The U.S. President's Emergency Plan for AIDS Relief

KIM NISBET: All right. Thank you so much for coming this afternoon. I'd like to welcome Dr. Mark Dybul, who's currently serving as the Acting United States Global AIDS Coordinator for the President's Emergency Plan for AIDS relief. He's greatly contributed to the fight against HIV/AIDS through his work with the National Institute for Health and Human Services and the World Health Organization and now as Global AIDS Coordinator. It's an important time for everyone right now, marking the 25th anniversary of the discovery of AIDS which will be next week, I believe, June 5th.

DR. DYBUL: June 5th is the -- what they say is the actual day.

KIM NISBET: And so I'll go ahead and let Dr. Dybul take it from here. Once he gives his opening remarks, then we'll go on to questions and answers. I believe we have the Washington Foreign Press Center also linking up via a DVC. I'm not sure if there are questions, but will they let us know, yes. Please state your name and affiliation before asking your question. Thank you.

DR. DYBUL: Thank you, Kim. And thank you all for coming. I know there's a lot going on in New York today, so we appreciate your taking the time to come be with us and to share information on this very important issue, Global HIV/AIDS. As Kim mentioned, this week gives us an opportunity to look backwards a little bit. It is the fifth anniversary of the 2001 declaration on HIV/AIDS by the UN General Assembly Special Session. But as Kim mentioned, it's also the 25th anniversary of the diagnosis of the first case of AIDS, so we have an opportunity to look back. And unfortunately, and very sadly, mourn the death of 25 million who have been taken from this disease. But most importantly, we think to look forward to how we can best save the lives of the 40 million people who are currently living with HIV/AIDS globally, and most importantly perhaps prevent as many new infections as possible. And that's why we believe this is an important week and this is an important session.

Our goal for this week is really to look at that big picture, to look at what we need to do globally together to tackle this epidemic, to look how we can save the greatest number of lives, and most importantly to focus not on individual words and declarations or even on declarations themselves but on action that comes out of declaration. And action has been the watchword for the United States on Global AIDS under President Bush. Just looking back to 2001, in 2001, globally the world was providing about $1.6 billion for HIV/AIDS and no one was talking about treatment. No one was talking about treatment, even at the General Assembly meeting.

In 2003, President Bush announced his Emergency Plan for AIDS Relief. That plan is the largest international health initiative in history dedicated to a single disease, a rather remarkable statement, I think. Still is the largest international initiative dedicated to a single disease, $15 billion over five years. And as Peter Piot has said, it was really President Bush's Emergency Plan that moved us from a discussion of millions of dollars to a discussion of billions of dollars for HIV/AIDS.

So I think it's important maybe to begin with money because dollars are necessary, resources are necessary to move. As I mention, this $15 billion initiative, the largest international initiative in history, comes at a time when the world was providing very little. Again, going back to 2001, because we are at the five-year point, the United States alone was only providing $840 million. In 2007, the fourth year of President Bush's five-year initiative, the President is requesting $4 billion, more than quadrupling of the commitment by the American people.

Now unfortunately, since 2001, and even since 2003, since President Bush announced his Emergency Plan, we have not seen that kind of dedication of resources from the rest of the world. It is estimated right now that approximately half of all global resources coming from international partners for HIV/AIDS come from the American people. In other words, the American people under President Bush's Emergency Plan are doing as much as the rest of the global international partner governments combined. And as we look forward to what needs to be done, we cannot tackle this problem as long as the United States is half, or as long as the United States is doing as much as the rest of the world combined. We need a stepped-up commitment and we hope coming out of this declaration, we get increased commitment from the rest of the world in this global fight.

I think it's important though to move beyond dollars to talk about what the dollars are doing and where we've come since 2001. As I mentioned in 2001, no one was talking about treatment. No one was talking about treatment. In fact, there seems to be some amnesia this week that there were actually people back then saying it was not possible to provide treatment in Africa, that there was no infrastructure and it just wouldn't work. There were people saying that it's not cost effective to treat people.

