said this can be done they are wrong. it is caused by a virus if we mobilize american industry with public-private partnership $15 billion over five years i can promise or i could pledge to you based on science we could reduce the burden and cut in half so i came back to the science so they plowed straight ahead. but you had recipients that said america stay out of our business it isn't caused by a virus antiretrovirals don't work but we relied on science. >> just to complete that

thought i would say then they became convinced once he saw results happening all around him. it took a while but to his point once you have the science and then the results it is hard to deny how you could do that to your country. >> i would add i remember sitting at a lunch next to an individual that you had an element but there were a lot of really good health people that knew what was going on. you had leadership problems that a real bureaucracy. >> and then countries like uganda but they came forward the first lady went on the equivalent of television at

the exact same time so this voluntary counseling and testing so then people began to live and uganda was probably at that time were the president and the first lady. >> i work at the urban institute and im curious about the connection between condoms or prevention method in the political issues around family-planning and from religious groups and others and how you dealt with that. >> first of all i don't know if i should answer historically or what it was at the time but people were dying

but suffering around the world and had to give voice to what that was at the time we didn't know much about anti- retro viral's but what the industry told us is if we come together we can get the price down so the therapy and event everybody rallied behind but the therapy with five people walking in with hiv every day, there is no way people were just coming up so the real answer was the prevention end of it even today. we have cut it way down this provision we know that it works. and that birth control condoms protection works.

so what we did with democrats and republicans and faith-based communities to come on board even though they were against condoms from a government policy we didn't get that involved with that certain parts had to be watered down a little bit for the coalition basically we brought to the faith-based community the way you want it then you push that forward with that legislation that you need to say you are for them or against them but if at that point in time we realized there were condoms already at that point in time. as people didn't come on board they would still come on board if they didn't believe in using condoms with the

abstinence part of that they would still come on board and that is how the coalition started. >> my name is sabrina and i'm just wondering what you thought of the future in relation to global health security and the reemergence of polio and malaria cases? >> i will just jump in really quick. the reason this funding, we have two issues and you brought up one we should have mentioned earlier. that is the reason why we have to continue to invest. we do not have a cure for hiv-aids. malaria is a little different

it mainly kills children but it was very much part of the global fund. but the thing that you brought up is the resistance to current therapies today whether malaria or tuberculosis or hiv. the emergence of resistance to give the anti- retro viral or the drug then all of a sudden malaria evolves so you have to have the continued research. the other big issue is this resurgence of young people in africa today so they need both to receive that education because culturally they are not but again those same behaviors with, right back.

>> we have mentioned a couple times of the importance of the infrastructure we created and that is so vital as we go forward. take the lessons learned there is a new concept often referred to as data diplomacy using data for purposes to apply what we now know the infrastructure that we have to address the challenges we now face. i don't think anyone can fully appreciate the magnitude of that contribution because it is hard to document in a macro economic fashion but it is there and it is real. data diplomacy and transparency and those values and tools that we brought our applicable looking to the next 15 years and apply them just as effectively. >> we have to conclude there but thank you for your leadership with cause and compassion please join me to

thank them. [applause] spee5 >> thank you to the senators for their leadership and contributions to this report and also thanks for helping us guide through the history not only of pepfar and its infrastructure by the touching impact story of the changes it has brought and change the lives of millions. to talk more about what pepfar does today and its continued impact i would like to call up our second panel to the stage. the u.s. global aids coordinator and the

representative for global health diplomacy from the european command and the national security program and amb. former u.s. abbasid or to zambia and current ambassador to secretary of state from bureau of refugees and migration our moderator today in addition to consulting on this report is the faculty codirector and a visiting associate professor department of medicine at georgetown university prior to joining georgetown he served four years as a ceo for center of infectious diseases research in zambia and the chief medical officer and aids coordinator for pepfar and the director for office science. >> it is a pleasure to be here this morning and given the range of diplomatic and public

