Government, as wellintentioned as they are, and i do believe that they are wellintentioned, i just simply do not think that they have the capacity. I think that there needs to be something to augment their capacity. I think that there needs to be some kind of coordination unit. Ive heard here today that the World Health Organization has the lead. Maybe, maybe not. I think something with a bit more of an operational edge to it is called for. That may be some kind of a i do not know what that could be, but more is needed. I think that if we leave the situation up to the ministries of health when you have a unique situation where you have three poor countries that have a communicable, infectious, and lethal disease, they clearly do not have the capacity to contain it. And is the world willing to allow the Public Health of the world to be in their hands while they try to contain the disease . That is the essential question. Finally, dr. Glover, you had worked on the outbreak of ebola, what, 20 years ago . Actually come at that time, i was in the zaire, but the outbreak was in another place. I was in zaire. Outbreakre during the but i was not working with ebola. How does this compare to that. Utbreak there is no comparison. You have somebody people in liberia that moved to the city. You wonder how you can get some people jampacked in a bus or how many people live in a house. Withdministrator came down the virus and he infected his eight children and his wife and all 10 of them died. The close proximity of People Living in the concentration of thisopulation means that epidemic no matter what we do will be a tremendous loss of life due to the nature of this disease. I thank you both. Is there anything else you would like to add before we conclude the hearing . That i amst say sure there is much more, but this Concept Research and development for a vaccine and a cure is very important. I think we will see death tolls in numbers that we cant imagine right now. Also, i will tell you that we are now in the process of distributing ebolareadiness information to hospitals across africa. Any final words . Thank you. I want to thank both of you for your Extraordinary Service to fornkind and especially those suffering this terrible outbreak of ebola. Least stay in touch with their subcommittee. We are looking to make sure that we are doing whatever we need to do as a congress and subcommittee, and me personally and my colleagues, what we want to do and your guidance is absolutely essential. And you for your wisdom insight. An incisive commentary to the committee. The hearing is adjourned. Thank you. [captioning performed by national captioning institute] [captions Copyright National cable satellite corp. 2014] two precincts were closed yesterday because of damage to a tropical storm. 8000 registered voters will have their absentee ballots. Democratia, the incumbent mark warner is challenged by ed lsp. They recently participated in a debate. We will show tonight at 6 00 p. M. Eastern here on cspan. Book tv in, watch prime time. Of tv features a wide range topics, including foreign policy, legal issues, iran and is successful across the country. Let us know what you think about the programs you are watching. Join the cspan conversation. Lycos on facebook. Follow us on twitter. Last month, posted the combating hiv aids conference in this is about an hour and a half. Good afternoon, everyone. We have three distinguished. Uests with us today and a very large audience. Thank you. The i first want to acknowledge this ongoing collaboration. Given the large audience that signed up for this and is actually here, i am curious how many people went to the conference. If most of you did not, it is understandable. It is far away. , i wante serious note to say a few words about the tragedy that befell all of us and that is the crash of , literallyirlines when they were traveling to melbourne. All of us collectively lost six incredible people who devoted their lives to do this very work. Want to name them all. The codirector of the hiv netherlandsaustralia research collaboration. The former president of the international aids society. Also at the Amsterdam Institute for health development. Martin, who is also at stop aids now. And glen of the World Health Organization. This experience should the beginning of the conference, which was somber and serious and full of a lot of shock and pain. It reminded all of us something really important about our community. It is a community of scientists. Many are embodied in the same person. Just to remember these individuals, i would like to quote a friend of mine who worked very closely as a reminder of who they were and what it means for our community. And also to recognize the act of violence that occurred. These are kates words. A tribute that she just gave a few days ago. It is incomprehensible that people who work so hard to save the lives of others should be shot down and the Collateral Damage in a war. Each of us needs to reflect on how to celebrate their memories. This world is a better place for them having walked among us. Let that be said of each of us too. I want to say a few more words on the conference and where it was in terms of the attendance. Not expected to have scientific breakthroughs, but nevertheless, it had an incredible depth in what was resented and presented and the come together of communities in what was a consensus on where we need to go from here that has not always been present and emphasizing the importance of focusing on key relations that are marginalized. Transgender individuals, sex workers, and confronting discrimination in all of their forms around the world. The emphasis on the need to scale up treatment and what we know now about treatment and how effective it is, and the power of convention again, some prevention, of again, some exciting new information about rep prep, which i am sure we will talk about. For now, i will