Latest Developments in Countering the Global Scourge of HIV/AIDS

11:30 A.M. EST

Real Audio of Briefing

MR. DENIG: Good morning, ladies and gentlemen, and welcome to the Washington Foreign Press Center. Welcome, also, to journalists assembled in our New York Foreign Press Center.

As you all know, Wednesday, December 1st, is World AIDS Day. We wanted to present a briefing in advance of that to highlight the issues, and, more particularly, some of the latest developments regarding world HIV/AIDS and American efforts to counter this global scourge.

To discuss these issues this morning, we have a very illustrious group of briefers with us. To your far left we have Ambassador Randall Tobias, the U.S. Global AIDS Coordinator. Next to him we have Mr. Andrew Natsios, the Administrator of United States Agency For International Development, then Paula Dobriansky, the Under Secretary of State for Global Affairs, and then to your far right, Secretary Thomas Thompson, the Secretary of the Department of Health and Human Services.

Each of our speakers this morning will have an opening statement to make. After that, we'll be glad to take your questions. I'll ask Ambassador Tobias to start us off.

AMBASSADOR TOBIAS: Thank you very much and good morning to all of you. I'm very pleased to be accompanied by my colleagues here: Secretary Thompson, Under Secretary Dobriansky and Administrator Natsios. As many of you know, the President's Emergency Plan for AIDS relief is the largest commitment ever made by a single nation for an international health initiative for a single disease. It's a five-year, $15 billion initiative, multi-faceted in its approach to combating this disease in more than 100 countries around the world. And I think the presence of the four of us together here today demonstrates, really, how we are implementing the President's Emergency Plan through a coordinated, inter-agency effort across the entire United States Government.

When he made this extraordinary commitment of resources on behalf of the American people, the President recognized that we also needed a single, common, government-wide strategy, something to point us all in the same direction in implementing programs for prevention, treatment and care around the world. Since the development and adoption of our strategy last February, I think we have made tremendous progress in not only implementation of the programs but also in making collaboration a reality. And I am very grateful to these leaders and the leaders throughout the various United States Government agencies for their commitment to making this new way of doing business really work.

Building on more than 20 years of work by America to fight HIV/AIDS, the President's strategy places a special emphasis on 15 focus nations in Africa, the Caribbean and Asia, representing approximately half of the world's infections. In 2004, we contributed about as much to the battle against global HIV/AIDS as the rest of the world's donor governments combined, some $2.4 billion, and we have requested even more for the coming year.

In order to ensure the effectiveness and the sustainability of our work, we are coordinating with our host country governments and with our partners in country to support the national strategies of the countries where we are working. Already we have thousands of programs that are up and running around the world and I am particularly pleased that 61 percent of our current partners in the focus countries are indigenous organizations that are local to those countries.

The President's Emergency Plan has just received our first data from the field on treatment numbers, and we are in the process of verifying those numbers. But we're very excited by what we have seen in the reported numbers, which we believe put us on track to meet the President's expectations that we will be supporting treatment for over 200,000 people in the 15 focus nations by June of 2005, which will be the end of the program's first year of full implementation of our treatment programs.

In meeting this interim goal, we will not only contribute to more than doubling the number of people receiving treatment in Sub-Saharan Africa within a one-year period, but we will also be on track for our longer-term goal of achieving the President's objective of supporting treatment for over 2 million people in the 15 focus nations by the end of the first five years of the Emergency Plan.

The work in our bilateral programs is furthered by America's donations to the Global Fund, to which we remain, by far, the largest donor nation, as well as by our partnership with other international organizations such as the World Health Organization and the United Nations Joint Program on AIDS. Earlier, I referred to the challenge of coordinating our U.S. Government efforts across agencies. And of course, we also face that same challenge of coordination with all of the other donors on the ground. In each country where the President's Emergency Plan is working, we are coordinating with our fellow donors to implement something that generally is referred to as the "Three Ones." It is the objective of having in each country one national plan, one national coordinating authority, and one national monitoring and evaluation system.

Now, it's not easy to achieve these goals, but I think we are making good progress and building a more coordinated and effective global effort to achieve our common objectives in defeating HIV/AIDS. In fact, in the spirit of the Three Ones, the President's Emergency Plan is currently working with the staff at the Global Fund, as well as the World Health Organization and the United Nations Joint Program on AIDS, to announce comprehensive, accurate and coordinated treatment numbers at the end of January. I think that this level of close cooperation on common data between bilateral and international partners is probably without precedent.

Because women and girls are the focus of World AIDS Day [this year], let me make just a few comments on our efforts to protect them under the President's Emergency Plan. The single most important thing that the U.S. can do for women and girls is making prevention, treatment and care broadly available to them. And we are ensuring that women are fully included in all that we do and that their special challenges are particularly addressed. One key example of that work is what we are doing in support of drug therapy and counseling to prevent mothers from passing HIV to their children at birth.