health as well as security concerns and issues that we talked about already, we really couldn't ask for a better panel today. i will not go into the bios but i will introduce ambassador in general and ambassador. i had the great honor with working with both ambassadors and various settings over the years so this is a special occasion. i would like to start with you, general as referenced earlier prior to pepfar with those hardest hit were truly ravaged by the hiv epidemic with the rapid rise of orphan hood but the new report finds that pepfar has been successful in impacting health

and social economic developments. and because of this we have heard of parallels between the pepfar program and given your background with the european central command, remind us of some of those objectives of the marshall plan and the advantages that has the build europe as well as the united states. do you see parallels? >> i do. i was asked to prepare for this question. [laughter] if you don't remember the market plan at the time was around $15 billion which today sounds like not a lot of money but at the time was quite a bit. and i read where there is so

much history now that says the marshall plan implemented by u.s. government to give us a better global market to increase the market of the administration which is a cynical meeting on -- meaning through our economy and there also was the reality that if you think back with today's context with president trump going to the naval summit this week and there was no more supportive person but say to yourself, why are we involved in europe or africa? what is the interest other than historical relationships

whatever the case may be? but you have a group of nations around the world that we can depend on. to hear from two significant people as far as diplomacy goes but the military aspect from senator frist and senator daschle but the best thing you can do is avoid aid involvement or conflict prevention is number one. and to say idealistic if you could do away with the military that is a good thing. so the marshall plan had a couple of things that there was a certain amount of benevolence and sincere concern we couldn't imagine

world war ii or the devastation and george marshall's presence and he was smart enough to know the tools of national security are multifaceted the former chairman in the united states of america was our military guy to say that to say forget about national security and then the third part is he saw the future to be repetitious and that security in europe isn't guaranteed.

to purchase their own military capability if you look at hiv-aids and with european command we had africa and the responsibilities were in africa we spend a lot of time there. it was thought of today because of what we consider extremist terrorist that are grown there it was great for us that the ambassadors were there that was great work. but no real strategy involved.

that was driven by the fact and replacing us to be influential but that became a huge issue for us and the more capacity they have to take care of their own problems the better it is for u us. >> thank you. >> as we talked about in the first panel with the younger population to be 50% of of people in sub-saharan africa under the age of 20 and in the study referenced in a new report referenced in a new report is called the destabilizing force.

and then just to stick with you but then the concern from a security perspective and with pepfar to be essential with that population. >> i sense that earlier i never had a chance to talk about this before but one of the sad parts of george w. bush administration as he should have taken big credit for this but when we first started the european command in 2003 it was fairly recent not a lot of people had not been there to africa there was growing instability already as alluded to and osama bin laden

was in sudan and there was a lot of activity in north africa we had europeans that were kidnapped about 40 of them that were the big issue in the group that kidnapped them became al qaeda. we had in timbuktu and molly -- and there had to do with the reality of social media with the arab spring but also probably most of that was communication among young people that there was a realization of the government that they had in the society they were growing up in with the disenfranchisement of young people becoming apparent we had a fantastic intelligence infrastructure

from the head of army intelligence that coined the word to be the disenfranchisement of the youth in africa and his concern was unless something is done they will be looking for things to do first of all they will support the government and number two they have no relief for what their life is all about their looking for a relationship. the whole issue about paying attention to the young folks in africa was again primarily a security issue. but that youthful transmission of hiv aids process was a growing issue in the mobility of society.

it became real apparent to us that the hiv-aids program would be a big deal for us. and again taking the senator who came to africa several times that realize the amount of money put into this program was paying big dividends and then we will talk about it later but the impact of the interest of the european command that is not in our best interest to do that. but with the hiv-aids program may have turned around much of africa today that would have been ten times worse without the pepfar program. no doubt about it. >> you have made the

collection with the data one of the hallmarks of pepfar and one of the major issues as the general referenced, we have the youth but also the adolescent girls of young women accounting 74% of new infections in sub-saharan africa in that age group. given the rapid growth of this population with these high rates of affection and that each group could that lead to a reversal of the hard-fought gains over the years? why are the rates so high in adolescent girls in the region and what is pepfar doing to protect from hiv infection while recognizing prevention isn't just a health issue but has societal determinants? >> that is a lot of