President Bush basically forcefully said that is not the case in 2003. It was the first international initiative -- funded international initiative to say we have to have integrated prevention, care and treatment, that we can't just have prevention, that we can't just have care, that treatment needs to be an integral part. And so he set global goals getting to action, action making resources work, supporting treatment for two million people in 15 focus countries, where 50 percent of the infection in the world is, supporting treatment for two million, supporting care for 10 million HIV-infected people and orphans and vulnerable children and supporting prevention of 7 million new infections in those countries.

I think it's also important to note that President Bush's Emergency Plan is not just the so-called two, seven and ten goals in these 15 focus countries. In fact, the Emergency Plan is very complex. It includes the 15 focus countries where we project commitment of $10 billion over five years or more. It also includes bilateral programs in another hundred countries around the world, including some countries represented here, like China and others, so it's not just 15 countries, it's 120 countries around the world. It is also our contribution to the Global Fund. The United States remains, by far, the largest contributor to the Global Fund. That is part of President Bush's Emergency Plan. That is part of PEPFAR as part of our strategy.

We are currently about 30 percent of resources for the Global Fund, which means that every grant that the Global Fund issues right now, 30 percent of that comes from PEPFAR. Thirty percent of that comes from the American people. And so that's the comprehensive and complexity of the Emergency Plan that covers an extensive bilateral program, but also the largest contributions to the Global Fund. And so as we talk about results, we're talking about results and activities in that larger picture.

When one looks at prevention, I think we need to focus on prevention as well, looking back to 2001. In 2001 there was no evidence of control of the epidemic in particularly sub-Saharan Africa. The only projections were for increased significant increases. Now five years later we're seeing remarkable progress. Back, even in 2001, we saw Uganda having some reduction in their infection. In fact, a significant reduction in their infection rate, more than 50 percent. In this past year, we have seen reports from Kenya and Zimbabwe and Botswana and 10 countries in sub-Saharan Africa have significant reduction in infection. In each of those countries where we've looked, it has been very clear what is the behavior changes that are associated with these reductions in prevalence. And in each case, it is incredibly clear it is associated with abstinence, being faithful and correcting consistent condom use, or the ABC's, all three components. Must have all three components to turn the epidemic in Africa and that's a fundamental piece of President Bush's Emergency Plan to support those evidence-based activities that will reduce infection.

So again we hope in this week -- in this week we will see a focus on commitment to the future. We will see a focus on going beyond words. We will see a focus on action that President Bush took for the American people in 2003 when he announced his Emergency Plan. The American people will remain committed through the Emergency Plan and beyond to support countries around the world to stand shoulder to shoulder with people of the world in their fight against HIV/AIDS. And with that, I'd be happy to answer any questions.

KIM NISBET: We’ll go aheadand open it up to questions. Before we get started, make sure to state your name and affiliation first before asking a question. Does somebody want to -- oh, thank you. Does somebody want to go ahead with the first?

QUESTION: My name is Shingo Egi from Asahi Shimbum. You mentioned that it's not an issue of words, but how it actually happens. But we're hearing during this AIDS conference that the Americans are resisting some kind of figures of the amount it goes to set on fundraising. Notably, it's something about 22.8 billion in 2008. Could you give me the reason?

DR. DYBUL: A couple of things on that. First of all, the United States doesn't believe in negotiating in public. Unfortunately, a lot of other people do and there's more misinformation out there than you can possibly imagine. The misinformation in today's news stories is unbelievable and absolutely untrue in terms of what U.S. Government positions are.

On the specific issue of resources, targets are not something we shy away from, particularly funding targets. I would challenge anyone in this room to find anyone's who's committed to five years or anyone who's committed to anything, even in the ballpark of $15 billion over five years, which is why we're sitting in a position now five years later -- five years from original targets and original goals with the United States having the only five-year massive initiative at this point.

