Now todays event is cosponsored by the center for aids research known as see far. Its a collaboration across the three Johns Hopkins schools the schools of Public Health medicine and nursing. And with support from the university provost. Founded seven years ago its committed to ending the hiv epidemic through the promotion of trans Disciplinary Research and importantly very importantly by training the next generation of hiv aids researchers both here in t the u. S. And abroad. The return on investment is quite clear. As just one example hiv funding for junior investigators has risen from 7 of nih funds from before cfar was established to 25 of all nih Research Funding now. This has created a larger pool of welltrained and empowered hiv experts who in the past decade have accelerated the work to get as near to the Necessary Solutions for this epidemic and getting us to the goals we are striving for. While hiv impacts the health of populations worldwide and particularly pleased that cfar has been on the forefront of supporting hiv research and programs here in our own city of baltimore. Limburg School Faculty are making a difference in participating in so many of the ending the hiv Epidemic Initiatives by collaborating with Baltimore City leaders and their state policymakers. This is a remarkable example of us working together to find programmatic and policy solutions that work across all levels of government to save lives, millions of the time. Who would like to close by offering a special thanks to cfar director chasten of the school of medicine into chris buyer who is the associate director of cfar. Thank you both for all you have done and continue to do and thanks to all of you for being here. Your determination and commitment to hiv is so critically important. Because of your worker dreams to and hiv is now on the horizon in the hope coming true by 2030. With that i will turn it over to over to dr. Chris buyer who will introduce todays guest. Chris. [applause] thanks so much and on behalf of jason and myself i want to thank you for all of your sustained support. It really has made a difference. We are delighted on behalf of cfar to welcome all of you to the special session and with our special guest in dr. Anthony fauci and jon burke ahead of the hiv Prevention Program of the cdc and therefore introduce them i want to make a few comments about why we think its so important that Academic Research institutions like ours that Johns Hopkins engaged in ending the hiv Epidemic Initiative and take on the role that we think we can play in helping to finally achieve the end of the hiv epidemic. I think before we do that we have to acknowledge perhaps two or three fundamental truths that you are going to hear about from both of our speakers today that are really i think very essential to thinking about the task ahead. The first of those is we have to acknowledge the hiv epidemic ine the United States particularly the new infections in the u. S. Has been stubbornly persistent. We have declined over a number of years and we have basically been in the plateau around 38,000 or so new infections were a number of years. So the first enormous goal that has been set by this initiative is a 75 reduction in new infections over the next five years. That is on a very different trajectory from where we are and where we have been. We have an enormous task ahead of us in primary prevention of hiv infection and delivering the new science and technology again that you are going to hear back from her guests that really could achieve reductions in new infections but we are going to have tout really engage those tt are risk for hiv acquisition if we are going to achieve those goals. The second challenge is hiv has always been marked by Health Disparities but as we have done better as a country hand over the last decade and Health Disparities are getting all thed more stark soea hiv is now very much geographically concentrated in the south and southeast basically a swap of the countries you will see that goes from baltimore down all the way to texas and across the south in the southeast so theres a geographic disparity. Course a marked and disparity in a concentration in africanamericans and native americans and that is particularly stark for africanamericanic women and africanamerican and latino men. We have a concentration by race and ethnicity in the concentration and vulnerable groups of people at a risk. We also of course have to deal with the emerging and quite different demography of the Opioid Epidemic and its impact on what we are seeing with new hiv cluster infections, really quite different that includes abuelaish and new england and the south and midwest. Finally the third area that i think we have all been surprised about after 30 years of effort here and a tremendous advantage in treatment and prevention is hiv remains a very stigmatized condition and the people who are both living with the virus or at risk for it are in very highly stigmatized roots so there is intersectional stigma and that relates to and ethnic minorities in this country that relates to sexual and genderin minorities d substance users but of course also adjusted the stigma around the hiv infections itself. And the persistence of that stigma remains a very important barrier to achieving these essential goals that we want to achieve. So we have to deal with stigma and we have to do with Health Disparitiesin and we have to del with reducing new infections and of course that means both getting the new prevention technologies to people and also getting the americans living successfully link to care and the virally suppress. The exciting thing is we really do have the scientific and technical capacity to do this and now the question is are we going to be able to achieve that as aub