questions. but thank you. we were very excited about this data because it lets us see the community so we heard that discussion where pepfar was grounded in transparency and knowledge and to the action we have to be able to see everything you cannot look at a country on the average to say that is how you serve everyone when we started to look geographically and started to do the surveys, that is when we found everybody went missing you can understand how this happened because went 11 started it really was an emergency to save lives. so a lot of the treatment went to the very second we had forgotten i think you have the disease eight or ten years

before you are sick but it is silent. if you think that way then realize you have 15 or 20 euros that were probably infected then but was not visible to the healthcare delivery system. so now it allows us to see everyone. it's not that we have to these incident rates and then absolute number of new infections on the incident rate as described in the prior panel is dropping but when you have twice as many 24 -year-olds then at the beginning of the epidemic then you have to do half of that to tread water so we really notice that young women with a study done that it showed us the risks young women but we did not understand that risk

and there was a sense it was generational or sexual activity but men that were six or seven years older with women and adolescents that were 16 with a 22-year-old. people always say that is so shocking but weren't you in high school? you want to date with the college career one --dash college kid? so we started to listen to the young women and what was putting them at risk and that is why we launched dreams to save your women. so we had to bring together just like pepfar always let bringing people together bipartisan inter- agency that ministry of education with the

ministries of health and gender to work together in a new way and to really look at every aspect of a young girl's life and address the issues they are faced with. one of the biggest issues with our violence against children survey is one third of young girls with the sexual experience is raped. so using diplomacy of data when you have that objective evidenc evidence, and work together to address an issue. when you have seen the recent report between 25 or 40% decline in new infections but the actual number of new infections. but like all data it points out where you are failing in part of this bipartisan

support and the bipartisan report that came out for us to understand where do we need to do better? with the young women we can clearly see we probably don't have programs that are optimized for young women in highly urban areas like agile hand is for or nairobi we had a ten or 15% of new infections were many other areas had a higher decline so data is useful to point out where you are doing well are not doing well to fix that and that is how we want to use the data to understand where we are doing well but also where we need to fix things. people say all the time when multi- 11 stop changing? never. because it is tricky they

constantly change and effect people so you constantly have to look at changing keep up with i it. >> in the same way you worked to make data more available and use data you also opened up the country operational planning process. and made it more transparent but you involved other governments as well as some of society and as we heard that transparency is the hallmark of diplomacy. what prompted your move with the involvement of both government and civil society? or those challenges you have experienced from that? >> you heard from the previous panel that pepfar was grounded so we went through and looked at thanks to the people in the

audience who wrote comprehensive reports how pepfar could be better and we work in those areas all the time that one of them said you talk about transparency but you are not transparent you writes this in secret rooms until everybody this is what you will do and the data is not available and we don't know what is going on. we felt we had to be more transparent that made everybody nervous that all this data would be up and available and it is. every site or 50000 sites have the data on the website so everybody can see it those communities we are serving and civil society. part of what we do in the planning process is to bring together communities impacted by hiv with the government

providing services and also with pepfar funding so we are listening to each other and that is the big difference we are listening and can double the number of people in treatment just by listening to how we could do things better and quadruple prevention impact so how do you do that by listening to the community telling you you are doing it this way you would be more effective to do it that way. these communities and governments do this when there is no funding going directly to them people are altruistically helping us to be better without paying them to help us do bette better. that has been the spirit of pepfar so when we constantly doing change management is to

listen to people talk about nac many of you in the audience who helped us with the dream program you were not receiving pepfar funding you wanted that program to have an impact because you cared about young women around the world. that is what we still see everyday people coming forward to help us. to bring their intellect and spirit and wisdom that is so powerful. keep writing your reports and help us get better. because we are in this until we get control. there is a cure for malaria so we are working against something difficult. those are developed and worked at right now at nih that says they need to continue to be funded to do that but in the meantime no excuse to go as as