The President's Emergency Plan also works to strengthen the support systems that can intervene on behalf of women and children. It works on locally designed behavior change strategies, direct tailored messages to appropriate groups, parents and others who can help girls to be educated about what they need to do; families’ and communities’ abilities to care for orphans and vulnerable children are being bolstered.

We are partnering with communities to find solutions to each of the issues that is particularly compelling with regard to women and girls, such as sexual coercion and exploitation of women and girls, as well as fighting sex trafficking and prostitution. And we are doing that while focusing on the broader range of activities in the program.

HIV/AIDS is a complex phenomenon, and its effect on women and girls has many facets. The U.S. recognizes these realities and we are confronting them with a range of interventions. For instance, the President's Emergency Plan also includes highly successful relationship and anti-violence programs aimed at men and boys to help them develop healthy relationships with women.

Women are impacted by HIV in another way because they are most often the caregivers in most of the societies where we work. And that burden, although often taken on willingly out of love for their family and neighbors, weighs more heavily upon women. So America is helping to build palliative care capacity to help relieve some of that weight.

The year 2004 will be remembered as the year that the emergency plan began. And thanks to the extraordinarily hard work of U.S. personnel all over the world, we have laid a strong foundation for the success of this plan.

President Bush's focus on this emergency is constant, and his desire for results is absolute. The President has led the American people on a historic mission to turn the tide against this pandemic and we will succeed with the help of our neighbors and our partners in the world community.

One of the benefits of working through our bilateral programs is the ability we have to leverage complementary U.S. Government programs all across the various agencies. And I'm very pleased that Under Secretary of State for Global Affairs Paula Dobriansky is able to join us today. Paula very tirelessly oversees our efforts on many of the most important issues facing humanity today. These issues oftentimes directly impact women and girls and their level of risk for infection by HIV/AIDS. And so today she is going to update us on the State Department's work in this area.

Secretary Dobriansky.

UNDER SECRETARY DOBRIANSKY: Thank you, Ambassador Tobias. I am delighted to be here with you, Secretary Thompson and Administrator Natsios. Each of you has done so much to fight HIV/AIDS and to help the women and men who are living with this pandemic or are at risk of becoming infected.

HIV/AIDS requires, first and foremost, prevention, treatment and care. Ambassador Tobias and Secretary Thompson, I know, have really put in and have talked about frequently, not only this morning but on other occasions, the unprecedented investment that President Bush has made and Congress has supported.

Yet HIV/AIDS is not strictly a health issue. Political, economic and social factors have also contributed to this deadly epidemic. This is especially true with respect to women. Just last week, a new report prepared jointly by UNAIDS and the World Health Organization stated that the rate of infection is growing more rapidly in women than men in almost every region of the world, referring to this as the "feminization of HIV/AIDS."

In Sub-Saharan Africa, 57 percent of persons living with HIV/AIDS are now women. And women between 15 and 24 years of age are three to six times more likely to become infected than their male peers.

Especially in the developing world, women shoulder the greatest burdens of HIV/AIDS, often bearing the brunt of caretaking for those who are ill while themselves facing unequal access to medical care. This can have wider implications. In some areas, eight out of ten farmers are women, and their diversion from the productive sector leads to deprivation for the whole family, affecting even basic food security.

Ambassador Tobias has mentioned a number of important initiatives for women that his office oversees, such as the President's Prevention of Mother-to-Child Transmission initiative, which makes critical drugs available to prevent newborn infants from becoming infected by their mothers.

But there are many other programs that the State Department and the Administration as a whole have undertaken specifically to address aspects of women's lives that may put them at risk. These programs seek to empower women politically and economically, helping them assert greater control over their lives. Education is an essential first step in creating opportunities and increasing the choices available to women and girls. We collaborate closely with USAID on projects that increase gender equality in basic education and provide training and vocational skills that can give women new hope and change their lives.

We also work to advance the rule of law and women's human rights, including reducing domestic violence and pressing for property and inheritance rights. President Bush has called respect for women a non-negotiable demand of human dignity; and this Administration has sought to promote that respect diplomatically and programmatically. The lack of property and inheritance rights, in particular, could keep women financially dependent on men, and can limit their control over their lives, including their sexual decisions.

Microenterprise programs can help women out of poverty, supplying additional income, creating new possibilities, and improving lives. The United States has provided over $150 million per year since 2000 for these programs, and women represent 70 percent of the clients receiving microcredit loans.