leave it at that. I would like to ask our three panelists to come up. The ambassador at large, dr. Birx. Dr. Chris beyrer, president of the international aids society. And dr. Steve morrison, director of the center for strategic and international studies. So please join me [applause] chris is here. That is my most important job today. [laughter] ok. As usual with our events, we will ask a few questions of our panelists and quickly get to your question. I hope this is a dialogue, especially for those who were not there and want to get a sense of how things played out. We know that the media itself did not cover the conference extensively. That has been a trend that we have seen for a long time. Bringing that information here is a critical task. My first question, i will start with ambassador birx to get a sense of your main impressions and takeaways. What were some big themes that came out . Thank you for having me here again today. Thank you for all of your information that you put on the website about hivaids. And every question that i have had from every african press. Site. Ll referenced this so aids 2014, when you start out with that level of heartbreak, all of us were very introspective the entire week because many of us came from that time when there were so many unexpected deaths among our friends for an unknown reason back in the early 1980s. I think you have to have that reflection at the beginning. Every time i heard something, i was able to think about the history of hivaids and where we are. To me, it was the historic content of our 30 years together and where we have been. What started out as heartbreak came forward very much as hope when they released the global report. I believe you all have seen it. It is a return to fundamental data reporting from u. N. Aids with clear analysis that we can all understand. Its the first time we look at the graphic without a lot of subtext. You only have to look at the pictures, which i really appreciate, and you get a sense of where we are around the globe. To me, the last thing was renewed commitments and the beginning of the week when things happened and advocates and activists spoke, there was a true resonating theme from all of us. When they were talking about they want to be undetectable, we all agree to that. It is so important. I think there is consensus. My final impression, probably the biggest impact on me personally was a session done with individuals who have lived with hivaids for more than 20 years. It was really i had somehow, in my years of travel, lost track of how those days felt and how sick those patients were. Hearing them relive the number of days they spent in the clinic, in the hospital, throughout their 20s, 30s, 40s, they were unable to work, unable to access effective treatment. We had monotherapy and then bitherapy. Fortunately, all of them in that room made it to combination. Hearing about their Life Experiences and the impact it is making in their 60s and 70s having lost their most Productive Work years reminded me why the United States turned to a huge epidemic in Subsaharan Africa and said we cannot stand by this. 2530 losing all of the year olds. Hearing their stories and understanding that their life journey had a tremendous impact and we all need to resonate with that and understand that we have a lot of patience now who live successfully with hiv but do not have the wherewithal to retire successfully. It renewed my commitment to understand all of the stages of a life experience, from prevention of mother to child to transmission to treatment that we are approaching and being able to understand peoples life is princes. Like experiences. Chris, i think this is your third of these that you have done. Yes. Just put it on your calendar for two years as well. Two years from now, we will be talking about i will come back to that at the end. I just want to add to those reflections. The mh17 tragedy changed all of our experiences, had a huge impact on the conference. Summarizedword that the response of our community, by midweek, we heard it repeatedly, unity. It just draws people together. I think this will be remembered as one of the conferences where the divides that we sometimes see in our community really got dissolved. Truly got resolved in some way. There really was a unanimity of purpose and engagement, which i know we will need for the next phases. Big picture messages that came out of the conference were certainly and debbies talks on the u. N. Aids data, there is as a consistent theme on using the data that we have more consistently and focusing on better quality, focusing on the people. The human age report showed that 50 of the new cases that is an incredibly important thing. They are predicted to be in key populations. They are relatively small portions of our community but bearing this burden. That is a combination we have to change. So that refinement of the response was a theme that occurred. If i might just go through a couple of highlights from each of the tracks. We have five tracks now. While there was not any one or two single big studies, there was a number of advances in each of the tracks that i think are important. Particularly because so many of you will not be able to attend, hopefully this will be your 10 or 12minute go through the signs. There were a couple of key talks to her example, with track a, there is a lot of focus on the cure. The big news was the breakthrough after 27 months of the functional remission of the mississippi child who is now four years old and doing well on therapy, but unfortunately was unable to us to stay off antiviral therapy. And the curing plenary on the opening day is a masterful summary. She managed to do both things. Not dumb it down and keep us all appraised. The big news from the focus on cure is the concept that you try and get hiv out of the reservoirs it is hiding in and use immunotherapies or gene therapies or drug therapies to