fast and effectively as you can. >> going back to the point of data, the irony is 100% of you already know the issue. and to understand the problems of hiv-aids but the narrative has to be better because they totally understand what you were saying so once when we were back in africa and we talked about the stability of operations with the benefits security wise to say i agree. my constituency does not understand why senator thune

would tell me my people in rapid city don't understand why we spend money on africa when they have a pothole on 16th street. you have to develop the narrative so i asked the general accounting office what you guesstimate the amount of money that we save by actually investing in prevention of soft power? they came back for a number every dollar you spend on prevention and i consider pepfar that many you save ten dollars in response. that is ten dollars of military spending. we should have more of those stories because that is exactly what is happening you can be the most heartless person in the world by the way

if you travel over their youth find out why this helps because the suffering is unbelievable but just from a purist but could care less those are the numbers we need to have out there. very sophisticated but the average american could care less unless there is a benefit for them. >> building on the idea to have more ownership or diplomacy with that transparency you and other ambassadors have referenced ways that pepfar has helped to open doors with relationships with government and build trust to pursue form policy

objectives. can you give us an example where you use that? in zambia pepfar was a game changer to achieve the broader objectives. we had a lot of trouble accessing the government he had the opportunity to announce the framework just because of its size has real weight. that opened up doors for us with the government and then said we have more money to bring to the table that we want you to match and it took three meetings with the president. he didn't know we would spend the money anyway. [laughter] but there are other areas that

matter. so a big thing we carried the democratic election that had a stormy and difficult history. and it turns out the most important allies in the united states was the independent intellectual mission the three other churches to skip aliens and evangelicals and the catholics they were all partners in pepfar and they trusted us so the same electoral commission we have these church in each day to say we want the commission and the election took place and the president was incumbent friday peaceful transition we

were working to have a defense relationship with cbi and they had a lot of trouble with the previous president and said africa will never lay in food on the ground and when china was active in men's we had no inroads. and as they noticed that the clinics we were supporting with pepfar funding it wasn't just their soldiers for their family and it took a little while but over those two years and things open for us and i remember taking the administer shortly after that you host

the african endeavor the biggest military exercise and not having to just three years. but pepfar was at the heart of making that change. so for american diplomacy and a diverse hearing you have spoken about the role of diplomacy efforts at best so help us to better understand the ways to make with diplomacy and the latest of the improved perception of the united states and using these efforts help to drive that influence that pepfar? >> it requires you reach the audience you try to sell to.

certainly pepfar is a great piece of that. one of the things that i saw was political leaders were fortunate that tribal leaders were very important. one of the challenges that is already referred to is voluntary meal circumcision. this was a way to really improve the hiv virus they were not used to this how do we convince them it is a good idea? we would have to reach out to the tribal chief who could partner with us and highlight their leadership to start changing 80 about -- ideas about the practices.

we needed to reach young people. that they have the future. so we brought with us the pop icons with musicians and artist artists, and put on a performance, track huge numbers of young people, but they were on their machine texting and tweeting that they found the artist and musicians much more interesting. [laughter] we reached much wider audience of the united states doing good things for zambia.

>> we could go much longer with this panel but i want to open to the audience questions . . . .

>> question it back. -- in back. panel is,tion for the how important do you think funding will be in preventing new infections globally? >> that is a quite question. our job is to constantly apply the new science. so the new sciences how effective approach can be among high risk young people, key populations. withe working very closely ministries to really work this we do, into the work

because again, just like young men, young people don't want to come to the clinic. they don't see themselves as l. remember, for the first eight years you feel great. if you feel great, you don't feel like you need prevention. we are working on how to bring the message forward. it clearly has a great impact. all of these pieces have to come together. we're pushing on all of the elements. there pushing all of elements to ensure we can have the maximum impact to prevent as many new infections has we can because the new infections are moving into this group that's going to be $.50 -- 50% of the population. we are working with the defense howes to understand

important it is. that is how we can get messages through two young people. we are working in a continually horizontal weight. we don't talk about that enough. we don't talk about the billions we have invested into institutions for young people's health and welfare. we have to do a better job of converting that message into the strategic message that is important for americans. group in the united with 185 for start general officers. 35,000 retired military. ngos as well. it is advocacy for foreign aid.