In addition, we support leadership training that prepares women to run for political office, lead businesses or nongovernmental organizations, or work as journalists. We have brought over 300 women to the United States through one such program in 2002, 2003, and 2004. They returned home with new tools to advocate on behalf of other women in their own countries or in their region.

U.S. programs also assist at-risk population groups. For example, women and children make up the majority of victims of trafficking in persons, and many are forced into sexual slavery and unable to protect themselves from H IV/AIDS or other infectious diseases. The United States Government as a whole spent some $295 million since 2000 to combat trafficking, to educate potential victims and aid those who have already suffered. More needs to be done to understand the linkages among trafficking, prostitution and public health, including HIV/AIDS.

Most refugees are women and children as well. Because of their desperate circumstances they can face higher risks from HIV/AIDS and other diseases. In 2004 we spent over $930 million to assist refugees. This includes targeted HIV/AIDS programs for refugees such as health education and prevention of Maternal-to-Child Transmission activities in refugee camps, for example, in Tanzania. The United States has also supported international programs to reduce gender-based violence, including sexual violence.

We recognize that the problem of women and HIV/AIDS is multidimensional, and we are pursuing a multidimensional response. U.S. programs in education, women's rights, microenterprise development and leadership training can help to empower women, while our efforts to combat trafficking in persons and assist refugees can help some of those facing greater risks.

Together, with the work of the President's historic Emergency Plan for AIDS Relief, we can and will make a difference. Thank you.

AMBASSADOR TOBIAS: Paula, thank you very much. Under Secretary Dobriansky has to move on to another commitment, but I'm very appreciative that she was with us here this morning.

USAID has been fighting HIV/AIDS globally for really more than two decades now, and Administrator Andrew Natsios has been a very valued partner and advisor to me in the 17 months or so since I've been in Washington and as we have developed and rolled out the President's Emergency Plan.

In addition to USAID's role in implementing our core HIV/AIDS prevention, treatment and care programs that benefit women and girls, USAID programs address many of the other needs of women in the developing countries and a broad range of other programs as well. And I'd like now to invite Administrator Natsios to make some remarks.

ADMINISTRATOR NATSIOS: Thank you very much, Randy. It's a pleasure to be here and it's a pleasure for us to work with you and with Secretary Thompson and Under Secretary Paula Dobriansky, my good friend, on this massive international effort that's now been organized by President Bush to fight this terrible pandemic.

One of the first actions I took when I became Administrator in the spring of 2001 was -- I guess it was in May, four years ago almost now -- was to send a message out, an executive message, my first to the field, to all of our AID missions to ask them to begin to look at HIV/AIDS in a multi-sectoral way instead of just looking at it as a health risk or health crisis. And what we did was to begin to look at all our programming in all of our areas to see how HIV/AIDS could be dealt with in those other sectors.

AID has at least 40 areas of expertise in development that we've worked on since the Marshall Plan, where AID's predecessor organization was formed. And we have now probably the largest micro-finance program of any bilateral aid agency in the world. It's $150 million a year. And the OECD, which is a group of donor governments, I think 28 of them, in Paris that coordinate policy, just did a peer review and we were voted, of the 17 governments and international agencies that have micro-finance programs, to be the best in the world.

What we have begun to do is to focus our micro-finance lending and training programs on women in particular who are breadwinners and whose spouses either have AIDS or are dying from AIDS in order to allow for families to support themselves if they are affected by the disease.

Secondly, we have many programs that affect children. And, as we know, there are a very large number of AIDS orphans, particularly in Africa and in Southeast Asia, that are being affected by the disease; and our programs in the health area, in child survival and maternal care have also been focused on children and orphan care.

And the third area that we focused on is the area of nutrition. It's very clear from the research we're doing that a person that is healthier nutritionally has a better chance of resisting the disease than a child or a woman or an adult who is malnourished.

And so, what we've begun doing is focusing our food aid programs. We have a $1.2 billion-a-year food aid program; President Bush, who is a big supporter of food aid, has increased our budget significantly since I became administrator for these programs.

We've begun to integrate our microfinance and our food aid programs with our HIV/AIDS programs, in terms of prevention, in terms of care, and in terms of treatment. We are carrying out a good portion of the program, the $2.4 billion program, and having all these things integrated together means a more effective response for the people who are suffering from the disease and from the pandemic.

There are countries in Africa like Botswana and Namibia where the infection rate of the adult population is approaching 40 percent. And when you have a disease that affects that many people in a society, the consequences are stunning and massive.

Now, in some countries in Africa, there are more teachers dying from HIV/AIDS than there are being trained by the teacher training colleges, and so there are crises in education. The President has doubled education spending through AID in Africa in basic education, and so we've begun to focus some of our education programs to look at the consequences for the educational system from the disease.