publichealth effort is a country and i think particularly for the young folks in the audience at younger investigators this is really going to be for the next decade or two decades an enormous implementation and technical challenge for your careers and they think its enormous way exciting. You are going to hear a lotot of rhetoric at the end of the day but it doesnt mean the end of aids research. Dont worry about that. Theres a long way to go to achieving these goals. Let meeoa turn now to a really delightful honor and task which is to introduce our first guess dr. Hensel the director of the National Institute of allergy and Infectious Diseases and dr. Fauci is one of the architects of ending the hiv initiative. This is also called as some of you will have heard this pepfar for the United States and thats perhaps isnt surprising because dr. Fauci was one of the architects of pepfar which of course has been a world changing Global Health innovation intervention the single largest commitment to a disease by government in Human History and really something that is enormous way important. Dr. Fauci, people always say about tony fauci that he needs no introduction but i think Everyone Needs an introduction so let mee just go on for a moment and say he is of course one of the most cited scientists in a field producers subpoena the president ial medal of freedom which is the highest honor a president can give. Hes played an extraordinary role in maintaining over decades now the Research Funding support for hiv aids and effort and for that all of us as investigators are deeply in his debt but more importantly everybody alive with hiv is in debt. It took 800 Clinical Trials to reach antiviral therapy and to be as effective as it is now without the sustained decades long support of the nih and funding that research we would not be where hiv is a manageable chronic condition and that is an extraordinary achievement of the saved will literally millions of lives. I will just add one more thing which is some of you may know im a past president of the International Aids Society and witty take on that path you get to give ann award. Called the ias president s award so when that felt fell to me to make that decision i had a short list of one person and so i would like to thanki you dr. Fauci for accepting the coming all the way to south africa to accept the award was a great honor and without further ado dr. Fauci. [applause] thank you very much christened that kind introduction. A real pleasure to be here with you this afternoon to talk about the subject that is at hand here ending the hiv pandemic. Im going to talk about it from the standpoint of whatt i call from science implementation. This is the paper that we put together describing right after actually we submitted it right before the president made the announcement on february 5 by the came out on line essentially the next morning and it was the. Version describing the plan which as was alluded to a moment ago was the 75 reduction in new infections in five years and 95 reduction in the 10 years to diagnose treat and prevent and respondes. You will hear more about that from dr. Brooks in the moment but what i would like to do is talk a little bit more in flush out what i refer to as the hiv vulnerability profile. Why did we feel we could actually end the epidemic given what we have . It starts off with a population that we have as a vulnerable population are both demographically and geographically so lets look demographically. You know the numbers. Its very prevalent here in a bald 13 of the population of the United States is africanamerican. If the new infections 43 are among africanamericans than 60 of those are among men and 75 are young menar who have sex wih men so as chris said we have a concentration of a vulnerable population. We also have a geographic concentration. What jon brooks and his colleagues at the cdc put together, this map it was stunning. It was 3007 counties in the United States and if you look at it up those counties plus the district of columbia accounts for more than 50 of all the infections in the United States. Thats extraordinary. 40 units out of 3007 units. Thats 50 of the population. So we have this plan. There are a number of agencies involved. Im going to focus just for a few moments on what the nihs role is and we were discussing this with some of the staff and students a little while ago. The khalid implementation science. Ti cdc will be responsible for going out and engaging in the community. Whether they are doing thatndga correctly which im sure they will but how do you make it even better from yeartoyear will depend on implementation science and that will be done through the centers for aids research one of which is right here in baltimore. If one looks at the map of the country and those red ribbons are for where the centers for age research are in the blue ribbons are where the age Research Centers are which is mostly Mental Health you can see an important overlap with some exceptions like in texas which unfortunately doesnt have that but we are going to be dealing with that by extending other cfars there. He rose to the occasion as it were of trying to get cfar who are doing an extraordinarily good job and other aspects of hiv aids, critical part of what we do but we needed to supplement them to do that extra mile of getting involved in this extraordinary efforts to end the epidemic. We took 65 supplements to 17 cfars. 