Except for the countries themselves, we've seen an extraordinary effort on behalf of the countries themselves in putting resources forward. But we've not seen the same global commitment and this is a global epidemic that requires a global commitment, not just a United States commitment. We welcome increased commitments and increased resources from other countries. We welcome goals and targets from other countries. We would love to see out of this meeting a number of other countries step forward and say we do need a larger commitment and this is what we're going to do and the United States has done that. The United States, to my knowledge, is the only one that's done that on a massive scale since 2001.

So now we're five years later, we think we have done exactly what needed to do be done. We are not opposed to targets in terms of resources. We are not opposed to targets in terms of goals. We actually have again clearly stated targets and clearly stated goals that money itself is not enough, that you need to not only have goals in terms of dollars, but goals in terms of targets.

However, I think it's also important to note that this is not the only meeting on HIV/AIDS internationally over the last year. There have been five, six, seven. All of which have had negotiated language and negotiated agreements. In September, the UN General Assembly, the very organization that is coming together this week, met and agreed that UN aid should lead a process, lead a process to come up with global -- to come up with targets, to come up with what is necessary moving forward. We've all participated in that. As Peter Piot mentioned on the opening day, 100 countries around the world have participated in a consultative process. We are in the middle of that process. The global steering committee has met, has put forward activities, has met in country, all these consultations in country. We would like to see the process that we all began in September have the breathing space to move forward.

And the primary goal of that initiative was to have the countries themselves set targets, to have the countries themselves say what they could do by 2008 and 2010, to have the countries say what resources they needed from 2008 to 2010. And then we'll have a rational target. Global setting of targets in the absence of country participation and direct participation of those doing the work, in the absence of direct country involvement on the ground to us does not make an enormous amount of sense. That what we want to do is find out what's possible, aspirationally possible, and go towards that. So again, we are not opposed to goals, we are not opposed to targets. We are very much in favor of them. But we also need commitments behind those to ensure that we can achieve them. And I think that's one of the issues from 2001 to today. A lot of targets put forward, but not a lot in terms of the commitments that were necessary to achieve them.

QUESTION: You know, something quite relevant. My name is Olaolu Akande. I work for the The Guardian of Nigeria. I don't think there's any serious doubts to the fact that the United States is the leading contributor to the Global AIDS funds. But there's concern that the United States has already set a target of $15 billion in the next five years, but as this Congress (inaudible) says that the United States cannot, you know, contribute more than 30 percent to the Global Fund. Now how does that restriction affects the commitment of the U.S. government itself to spend $15 billion over five years should other group of partners refuse to, you know, come up to say about 70 percent, which the U.S. Congress is asking for other countries to put in.

DR. DYBUL: Right. It's a very good question. It gets to the multiple components of President Bush's Emergency Plan of which the Global Fund is a component. And it gets also to the nature of the U.S. Government programming and how the U.S. Government operates in country including in Nigeria. We are fully on track to meet and probably exceed the $15 billion over five years. With President Bush's request in 2007, again, the fourth year of the five-year initiative, we're already at $12.5 billion. And so in the fifth year, you can see, you know, with $4 billion in '07, we are certainly going to meet and probably exceed the $15 billion. And the reason for that is that we have multiple components of the plan.

We have a bilateral component which is the bulk of the resources and then also the multilateral component. Now why do we have a significant bilateral component? Well, the reason is in many countries, including Nigeria, we have U.S. government, HIV/AIDS experts, 15, 20 of them on the ground working shoulder to shoulder with the government and people, nongovernmental organizations and others on the ground. We have contracts officers, HIV/AIDS experts that work with the Ministry of Health in Nigeria, that work with the nongovernmental sector in Nigeria to move quickly, to move resources quickly. The U.S. Government has that strength bilaterally and so that's why we have a significant bilateral program. I believe last year in Nigeria alone, the U.S. Government resources for bilateral programs were around $150 million plus, of course, our contribution, our 30 percent of Global Fund grants to Nigeria.

Our view is the rest -- every country in the world should look to see what's the right mix of multilateral and bilateral programming and commit. We don't honestly care if it's bilateral or multilateral. What we care about is it be the most rapid way to achieve results. And every country should look at the right mix and commit accordingly. For us right now, the best mix is bilateral and I think we've demonstrated that in terms of results of what we've supported and Mrs. Bush will give an update on that tomorrow morning.