And so by looking at these things in an integrated fashion, we increase the chance that we can slow down the spread of the disease, treat the people who have it, and then care for the people who are affected by it.

Thank you.

AMBASSADOR TOBIAS: Andrew, thank you very much. Finally, I want to turn to my good friend, Secretary Tommy Thompson of the Department of Health and Human Services. Let me say that the Secretary has been an indispensable partner in the creation and the launch of this effort. Through his leadership at HHS and all of the various parts of HHS that are integral to what we are doing in the Emergency Plan. And in addition to that, Secretary Thompson has been the inaugural chairman of the Board of the Global Fund to fight AIDS, Tuberculosis and Malaria, and has played an extraordinarily important role there on behalf of the United States, but more broadly, on behalf of the entire world community.

So let me invite Secretary Thompson to talk to you about the Global Fund, as well as what we are doing here at home to fight this disease on our own soil.

SECRETARY THOMPSON: Thank you very much, Ambassador Randy Tobias. And it's a pleasure always to be with you, Administrator Natsios, and of course, Under Secretary Paula Dobriansky. It was just a short year ago, Randy, that you and I were on a plane flying to Africa and participated in a parade in Zambia on World's AIDS Day a year ago this week.

World's AIDS Day this Wednesday is a great opportunity for all of us to talk about the scope of the problem, as well as the chances of successes and the progress we have. It's also a chance to focus attention on a particular aspect of the disease. And this year we're focusing on how this disease affects women and girls. We estimate here in the United States -- because even though we're fighting it internationally, we're fighting it domestically as well -- that in the United States there's about 950,000 Americans who are currently living with HIV, and about 40,000 more get the virus each and every year. Women and girls compose almost half of the people with HIV in the United States. In sub-Saharan Africa, 57 percent of the individuals living with AIDS are female.

I am absolutely honored and privileged to serve as chairman of the Global Fund to fight AIDS, Tuberculosis and Malaria. I just returned for the ninth meeting of the Fund's Board of Directors in Arusha, Tanzania, this past week. I'd like to bring you up to date on the work of the Fund, and then talk about what my Department and the Fund are doing to control the disease among women and girls.

Three-and-a-half years ago, in May of 2001, President Bush announced, with the help of Kofi Annan, the creation of a Global Fund to fight AIDS, Tuberculosis and Malaria. The first contribution to the fund came from the United States. The Fund is an innovative public-private partnership that mobilizes resources to fight the spread of disease all around the world. And the United States was proud to be one of the founders and the largest contributor to that particular fund. No government has ever committed the time, the energy and the resources to fighting AIDS on both bilateral and multilateral bases, as the United States has under President Bush and under the great leadership of Randy Tobias and Andrew Natsios.

So how is the Global Fund doing? I think it's doing great. Name a company that has just been an idea three short years ago, and now this idea has grown into a business of over $5 billion in capital in less than three years of operation. That's what the Fund has achieved. And today, the Board has approved 297 grant programs in 128 countries and two territories for a total amount of $3 billion, which have been committed over four rounds of grants.

Of this amount, the Fund Secretariat has already disbursed almost $700 million. And just last week in Arusha, Tanzania, we approved a fifth round of funding that's going to roll out in the year 2005. We are also increasing the staff of the Secretariat, not that we want to increase the staff for that purpose, but we want to make sure that the Fund is going to be able to focus on measurable results. The Fund Board is insisting on accountability both from our staff in Geneva and from the recipients of our grants.

Public-private coalitions, called Country Coordinating Mechanisms, apply for money from the Fund by submitting five-year proposals, which the Fund Board reviews for performance after two years. Our first and second rounds of grants are now reaching the points of the two-year review. This means we are measuring the results that have already been achieved with the money that we've already spent. We'll take this into account when deciding which plans deserve more funding. The meeting in Tanzania was the first time that the Board of the Global Fund had met in Africa and it was very productive.

I think my colleagues on the Board would agree that the Board is maturing. We understand each other. We trust each other. And we're better able to reach consensus, while all the while remaining realistic and staying focused on the impact that we've having on real people's lives.

At the meeting the Board decided to issue a call for a fifth round of proposals in March 2005. The Board will consider these proposals for approval in September of 2005.

I was pleased with this outcome. This timeline will allow the Secretariat to staff up and focus on existing grants, as well as the renewals for the next several months, while also giving the applicants more time to polish their proposals.

The unanimous decision on a fifth round of funding reflected the Board's clear commitment to turning the tide against these diseases and ensuring the long-term viability and the accountability of the Global Fund. For the fifth round, I would like our independent technical review panel to consider how well proposals account for the prevalence of HIV among women versus men to make sure that we are funding efforts that understand and acknowledge this situation.