oftene foreign aid it is a last resort. , and youicans think are probably at the high-end of the educational levels. we get about 25% of our foreign budget for foreign aid. congress asducate well. is there a senior staffer in here? i used to take senator inhofe to africa quite a bit, too. he would pray with the president's of those countries from a religious standpoint. he was pretty supportive of the foreign aid program. he is one of the last people most people would guess what do that. ofdsey graham is way on top those things.

senator mccain, it goes back to what the ambassador said. we have two of the narrative for people who don't necessarily think of foreign policy or foreign affairs. -- theber the saying chinese gives the africans what they want and the united states all somewhat to do. we are losing the battle they are. we need to look at it as a humanitarian issue. or is nothing wrong with feeling good about what you do, but we have to get the story out. early on, we talked about the marshall plan. read, and i recognize you do, president bushes autobiography, he was asking for a medical marshall plan. i was surprised at what senator daschle said. africa, parts of

africa would hollow out. i would say when it does, does not go silent. disease can spread to the united states. disease will take the opportunity for radicalization. be opportunity for people to flee, migrants showing up at borders all over the world. helped,ed states has not just for the good we have done which is absolutely fundamental but for the real strategic interest of the american people going forward. i hope strategically that will be well understood and appreciated, especially by congress. >> thank you for that. with the benefits identified in all of these different realms, it is very clear the robust support must continue.

with some of the emerging challenges, particularly with preventing hiv, it will be needed in the coming years i would imagine. with that, i would like to thank our distinguished panel. thank you. [applause] >> it was a terrific discussion. thank you. i hope everyone has a chance on your way out to pick up a copy of the report released today on shoot you ehealth diplomacy. we welcome your feedback and comments over the weeks and months ahead. if you don't get a chance to at page 15ke a look figure six. they say a picture speaks a

thousand words, if you take a look you will see. when you have a program that has at your units of diplomacy there can be secondary effects. so, please take a look at that. i'd like to conclude today's program for saying thank you to for theirnd leadership on this project. thank you. i also want to thank the senators's staff as well. consultants.r is a politicalgh scientist and director of the global policy for governance initiative at georgetown law. i want to thank all of our panelists and moderators as well today. it is your validation of the strategic health concept that is central to support for global

health initiatives and the center of soft power diplomacy in america. i want to thank all of our funders for their support. we look forward to keep in touch. thank you. [applause] [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. 2018] announcer: c-span's washington journal, live every day with music and policy issues that impact you. coming up this morning, looking at the recent nato summit and president trump's recent

upcoming meeting with vladimir putin. the new bookabout "the brink: president reagan and the nuclear war scare of 1983." ,-span's washington journal live beginning at 7:00 a.m. eastern this morning. join the discussion. >> tonight on q&a -- >> when she came back a few days later she saw me sitting in the aisle and she physically tossed it at me and said, no change. there,ed right then and i will get that amendment ratified. never forget. i was in the library in downtown austin, texas, and i came across a book that had in it an entire

chapter devoted to amendments that had passed congress but not enough state legislators had approved it. this one just jumped right out at me. theaid, no law varying compensation for the services of the senators and the representatives shall take effect until an election of representatives shall have entered in. i can remember standing in the il holding netbook in my he and and it was as if lightning had struck. the pulsating electricity of it all. and i thought, you know what? it's that important about the equal rights amendment and the disputed extension in ratification deadline, why don't i instead write about this amendment because when members

of congress want to adjust their salary they have to wait for the next election. p.m.ncer: tonight at 8:00 eastern on c-span's "q&a." testifying before the house foreign affairs committee. this is about 2.5 hours. [gavel pound] >> we will call this meeting to order. today would look at foreign policy towards latin america and the caribbean. we are forced by deep cultural and economic ties.