Lambros Papantoniou Against the PEPFAR Drug Pushers

December 1^st 2008

MODERATOR: Good afternoon. As this is World AIDS Day, we are very pleased to have the Deputy Coordinator of the U.S. Global AIDS Office, Ms. Michele Moloney – did I pronounce that correctly? And she will be giving us a report on the President’s Emergency Plan for AIDS Relief. Please.

MS. MOLONEY–KITTS: Thank you. Thank you very much. I just have a few opening remarks and then we can take questions and answers.

So for more than 25 years, the world community has witnessed the devastating impact of HIV and AIDS. And until recently, many wondered whether prevention, treatment and care could ever successfully be provided in resource–limited settings where HIV has historically been a death sentence. Just five years ago, only 50,000 people living with AIDS in all of su b–Saharan Africa had access to treatment. In 2003, President George W. Bush promised to lead the fight against global HIV/AIDS with the President’s Emergency Plan for AIDS Relief, or PEPFAR, which is the largest commitment by any nation to a single disease internationally in history, actually.

Through PEPFAR, the U.S. Government has already provided $18.8 billion, so we exceeded our initial commitment of 15 billion. And recently, the U.S. Congress authorized up to $48 billion for HIV/AIDS, tuberculosis, and malaria over the next five years. So we basically have recommitted ourselves and provided, hopefully, resources to meet those commitments. Through the power of these partnerships, dedicated men and women in nations devastated by HIV and AIDS, with the support of the American people and others around the world, have proven that the seemingly impossible is possible.

What I’d like to share with you briefly is some of the program results, because today is World AIDS Day. And I think as many of you know, when PEPFAR was announced, the program set out aggressive goals to s upport 2 million people on treatment, prevent 7 million new infections, and provide care for 10 million people infected or affect ed by AIDS, including orphans and vulnerable children.

I’ve just come from the Saddleback Forum on Global Health, and at this event, President Bush announced that the United States has fulfilled its commitment to support treatment for over 2 million people–ahead of schedule. And as of September 30th, 2008, PEPFAR supported lifesaving antiretroviral treatment for over 2.1 million men, women, and children living with AIDS around the world. And in addition, as of September 30th, nearly 9.7 million people affected by HIV/AIDS in PEPFAR’s 15 focus countries have received compassionate care, including=2 0nearly 4 million orphans, which is safe to say that as of December 1st, the U.S. has also met the global goal of supporting care for 10 million people affected by HIV. We’ve also provided support to the prevention of mother–to–child transmission, and nearly 240,000 babies have been born free of AIDS thanks to their ability to access these services.

In the next phase of PEPFAR, we have new goals, which are to support treatment for 3 million people, prevent 12 million new infections, and care for 12 million people, including 5 million orphans. Some other changes in the next phase of PEPFAR also include a real focus on addressing the human capacity and healthcare worker issue in Africa, which I know people know is really devastating, and looking more at the integration of HIV/AIDS with other health and development programs.

But what makes PEPFAR work is not really just about providing services or sending messages or working with individuals. What makes PEPFAR work is the power of partnerships. And PEPFAR represents, really, a bold change from traditional thinking about HIV and development, and it really presents a change in kind of typical or traditional donor–recipient relationship s. Basically, PEPFAR tries to mobilize broad resources that would include the faith community, community–based organizations, schools, clinics, and leadership at the highest level as well as at the community level to really change the face of AIDS. We know it’s not something that governments can do alone or individuals could do alone. It’s only through partnerships.

So our theme for World AIDS Day this year is celebrating life. And we think that if this is the 20th anniversary of World AIDS Day and you think about where we were 20 years ago in the fight against this disease, how fa r we’ve come is really remarkable, and we’re pledged to continue the fight into the future.

And with that, I’ll stop and I’d like to take some questions. Thank you.

MODERATOR: I would ask, please, that you identify yourself and your media before the question. Mr. Lambros.

QUESTION: Lambros Papantoniou, Greek correspondent, “Eleftheros Typos”, Greek Daily, Athens. Ms. Maloney, first of all, what happened to the Global Coordinator Mark Dybul? Where is he today?

MS. MOLONEY–KITTS: The Global Ambassador Dybul, the Global…

QUESTION: Yes.

MS. MOLONEY–KITTS: – AIDS Coordinator? He has been with the President and he’s currently at the White House.

QUESTION: Okay. And as a Deputy Global Coordinator, Ms. Maloney, have you seen HIV isolated virus from the blood or tissue from any person who is HIV–positive? And do you have any paper to this effect?

MS. MOLONEY–KITTS: Indeed, I think – are you getting to the question of is HIV really a virus?