The United State continues to remain a strong supporter of the Global Fund. So far, the United States Government under President Bush has spent, requested, or has pledged to seek $1.9 billion to the Global Fund. That's more than a third of the $5.4 billion pledged to the Fund by all nations, organizations and individuals. The United States is by far the largest donor and has paid almost $1 billion of the $3.1 billion total funds paid into the Fund by all donors. Our commitment to the Fund is unwavering.

Congress mandated that the United States cannot contribute more than one-third of the cumulative cash reserves of the Fund, which makes international cooperation and commitment all the more important. And before the Fund Board meeting, I had the chance to meet both privately and publicly with the presidents of three of the hardest hit countries in Africa: President Museveni of Uganda, President Mkapa of Tanzania, and President Kibaki of Kenya.

President Museveni emphasized, as he always does, the importance of abstinence and fidelity in controlling AIDS. He and his wife, Janet, go on the radio very regularly to remind people to practice abstinence before marriage and faithfulness thereafter. Ugandans have responded to that message and have successfully kept their infection rate down to six percent. They have demonstrated that encouraging and motivating people to take responsibility for their lives, avoiding risky behavior, embracing changes in their lifestyles, can keep them safe from AIDS.

That is why President Bush's Emergency Plan, under Ambassador Tobias' great leadership for AIDS relief builds on Uganda's ABC model of placing a priority of encouraging abstinence until marriage and being faithful to one's spouse.

As President Museveni says, "When a lion comes into your village, you must raise the alarm loudly."

My friends, there is a lion in our village. It stalks the villages of Africa and the neighborhoods of America. And we are raising the alarm loudly everywhere. In a minute I will show you our latest ads that remind people to get tested. But first, I'd like to talk about our efforts to help women and girls in America.

Ambassador Tobias discussed the efforts of the President's Emergency Plan to protect women and children from AIDS in Africa, and I congratulate him for his leadership and his innovation in this area. It is so important for so many reasons to prevent sexual perversion and exploitation, prostitution and the trafficking in human persons, a particularly horrible form of slavery. These activities are obviously wrong in and of themselves, even before you consider their potential for spreading HIV and other viruses.

My Department is also working to target help to American women and girls. Let me just give you a few examples: The Children's Hospital in New Orleans, with support from my Department, provides confidential, culturally-competent, family-centered care to women with HIV, including transportation and childcare. They have provided a coordinated care to more than a thousand women.

The Well-Being Institute in Detroit serves HIV-infected women, mostly African American. It targets women who have sought healthcare for their HIV but have been unable to consistently follow through with their own care.

The University of Miami School of Medicine is implementing the Caring Connections Intervention which targets sero-positive women and children, helping them take their medicines and to be able to show up for their doctors appointments.

My Department is very proud to help women through these and other projects. Of course, it's also important that men know their status and take the responsibility to avoid passing HIV and other diseases to women. That's our goal behind our new ad program, "Know Your Status." It's a new ad campaign with the Ad Council, and I'd like to show you just a few, a couple of those ads, if I might.

(The ads were shown.)
MR. DENIG: Many thanks to our briefers for their opening statements. They will be glad to take your questions. We will take the first question from the New York Foreign Press Center.

QUESTION: Yes, thank you for taking my question. I am Neme Raud from Estonia.

We've heard lots of talk about Africa, Asia. Is there any specific U.S. plan towards Eastern Europe and former Soviet bloc where the spread of AIDS is also very rampant? Thank you.

AMBASSADOR TOBIAS: Well, let me remind everyone that the President's Emergency Plan, even though much of the attention is to the 15 focus countries, we are supporting programs in over 100 countries. In addition to that, we are, as you've been told, providing a third of the support for the Global Fund, which is working, also, in over 100 countries.

We are working closely with the United States Ambassadors to each country, who, in each case, have formed an interagency team of people from Health and Human Services, and people from USAID and other agencies to work closely together to address the problems there.

This is an issue, this is a disease that is not going to respect borders, and so in a variety of ways, we really need to take a very global view.

SECRETARY THOMPSON: Can I respond to that?

AMBASSADOR TOBIAS: Yes, please.

SECRETARY THOMPSON: We have a delegation and a Board member from Eastern Europe who serves on the Global Fund Board. And we are in 128 countries and we've got over 200 programs going in many different countries; several of those are in Eastern Europe. I can't tell you if Estonia's got one of those or not, but I know a lot of the countries surrounding there do, and we're going to continue to look at it, and if Estonia doesn't have one this year, they certainly will be applying in the fifth round as they have in the past.

ADMINISTRATOR NATSIOS: If I could just add, I was in the Ukraine in the spring of this year and met with the AIDS networks through the NGO community that USAID has been funding for several years now. These are indigenous NGOs; USAID does the funding directly, not through the Ministry of Health, in supporting civil society responses to the HIV/AIDS spread.