In terms of the Global Fund, we are huge supporters of the Global Fund. It's a component of PEPFAR. But Congress did set that 33 percent and there's a reason for that. It is the Global Fund. It is not the United States fund. It is the Global Fund. This is a global epidemic that requires a global response. Very few countries out of the United States have a bilateral program that is very large, so it's rather appropriate for those countries to give the majority of their resources to the Global Fund perhaps. Again, we don’t care how they do it. If you go back to the estimates from 2004 of OECD who tracks giving, in that year, for example, the UK gave 7 percent of their global resources to the Global Fund and the rest bilaterally which was actually less than the United States gave to the Global Fund relative to its bilateral programs and the French were about the same as the United States. So every country should do that appropriate look and mix and give what's appropriate through bilateral and multilateral sources.

I would also like to add, based on your question, we don't say that we're giving as much as the rest of the world out of pride at all. We say it somewhat out of dismay. It is not -- there is no way to get to any goal beyond the President's goals unless the rest of -- unless the United States is giving less than the rest of the world combined. That's our concern. We need a larger commitment. We cannot get to where we are now to where we need to be in the future, as long as the United States is giving as much as the rest of the world combined.

QUESTION: My name is Zhiwang Yang from China’s Xinhua News Agency. I think --I have a question about is there any further action on the medical research in this five-year strategy plan?

DR. DYBUL: Yes. And because we're talking this week mostly about prevention, care and treatment programs, I didn't mention that another part of PEPFAR, an active part of the PEPFAR, is research. The United States Government is currently providing about 80 percent of the resources that international partner governments provide for vaccine research for example. That is part of PEPFAR. Microbicide research is part of PEPFAR. Evaluations of programs to determine what are the most effective programs is part of PEPFAR. So there is very much a strong research component to what we do. Particularly, you know, one of the goals we agreed to in September was to work towards an AIDS-free generation. We cannot get to an AIDS-free generation without a vaccine and probably a microbicide either, so we very actively and very substantially support the development of vaccines and microbicides. So research is an important component. I didn't talk so much about that today because we're really focusing on programmatic efforts today. But we think there's certainly a need for stepped-up efforts around the world on research as well to get to vaccines and microbicides and other important interventions.

QUESTION: (Z.Y., Xinhua News). I'm working with a new China news agency. I'd like to ask you question about critical declaration which is being negotiated in the General Assembly. I was told by some diplomats that the United States and some other countries are opposed to the inclusion of a language that gay people are -- should be available to prevention programs and prevention of treatment. So is it true?

DR. DYBUL: Unfortunately, this isn't just being said by some people in negotiations. We have major press organizations repeating these complete untruths. Christian Silverberg, who's the assistant Secretary in our State Department for international organizations, made the position of the U.S. Government incredibly clear yesterday in the AP newswire. We are very supportive of language that would mention vulnerable groups, either collectively or by individual designation, because we believe we must overcome stigma and discrimination in prevention, care, and treatment. This should not be surprising because in our own documents and in our own public statements, we include these groups and talk about all of the groups. So it should not be surprising that if we say it in our own documents and in our own public statements that we would support similar mention in the United Nations declaration. It is emphatically and absolutely untrue that we would impose inclusion of such language.

QUESTION: (O.A. The Guardian)I want to ask you two questions. One, what has been your experience in Africa? I'm talking now in terms of the bilateral agreements that the U.S. has with some African countries, in terms of the AID care infrastructure? Has it been useful? What were the problems that have been confronted in terms of trying to permit all the PEPFAR initiatives in Africa? And then secondly, when do you think, you know, as a big player in the AIDS issue around the world, at what point do you think you're going to get the AIDS vaccine?