QUESTION: I sai d – the question is that if you saw – if you saw any HIV isolated virus from a blood or a tissue of any human being? (Inaudible.)

MS. MOLONEY–KITTS: I apologize. I have colleagues at NIH and other institutes who are virologists and who have studied the virus for a very, very long time. They are probably more ably equipped to answer the question than myself who basically implements a program. But if – but absolutely we have evidence that HIV/AIDS does exist, yes.

QUESTION: Question based to your answer. Do you know where we can see the original paper of the existence of HIV virus that causes AIDS and is transmitted sexually? We would like to see what is going on.

MS. MOLONEY–KITTS: Well, I mean, we have many scientis ts who discovered the HIV virus starting with, you know, at both NIH here in Bethesda, as well as in France. And I would encourage you, if you would like to have more information about that, we can help direct you. I’d like to maybe not take time right here, because I think I need to direct you to some scientific resources, which I don’t have immediately available to me.

QUESTION: Based on whatever you told us earlier from the data you provided was very useful for those who are suffering. However, Doctors Without Borders stated before yesterday that Africa does not need AIDS drugs, but food. How do you comment?

MS. MOLONEY–KITTS: I think Africa needs both. And I think that what we are finding is that, in fact, people need many th ings. And we have some very innovative programs that basically provide not only antiretrovirals, but I think you have to start at the very beginning. People need to have information about AIDS. They need access to counseling and testing, so that they can know their HIV status, which means that they can either continue to prevent the disease or they can seek care and treatment if they need it.

When they get care and treatment, of course, they may need support with nutrition, particularly in the beginning, as sometimes HIV/AIDS drugs are difficult to absorb and they may be very malnourished. Also I would say people need access to long–term sustainable income generation. Children need access to education. So there are many things that people need. We have a very specific mandate from Congress to achieve very specific results in HIV and AIDS. We believe and will continue to work on the linkages between the different sectors, because we think they’re hugely important.

QUESTION: And one more –

MODERATOR: We have a question from New York.

QUESTION: One more question. And how do you explain the fact, Miss Moloney, that sixty-three HIV vaccines trials failed from an isolated virus, as you said earlier, of 25 years?

MS. MOLONEY–KITTS: Again, I’m sorry, I’m just not the scientist. But you should20ask them, because it’s a good question.

QUESTION: Thank you.

MODERATOR: New York, please go ahead.

QUESTION: My name is Bukola Shonuga and I’m from Africa Independent Television. There are 33 million people living with HIV worldwide. Many do not know that they are infected, especially in Africa, so my question is: Does PEPFAR have any agenda on the table to help those people, especially Africa, about the awareness of this disease and how do they plan to treat them?

MS. MOLONEY–KITTS: Thank you. It’s an excellent question. And absolutely, we think that it is incredibly important that people know about HIV, they understand how it is transmitted, they unders tand how they can prevent it. And as I stated earlier, we think that access to counseling and testing is very, very important. And in PEPFAR programs around the world, one of the very important things we do is help set up counseling and testing services. We provide laboratory equipment. We work on policies that make sure that if there is a lot of HIV/AIDS, any pregnant woman has access to a test. People with tuberculosis have access to tests. People who live in – who are in a hospital for an illness have access to a test, because we think it’s so important that you know your HIV status.

One of the challenges that we face is that in many places, populations are remote, they don’t have access or it takes two or three days to get to a health center. And we have been supporting very innovative approaches to counseling and testing that include mobile vans that go into communities and provide the counseling and testing. We’ve also supported the development of rapid tests, so people can get their results right away.

QUESTION: Hyung Chui with Munhwa Daily, a leading Korean paper. I think the HIV project has shown the exemplary global leadership of the United States. I would like=2 0to appreciate your great initiative. I wonder if Korea or Japan and China notice in Asian countries which were – have been regarded as a safer region relatively, so what kind of efforts of global partnership were supposed to do to provide with your great initiative?

MS. MOLONEY–KITTS: Thank you for that. And I maybe heard two questions, and I might try to answer both. The first was: How do we partner with countries like China, Japan and Korea, and the second might have to do with epidemics in Asia. So on the first, we definitely view our internatio nal donors and certainly Japan and China and Korea as very important partners in the fight. United States Government resources are not only provided on a bilateral basis for the fight against AIDS, but we also support multilateral institutions. And certainly, the Global Fund for AIDS, TB, and malaria is a very important institution that the U.S. Government helps finance, but also receives financing from other countries in Asia. So we do look at those for – also as a part of the G–8, we make our commitments known.