As you know, in many of the Eastern bloc countries, the transmission is principally through drug networks -- people who use dirty needles may infect themselves and other people. That's the primary mechanism for the spread of the disease. But the two fastest growing countries, even though the population are small, are Russia and India now. So it is a serious problem. It's a small number of people, but the percentage growth is high, and so USAID has programs in Eastern Bloc countries on HIV/AIDS, and has for several years now.

MR. DENIG: Here is a general response to everybody: If you want to know specific amounts of aid that are going to various countries, we can give you the list afterwards.

Let's go to Africa, right up front here.

QUESTION: Adam Ouologuem with the African Sun Times.

There was a good information today regarding a vaccine implemented by Dr. Jean-Marie Andrieu of the University of Paris-V, which was tested on some number of AIDS patients, and the news says that they are free of the AIDS virus up to 90 percent. Are you aware of this information? And if you could give us your input on that?

AMBASSADOR TOBIAS: Well, I'm not specifically aware of that information, but there is a great deal of work going on on vaccines, and in the long term, it's a very important effort.

Do you, Secretary Thompson, want to comment any further on --

SECRETARY THOMPSON: There's of work going on in vaccines. Out at NIH, Dr. Tony Fauci is leading many efforts, and there are several programs that are under examination and looking for further examples, but as far as that particular one, I'm not familiar with it.

MR. DENIG: Okay. Let's go to Guinea, up front here please.

QUESTION: Thank you, sir. My name is Ben Bangoura. I'm Washington correspondent for Guinea News and Radio Tam-Tam.

Most HIV/AIDS advocates agree by pointing out that if developing countries were able to manufacture AIDS drugs in their own countries, that would be a great help in terms of drug availability to everyone affected. Is Mr. Bush plan provide anything along that line?

AMBASSADOR TOBIAS: Well, I'm not sure that there is a need to manufacture drugs in every country, but certainly there is a need to ensure that drugs are broadly available and that the drugs that are being made available are safe and effective and of very high quality. And so the policy of President Bush's Emergency Plan is to provide funding for drugs that are manufactured by any company any place in the world. And we're interested in finding the least expensive drugs that we can find. But we also want to be sure that any of the drugs that we are funding are safe and effective and of high quality.

And so Secretary Thompson put in place through the FDA at HHS an expedited review program that he and I announced earlier this year, inviting every company any place in the world to submit their AIDS drugs for an expedited review at the FDA. And if those drugs are given what's called "tentative approval," meaning that they passed the bio-equivalency standards and are deemed to be safe and effective and of high quality, then they will become eligible under the funding for the Emergency Plan.

There are certain economies of scale here, so that I'm not sure that it's really necessary that every country manufacture its own drugs. But as we are successful in getting more and more people under treatment, clearly the supply and the management of the supply chain and the dependable quantity of drugs is going to be very important as we go forward.

MR. DENIG: All right, let's go to Russia in the second row, please.

QUESTION: Pavel Vanichkin, TASS News Agency of Russia.

Ambassador Natsios, you mentioned India and Russia as the potential hotspots of AIDS. What's the United States approach to these countries? And what do you think the Russians, as well as Indians, should do themselves to handle this problem? Thanks.

ADMINISTRATOR NATSIOS: There is an increasing awareness in Russia of the problem within the ministries themselves and by the national leadership. That had been a little slow in coming in some respects, but it's now, I think, reached a senior level.

We tend to work through civil society in most countries. We coordinate with the ministries of health. We want our policies and programs to be consistent with the approach they're taking, so we've worked with people in the ministry in Moscow.

But our approach in Russia, as is the case in the Ukraine and in many countries in Africa and India as well, is through civil society, through NGOs, through faith-based organizations. In a number of countries, for example, AID for a decade now has been working with religious institutions. I was recently in Ethiopia and I met with the Patriarch of the Ethiopian Orthodox Church, and we are working with the Patriarchate and the archbishops in the Ethiopian Church on HIV/AIDS. And I also met with the Chairman of the Islamic Council. Forty percent of Ethiopia is Muslim. And we are working with the mullahs in the mosques and the priests in the churches in Ethiopia. And we're doing this in many other countries as well because they can be a very powerful force in spreading the message on behavior change. Abstinence and faithfulness are issues, which, not only in Christian teaching, but also in Islamic, Jewish, Buddhist teaching as well, have a central role. And so working with the religious institutions has been very important for us over a very long period of time.

Thank you.