DR. DYBUL: Let me deal with the first one because it actually is easier, although it may not seem like it. You put your finger on something very important. And what we'd like to see out of this week, not a discussion of individual words and yet another document, important as documents are, but a discussion of what are the issues going forward? It's not just resources. You can have pilot projects without systems and health care strengthening generally. You cannot have national coverage without strengthening of systems. And it's not just workforce, it's physical infrastructure, communications systems, human resource management systems, logistic systems, supply chain management systems, things that we don't even think about normally, like waste disposal systems. If you're going to expand treatment services broadly, you have to have waste disposal systems. So this is one of the great challenges.

Currently, the Emergency Plan is dedicating about a third or more of its resources to these issues, to strengthening and supporting national programs, multi-sectoral programs to expand programs for national reach. A fundamental part of what we do is working in partnership with the countries in which we're fortunate to work to support their program to build those systems and we're very actively engaged. There's a nonsensical, I believe, almost debate in development or has been and maybe that's because of resource limitation that you either achieve results or you build capacity. You can't do both. To us that makes no sense. You're not going to achieve results unless you build capacity, particularly for national scale -- pilot projects maybe, but not national scale. So a big part of what we do is supporting local programs. And the only way you're going to get there is by supporting those local programs. This isn't a United States initiative. This is a Nigerian initiative. This is a South African initiative. We're supporting those activities and we're doing everything we can for information exchange because it has to be the Nigerians and the South Africans and the Kenyans and the Vietnamese doing the work. We're just fortunate to be involved in pieces of it and that's an incredibly important point. And really it goes back to what was a monumental effort in development, the Monterrey consensus that began with country ownership as principle for going forward in a multisectoral way and that's what we're trying to build within PEPFAR.

QUESTION: (O.A. The Guardian) And the vaccine.

DR. DYBUL: The vaccine. Well, you know, I come from HIV/AIDS research. I actually am a researcher at our own National Institutes of Health. I would love to say that there's -- we're going to have a vaccine soon. I think we need to remind ourselves that twice in the last 20 years we've heard projections that within 10 years we'll have a vaccine. The fact of the matter is that we're not in a position right now to say that that's the case. We are not there scientifically. And we need to do a lot of work to identify vaccines. My own view and this is a personal view, not a U.S. government view, is that we need a technological breakthrough. Just as we had a technological breakthrough that allowed us to develop antiretroviral therapy, crystallography, my own view is that we need a breakthrough in understanding immune responses and understanding retroviruses that we don't yet have if we're going to develop a good vaccine. And in the meantime, we need to be working on things like microbicides and other products that we can use and put a strong effort in vaccine.

Now certainly, I, like everyone else, hopes there'll be a vaccine soon. But I think we'd be deluding ourselves if we said there's currently scientific evidence to suggest there will be a vaccine soon.

QUESTION: (Z.Y. Xinhua News) Two questions. One is a follow-up of the political declaration. Can you address the issue of the differences in how to treat the TRIPS agreement and the U.S. position on that? And the other question is you mentioned that there's a huge misinterpretation, do you have any idea of why this is?

DR. DYBUL: No. On the second issue, no, I don't. And we also tend to not want to ascribe motivation which, unfortunately, doesn't seem to be the case in New York or anywhere else. I mean, I don't think we should ascribe motivation for positions. I think we should talk about what the issues are and have serious discussions. There should be discussion and disagreement respectfully. And respecting each other's positions and respecting where you're coming from because no one has all the answers on this issue. It's a very complicated issue. What we'd like to do -- what we would like to see is an open active dialogue with mutual respect and assume that everyone comes from the position of trying to do what's best. And that they just have a view -- a different view of how to do what's best and try to resolve those issues and that's how we look at things. So I don't want to ascribe motives to anybody, why people are saying these things. Unfortunately rumors spread awfully quickly around the cities, so all it really takes is one person to say something and all of a sudden, it's all over the place. So I don't want to ascribe motives to people who are passing on things they hear. We hope people are acting the way we're acting, trying to come to the best solution to the problem.