In terms of the epidemic, and we do have partnerships with all three countries, in terms of the epidemic, Asia is very interesting. There20is an emerging epidemic there. In China, in particular, it’s largely driven by injecting drug use and the Chinese Government has actually been quite enlightened in their work to really provide a comprehensive approach to HIV/AIDS and drug addiction. They provide methadone to help people get off of their drugs, so that they can be more adherent to their AIDS treatment. But certainly, it’s a major epidemic emerging there, and we’re partners in the fight.

MODERATOR: Are there any more questions in New York just before – no, okay.

QUESTION: Lambros Papantoniou, Greek Correspondent, Deputy Global Coordinator, I’m wondering since there is a disagreement about the existence of HIV virus, why you don’t bring the two sides together in order to have a conference, here in Washington, D.C., for a full dialogue for a final solution?

MS. MOLONEY–KITTS: I guess it’s maybe because we don’t think that there is a controversy. The only people – I mean, to my knowledge, the only place that th ere’s ever been a suggestion that there hasn’t been really an HIV virus has been largely the minister – the ex–minister of health of South Africa, Minister Manto, and I think that there’s been some discussion in South Africa about that. But it is not really credible in the international scientific community. And I think that if you have the opportunity to see people who are dying from AIDS come back to life when they receive antiretroviral therapy, the fact that we can monitor the level of the virus in their bloodstream, and we see that when they come in, where the virus is, and then what happens after we give them the20drugs, and in fact, there was an article – in fact, last week, that I would encourage you to look at, that comes out of the Lancet –
–

QUESTION: I saw that.

MS. MOLONEY–KITTS: – where they’re actually suggesting that if we can test, you know, many, many people, that we can put them on treatment very early, that in fact, th e model suggests that that might be a very important way to prevent the spread of the epidemic.

QUESTION: Ms. Moloney, since whatever you are saying have a basis, why then anyone does not release any paper, legal paper, that the virus exists? So far – what do they say – they say out of 400,000 research papers (inaudible), I never saw any kind of paper to this effect, as you just told us.

MS. MOLONEY–KITTS: Did you look at the Lancet?

QUESTION: Since you are talking about the existence of the virus, I was wondering why you don’t release any paper which says that the virus exist? I didn’t see it. I din’t see anyone so far
.

MS. MOLONEY–KITTS: I think there is many papers on the existence of the virus, including the ones that20were relea sed in the very beginning of the epidemic when the virus was released. But what I would like to do seriously is that – why don’t I take your card and then we can – I can go back to my experts and we can provide you with the scientific resources that you’re looking for.

QUESTION: Not a scientific one. Kevin de Cock…

MS. MOLONEY–KITTS: Right.

QUESTION: the head of HIV/AIDS of the World Health Organization, stated the other day – quote – The HIV heterosexual epidemic is over except in Africa – unquote. Why not in Africa?

MS. MOLONEY–KITTS: The reason why I’m hesitating is because I know Kevin de Cock extremely well and I find it surprising that he might have said something quite like that. But certainly, the reason why we have what we call really almost a hyper–epidemic happening in southern Africa where infections continue to spiral, new infections, no matter how well we’re doing on getting people on treatment, we’re definitely fighting an uphill battle.

And we think that there’s probably many reasons. It may have to do with behaviors. It might have to do with once you start at a certain number of people who are infected in a community, then just by modeling, you can see that you would have more and more people who have opportunity to be exposed. There are different kinds of viruses. Cert ainly, we know now that you are more infectious at different stages of your disease. So it’s probably a combination of factors, but certainly, there’s a behavior.

QUESTION: And the last one. Here in Washington, D.C., the rate of infection among black men is over 100 times higher than in North Dakota with the lowest rate. Washington, D.C. is the number–one region all over the world. How do you explain that?

MS. MOLONEY–KITTS: Well, it’s not in the world, but it’s amongst one of the highest.

QUESTION: 57 percent of the blacks are infected.

MS. MOLONEY–KITTS: Fifty–seven percent among African American men of –

QUESTION: That’s right.

MS. MOLONEY–KITTS: I t’s one out of eight is my understanding.

QUESTION: One out of 20, correct?

MS. MOLONEY–KITTS: I’d have to double–check the figures.

QUESTION: In the District of Columbia?

MS. MOLONEY–KITTS: In D.C. It’s very high, there’s no doubt about it. So why is it higher here than it is in North Dakota?

QUESTION: And the rest of the country?

MS. MOLONEY–KITTS: It’s – it – you will find it always higher in communities of lower socioeconomic status, and particularly, we know it’s an epidemic in African American communities. It is tied to the same things as – transmit AIDS around the world: lack of knowledge, lack of understanding of what transmit – how the disease is transmitted, inequality in relationships, poverty, injecting drug use, multiple partners, those kinds of issues. And certainly, those are issues that the District is aware of and is working on trying to combat.

Thank you very much. Thank you.