SECRETARY THOMPSON: I would like to just interject something here. We have found, from the Global Fund's perspective, that the government leaders that get involved and really lead on this subject can really make a difference within their country. The prime example of that is President Museveni in Uganda. He has proven time and time again, and he and his wife Janet get out on television, get on radio, go in communities, go to schools, ask people to come in and be tested, and they're really doing a tremendous job of leadership.

I have gone to Russia and met with the Minister of Health in Russia, as I've gone to India and met with the Minister of Health in India. And I'm trying very hard to get the ministers of health, and all of them have indicated that they are going to become much more focused, much more involved. But it really takes a commitment from the leadership of the government if you're going to really turn it around. And that's what Russia needs to do; that's what India needs to do; and I think through their ministers of health that's what they're starting to do.

MR. DENIG: Let's take the next question from New York, please.

QUESTION: Yes, thank you. Secretary Tommy Thompson just mentioned that governments that lead make a difference. In the initiative that is being taken now by the United States, are there legal provisions for governments or leaders that are not helping or protecting their own people, in particular in terms of the children's rights and orphans?

AMBASSADOR TOBIAS: Well, there are not explicit provisions in the program, but as Secretary Thompson has said, I think that when any of us are asked about the single most important element in being successful in this fight, I think there's no question that it is leadership. And so in those countries where it is not taking place, we are using every means available to us to encourage that kind of leadership. And it's leadership at all levels. It starts at the national level, but on through.

While our prevention strategy is based strongly on the ABC approach that was developed in Uganda, it's also true that there are a number of other issues that need to be addressed: Among them women's rights, children's rights, the issues of exploitation of people, and we are working not only in the Emergency Plan, but cooperatively with other programs in the United States Government to do everything we can to leverage those programs also.

MR. DENIG: All right, let's go to the gentleman in the middle, please.

QUESTION: Thank you. Excuse me. My name is Arshad Mahmud, and I represent Prothom Alo in Bangladesh.

And my question, first to Secretary Thompson: You emphasize the role of abstinence and faithfulness. Do you foresee some kind of enhanced role of religious organizations -- mosques, synagogues, and Christian churches to promote that kind of message?

And number two, there are 40 million people now infected, and three million people died last year. And you have committed billions of dollars to battle this thing. And we have noticed before, when there is a crisis of this proportion, so many groups come up to grab a slice of that money, to do this and that, and ultimately, it doesn't really help much. Have you given some thought to that, how to prevent these kind of things? Thank you.

SECRETARY THOMPSON: Well, I think this is a subject that every one of us up here has got some observations about. I don't think there's any one perfect model. I think the religious model, that faith-based organizations can play a tremendously important role. But government leaders, NGOs, Country Coordinating Mechanisms (CCMs), Local Financial Authorities (LFAs), all of these, from the Global Fund's perspective, can play a role. I don't think that you can just point to one model and say that's the only model that can be utilized and the only one that will be successful. What we're trying to do is we're trying to bring in as many diverse groups, as many diverse people and organizations as possible to battle this insidious virus wherever it possibly comes up. And so, the faith-based organization can play a great role, but so can the government leaders.

In regards to accountability, that's one of the reasons that we set up the three tier -- that thing you have. You have the government leaders, you have NGOs, you have CCMs, and you have LFAs. The CCMs apply for the money through the Global Fund, but then we hire LFAs, financial authorities, that go in and look and audit the books and make sure that the results are there and make sure that the money is getting to the people that need it. It's a little bit bureaucratic, but it works. And we're making sure that there's accountability. It's a different model than what Ambassador Tobias is doing, but Ambassador Tobias is also using ways in which they can get accountability.

QUESTION: (Inaudible) slow down this effort, the bureaucratic process?

SECRETARY THOMPSON: Pardon?

QUESTION: The bureaucratic process that is just mentioned involved in this thing. Don't you think it's going to slow down the efforts?

SECRETARY THOMPSON: I don't see how you can say that when you look at our record. We've been in operation less than three years; we've raised over $5 billion; we have committed $3 billion of that $5 billion; we're in 128 countries plus two territories; and we're in over 275 different programs in less than three years. There's no example, ever, of any particular organization reaching that kind of status and stature [so quickly] before. So I would say that bureaucratically, it hasn't slowed us down a bit. It may in the future and we may have to refine it. So we want to make sure -- to get back at what you asked in the second part of your question -- make sure that money gets to the people that need it, the people that are sick.

MR. DENIG: Let's go to the far right please.

QUESTION: Jim Lobe, Inter Press Service, Italy.

I have one question for Mr. Tobias and one for Secretary Thompson.

Mr. Tobias, you mentioned the FDA expedited approval. How many drugs have been tested to date? If there haven't been very many, why is that? And how many have been approved, if any have been tested?