Now in terms of TRIPS, this is one of the difficulties with a meeting like this. We have world trade representatives. We have world trade meetings. We have experts in trade who come together to discuss these issues. Those people are not present during these meetings. We think those discussions are better had by trade representatives in a trade session. I think it important to point out that the United States said that they would unilaterally act on TRIPS in Doha before it was accepted by the rest of world because we thought it was so important. We are still very supportive of TRIPS. We are very supportive of what was in TRIPS and we will remain supportive of what is in TRIPS because we signed it. So we just don't know that we need to go through those issues at this meeting, other than to say we all support the TRIPS agreement as we previously agreed to.

I don't actually know the specifics of what's going back and forth on that language because I'm not in the negotiations directly. We have other people in doing the negotiations. But our position is rather clear. We have a very good agreement on something going forward. Let's continue to agree to that and act on it.

QUESTION: (O.A. The Guardian) What has been your experience in terms of how the African countries are meeting hope to be (inaudible) their own part of the bargain? You did talk about Monterrey and the fact that it is important for the countries to take ownership of their own initiatives, you know, and that has to do with doing their part also. So as individual countries and as a continent as a whole, how do you assess the efforts and the response of African countries to meeting of these goals?

DR. DYBUL: I think the same as any other country. This is a very complex and difficult disease that has enormous challenges. And whether you're in Africa, the United States or Europe there are enormous challenges to overcome. Some unique to different environments, and in some cases it's resources, and in some cases it's infrastructure. But everyone -- this is one of the great stories from 2001 to 2005, particularly in Africa. If you go -- if you were in Africa in 2001 and now in 2005, or really in 2003 and 2005, the sense of hope is palpable. The conversion of a total sense of despair to a sense of hope is very palpable and that is driving country ownership. That is driving results. That is driving action. And we're seeing an enormous culture of accountability growing and I see this all the time on a daily basis.

I go to the same place at six-month intervals sometimes and you can see a transformation in just six months of this tremendous hope, of just the sense that we can do something now. And we're going to do it and we're going to do it well because we need to because our friends are dying. And I've had people thank us for the reporting requirements. They don't initially, though. They're opposed to reporting requirements. But over time, they see that the reporting actually makes them understand the programs better and leads to the sense of accountability in a culture of accountability across the board. We're seeing a multi-sectoral response with the government authorities leading the strategic vision, but that multi-sectoral approach, the community-based, faith-based, private sector all getting involved. But this is one of the issues around certain targets. You can't expect a country that begins in a much different place to have the same target as a country that begins in a different place, or a country that begins with a lot of infrastructure, begins with a national strategy in place or begins with substantial resources in their own country, cannot possibly have the same target as a country that does not currently have resources or does not currently have a strategy or does not currently have infrastructure.

So rather than setting these global targets, which in some ways aren't fair to individuals countries that are starting in different places, let's have the countries evaluate what they can do during a period of time and come up with something that's rational.

QUESTION: Danuta Szafraniec, Poland National Radio. I want to switch focus to Europe for a while, if we may. I'm looking at the map that we have here in our press kit and I don't see any activities being present in Poland, but there is quite a lot, as far as bilateral efforts going on its eastern boarder. And I remember I was talking to Dr. Piot, I believe, around a year ago, and he said back then there is quite disturbing data coming as far as the disease is concerned from the former Soviet Republics. Would you be aware of the efforts, money put there or anything? Can you comment on anything going on there?

DR. DYBUL: Yes. We actually do have significant bilateral programs in Eastern Europe. That's part of the 120 countries where PEPFAR is active. Again, there are 15 focus countries where half the disease in the world currently is, 12 of those countries are in Africa; two in the Caribbean and one in Asia. Eastern Europe is in those other 100 countries or so and we actually do have significant activity in Ukraine and a number of the former Soviet states along the borders and so we are very much involved there. But again, many of those countries also have Global Fund grants and 30 percent of each of those Global Fund grants currently is part of PEPFAR, that's part of what the American people are doing on global AIDS, so we're very much active there.

QUESTION: A lot of the remaining development goals is to curb and reverse the spread of HIV/AIDS globally. So do you think it is -- this goal achievable?