36 of the 40 counties of high burden were involved with the cfar pearly collaborated with Health Officials in that it the optimal delivery of evidencebased intervention. I just had thef pleasure of listening to two hopkins people present Work Associated with the hopkins is cfar. The collaborative project was joyce jones in the linkage and retention care upon release from the maryland state prison by gene anderson. If everything that is done here is as t good as what i saw this morning you guys are in really good shape. So lets get on to the science. Besides the one plantation implementation we should not forget to how we got to where we are now and it really is the science that got us there namely the scientific races or even our ability to implement a program so let me talk about that for a few minutes. We have hiv treatment and prevention tool kits that have accumulated as chris said over decades of research with basic research and Clinical Trials including the drugs on the left hand toolbox in the prevention of callow days. I begin taking care of hivinfected individuals in the fall and winter of 1981 before was called aids, before we knew it was. At that time the patients that i admitted to my unit at the nih had a median expectancy of about a year which means as you know 50 of the patients are dead and when youre in following them about 95 of them were dead and two to three years. If you look now today when patients come into the same clinic which i should have actually have been having rounds today i but im here with you in baltimore but thats okay but if a patient came and it was reasonably newly infected and i put them on the antiviral application i could look them in the eye and tell them they would live an additional 50 plus years which would give them almost not quite but almost a normal life expectancy. In the 20 years from 1995 to 2015 almost 10 Million Deaths were averted andm almost eight million infections were a verdict in the saved 1. 05 trillion. For every dollar spent, 3. 5 in benefits were realized. What about the 55 reduction in debt from 2005 to 2018 . We have had some gamechanging scientific advances. The one that is linking to them has been the concept as simple pl it may seem but we didnt realize it the treatment equals prevention. In two ways treatment as prevention. The iconic hpv in 052 trial which showed couples if you start therapy early an individual who is infected as opposed to waiting till the guidelines triggered it at the time, the guidelines did not say everyone thats infected should be treated it decreased by more than 95 the likelihood he would transmit to your sexual partner. We followed up five years later and we started to look at the relationship between viral load and the chance of transmitting and there was a strong suggestion that if you are below the technical level that you wouldnt w transmit. Very few people believe that so we had to prove it. We did three studies. And to our amazement of very positive amazement out of more than 150,000, less sex acts not one hiv linked infection that led this is something we are hesitant to say before that actually treatment is equal prevention and undetectable does mean untransmittable. A very important concept. The next was preexposure prophylactics. One pill containing two drugs if taken optimally and consistently with more than 99 effective in preventing sexual transmission and acquisition of hiv. If you put those two things together, treatment is prevention and breaks grosser prophylactics and take a deep breath and think about that for a minute t theoretically if you put everybody on treatment, while almost everyone and put all at risk people on prep theoretically you could end the epidemic tomorrow really. But we dont live in a theoretical world. We live in the real world and the way you make that bridge of that gap is by implementation. Thats what its all about and thats what you guys are going to be doing. At now, in order to do that we have also got to optimize the toolkits that i spoke of in two ways. Maximal implementation. Why do we need maximal implementation . Lets look closely not just that the United States. 23 Million People are receiving antiretroviralll therapy, great news. The challenging is almost 15 Million People who should be on therapy are not on therapy. That has led to a very modest in fact even less than modest reduction in incidence globally. In fact its a less than 2 animal decrease in incidence since 2010 so as chris said although we are going down we kind of plateau to bet which is why would we put the plan together. Retention in therapy is also challenging. Up 100 is the day you go on therapy 48 months later only 60 of people are still on therapy. Youre not going to end the epidemic thatin way. Utilization of prep the 2020 u. N. Target says the 3 Million People should be on prep. There are only about 380,000 people as of last month who are in on prep. Now can we overcome those implementation gaps . Some groups have actually been successful particularly in San Francisco with the Rapid Program in which they were aggressive in going into the community identifying people putting them on therapy immediately and if they are at risk putting them on prep immediately and following them up closely. It resulted in a rapid dramatic increase in new diagnoses in San Francisco. Youre probably going to hear from jon brooks in the bit that new york is doing the same thing. Governor cuomo decided if San Francisco can do it new york can do it and in fact it has gone down. We in d. C. T in collaboration wih the d. C. Pepfar program and the d. C. Department of health have tried to mimic what was being done in sano francisco and began the new diagnoses have gone down dramatically in my city of washington d. C. Now, in addition to implementation you need to develop new and improved tools. Why . Because we have to make treatment and prevention more userfriendly for people because as much and as strange as it seems they dont optimally utilize separate the two ways of developing new improved tools. The first is the arena of treatment. How do you improve treatment . There are a coupl