And to Secretary Thompson, the Congress just cut from the omnibus spending bill about 200 million for the Global Fund. I guess, did they come to you and ask for your advice as chairman of the Global Fund? It seems to me you have a kind of tricky position, both with respect to the Administration and as chairman of the Fund.

Obviously, more money for the fund might encourage more donors to provide more money. How did you -- if they did come to you, how did you handle it? How did you think it should have been handled?

AMBASSADOR TOBIAS: With respect to your first question, I don't know the exact number, but we can get that for you. But there are companies that are in various stages of either having submitted their material or having announced that they would be submitting their material but perhaps having not done so.

I think in a number of cases, companies have been looking at their data to ensure that they had good, solid data to submit; and there may be other reasons why companies haven't moved more quickly. But there are a number of companies that are now moving in this direction, and that's very good news; and we've been doing everything we can to encourage companies to apply expeditiously.

SECRETARY THOMPSON: Ambassador Tobias is absolutely correct. So far, there have not been any approvals through FDA for any of the expedited process. We have just received our first application, and we will be going through the application very quickly.

In regard to your second question, I was in Africa when Congress was making the determination on the Global Fund. But you've got to realize that last year the amount of money that was appropriated could not all be utilized. Because if you remember what I said -- and the law is is that the United States cannot contribute more than one-third of the cash that's going into the Global Fund. We had exceeded that, so the amount of the appropriation from last year, fiscal year 2003, was not able to be fully utilized. I think it was -- Randy was left an 80 or 90 --

AMBASSADOR TOBIAS: $88 million.

SECRETARY THOMPSON: $88 million that could not be utilized.

No, Congress did not ask me. I knew the situation was going on. We had sent a message to them that we were hoping that they would continue to fund it at the level it was before. But I don't think it's that tricky. I think that Ambassador Tobias and I have one of the best working relationships you absolutely can imagine, in regards to bilateral assistance, as well as the Global Fund. We work together because we've got an insidious problem out there fighting AIDS, tuberculosis and malaria.

MR. DENIG: Let's have a very quick question from the lady in the middle, please.

SECRETARY THOMPSON: I've got to run.

MR. DENIG: Okay. Thank you, Mr. Secretary.

SECRETARY THOMPSON: Thank you.

QUESTION: Secretary, is it okay if I ask you one last question. It was for the Secretary. I'm Muna Shikaki from Al-Arabiya TV.

I was wondering about the funding for educational programs to prevent AIDS that concentrate on abstinence versus those that talk about condom use, and if there is any change in the U.S. policy within the last 20 years with regards to funding for these programs.

SECRETARY THOMPSON: I haven't been around 20 years, I'm sorry to say -- but I haven't been around 20 years. You know, we 're looking at many different ways. There is just, as I'd indicated to an answer before, there is no one perfect answer to that particular problem. We're trying to fund and trying to make sure that all of these facets are looked at and we try to put the money where we're going to be the most successful.

QUESTION: You don't have preference for specific programs that focus, for example, on abstinence as opposed to condom use?

SECRETARY THOMPSON: I have a preference for those programs that work.

MR. DENIG: Thank you, Mr. Secretary, appreciate it.

SECRETARY THOMPSON: Thank you.

MR. DENIG: All right. Did we have a question from Latin America, on the far right, one last question?

QUESTION: Yes. I'm Nestor Ikeda, an Associated Press reporter for Latin America.

As you know, one of the major problem for treating the AIDS patients in poor countries is the cost of the drugs. And some countries, like Brazil, were trying to break down the formula for those drugs in order to make more accessible for the AIDS patients. What is the U.S. Administration position on that kind of attempt by trying to break down the formula of those drugs?

AMBASSADOR TOBIAS: Well, there are international agreements and international understandings that have been put together to address intellectual property issues, the net effect being that countries in the developing world who are facing an HIV/AIDS crisis have the capability under these understandings to issue a mandatory license so that they can, in effect, copy for use in their country drugs that are under patent protection, let's say, in the United States. They further have the capability to issue an import license if they don't have the capability within their own country -- and many do not -- to manufacture those drugs themselves.

So the net effect of that is that it is possible for countries in the developing world to bring in drugs that are copied from patented drugs that may be manufactured in their own country or someplace else in the world in order to address this issue in their country. That, then, leaves the issue of safety and effectiveness and quality.

And so we have a policy that we will buy the least expensive drugs we can find without regard to the company that manufactured them or the country of manufacture, as long as they comply with the provisions I just described, and as long as they are demonstrated to be safe and effective.

So I think we have a good, solid program in place to really encourage many companies to be in this business and to be sure we have a large supply of drugs around the world as treatment programs are ramped up.

MR. DENIG: Thank you very much. Thank you, ladies and gentlemen.