DR. DYBUL: I hope so. And I think that's one of the differences between 2001 and 2005. We're seeing that as a possibility. We're seeing finally in sub-Saharan Africa reductions in infections, substantial reductions -- 25 to 50 percent reductions in countries with generalized epidemics. We're seeing reductions in the Caribbean. We're seeing reductions in part of India -- parts of India. So we are seeing reductions across the globe. Now, the trick is to get from those reductions from 15, 20 percent going down to 12, 15 percent to keep coming down and that's difficult.

But in terms of the goal which is to reverse -- which is to stop and begin to reverse, we're starting to see that. So I think there is tremendous hope that we can get there. It's going to take an awful lot of work and an awful lot of complicated activity. And fundamentally it's going to take sticking to the evidence. And that's what we like to see out of this document as well -- an evidence-based approach to prevention. The evidence base in generalized epidemics is as clear from sub-Saharan Africa, is you need, A, B and C. You need all three components. You can't have A only and you can't have B only and you can't have C only. You need all three components. And so if we have sound policies and sound approaches based on evidence, I think we can get there. One of the difficult issues is gender issues. You know, a woman who is in the sexual coercive or sexually violent circumstance can't negotiate C, anymore than they can negotiate A or B, so we've got to work on gender issues.

In fact, today I flew back to Washington for a session this morning because we're having a day-long gender consultation on additional programming interventions we can to do deal with gender issues. We're already done quite a bit. We probably have more than 300 programs on gender across the world, are supporting local efforts on this. President Bush has a women's violence initiative which is very much tied to HIV/AIDS and we're linking those initiative -- that initiative with PEPFAR. So we do have to go -- so there's a lot that needs to be overcome here. But I think there's hope we can get there, as we're making tremendous -- as we're seeing some progress now and as we're making great progress in treatment.

QUESTION: What types of human trafficking initiative are involved in PEPFAR now?

DR. DYBUL: Right. Well, trafficking is, of course, one of the blights on the world and the direct link between trafficking and AIDS is something that's being evaluated. Certainly women within trafficking are exposed to HIV/AIDS in many countries and so we're working together to ensure that President Bush has a trafficking initiative as well, an anti-trafficking initiative. And we're working to see, as, we are with the women's violence initiative, how we can best work together to ensure that we're achieving all of the goals, anti-trafficking, anti-women's abuse and anti HIV/AIDS, how we can have a comprehensive approach to tackle each of those. But President Bush has had independent initiatives on women's violence and trafficking because they are such critical areas and extend beyond HIV/AIDS.

QUESTION: (Inaudible) in the latest report that (inaudible) has reached its peak in the late 1990s and now it is believed to have stabilized and this is the first time in the past 25 years. So do you agree with this assessment?

DR. DYBUL: There's certainly data for that, but you have to say within areas. So we've seen stabilization in Africa. We have not seen stabilization in India. We have not seen stabilization in Asia. We have not seen stabilization in Eastern Europe. So it's a mixed picture. It depends on where you look. You know, Dr. Piot has been very clear on that, both in this document and this week that you can't make sweeping statements that cover the world because the disease is at different stages around the world. So there are certainly places where incidents seems to be peaking and coming down. And we think programmatic interventions has had a significant role in that and that's certainly what we're seeing sub-Saharan Africa. But we're also seeing very disturbing signs of increasing infection in other parts of the world and even in some countries in Africa.

KIM NISBET: I believe Dr. Dybul has a one-on-one interview following this roundtable, so we'll probably need to wrap it up. Again, I thank everyone for being here. It's an important week ahead with the meetings tomorrow that you'll be a part of at the UN with the First Lady and others. So we thank you again for being here with us today.

DR. DYBUL: I would just point out we are thrilled Mrs. Bush will be here. And I think it's a true representation of the commitment of the American people, both the personal commitment of President Bush and Mrs. Bush. But more than that, it truly represents the commitment of the American people to support the people of the world in their fight against, so we're just thrilled that Mrs. Bush will be here tomorrow.