try to go after that reactivation of the virus. Quite a lot of information on that and early studies that suggest this may be the way forward. There is clearly a consensus emerging that the best thing from make your perspective and probably also from a clinical perspective is earlier initiation of therapy is better and the people who are likely to be the most to benefit from fewer strategies cure strategies are the people that start in the very near term. This includes a large pool of children worldwide. So that is going to be a very important area. The clinical track him the great news is that basically 13 Million People worldwide are on antiviral therapy at this moment. With the new w. H. O. Guidelines, another number the will to that are now eligible for therapy. There is an enormous still untreated population. More people have started than at any other time, partly due to the global fund. In terms of treatment areas that emerged, there was a big focus on tuberculosis. There was a great summary with very important findings. There are some new Combination Therapies that looked quite promising. There is an emerging area related to Clinical Care and smoking, particularly thinking about chronic obstruction pulmonary disease. Probably the next tier. There is a lot of action on that front. And then probably track c, epidemiology and prevention, the area where there was the most action because there has been the most news and trials out. A couple of things to highlight. First of all, new w. H. O. Guidelines were released just for the conference. I should say that i cochaired the guideline process. The dean of the university of the medicals cool the medical school in malaysia. Those guidelines made one of the strong recommendations for more consideration of the use of exposure prophylactics for men who have sex with men as an additional prevention option. Some of you saw that this got very misconstrued in the media, saying that all gay men should be on prep. Please do read the guidelines. I think they are a real advance. In addition, there is the recommendation for community distribution. In companies where there is good coverage of a. R. V. s, it can replace hiv as the leading cause of death. There was also good news on prep with transgender women who have sex with men. Iprex was the critical trial that came out in 2011. This is the open label extension. This is really the question of the effectiveness of the prep where people know what they are taking and can choose to take it or not. The good news is that the effectiveness was higher in the trial, about 50 overall. Looking at blood levels and people who took the drug, it turns out that the efficacy was 100 as measured in people who took it every day. But it was just as good at six times a week, five times a week, four times a week. While that is a difficult message to put out there and we are not backing away from daily prep at this point, the adherence does not have to be perfect. That is a real advance. The other thing that emerged from that study is that people had a good sense of their own risk. Taking the drug daily was more common for people who had a high risk of exposure. Less common among men and transgender women who did not. People are smart and they know what kind of behaviors they are engaging in. Nevertheless, important. There has been all kinds of concern about people being on this drug and using condoms less. Lots of science around this. Turns out it is theoretical. Condom use is better in couples where one of them is being treated there was great data on that from zambia. No evidence of behavioral there was also encouraging news on terry male on voluntary male medical circumcision. The first trial showing the benefits for women of male circumcision. That is the data we have been waiting for. It is very encouraging. I would say on track d, our human rights policy and law, there was an enormous amount of work. Michael kirby let us all off with that theme. Also some Empirical Data from the special issues that have been happening regularly at these conferences. This one was on hiv and sex workers. I also edited that. Full disclosure. It is a Wonderful Group of young investigators who wrote those papers. I am very excited. There is strong human rights evidence for potential benefits of reducing hiv incidence. And also on decriminalization as hiv prevention. Finally, the implementation track now has the largest number of abstract submissions of any track. Those of you who work out there, you are an enormous sector. There was great science so very encouraging outcomes. Also one or two warnings. Good news that earlier disclosure turned out to have adherence to therapy. That is an important finding. Happily, in africa, many of those kids are surviving. A challenging issue with plan b, occluding the hiv therapy which looks like their retention is not as good as we had hoped. They are falling off and that is going to be an important challenge. So i would say that finally, the other thing that emerged was how much more granular you are talking about the data and the strategic use of data, the importance of targeting resources to where the virus is, to where people need treatment. Where transmission is ongoing. Given what the Global Funding climate looks like and given the fact that we are beginning to bear down on this. I have to thank you, because i was at many of the sessions and have read so much that has come out of the conference. That was the best summary of everything that happened. You got the best summary right here. Thanks jan, and Baxter Kaiser incurred for hosting us. And congratulations, chris. Youre a sent to being president for the next two years and working with and moving towards durban, which is very exciting. I was really struck by the emergence of opinion. The convergence of opinion. In sitting and listening to deborah berks, to Michelle Sidi bay. Degree to which is a very mature in advance consensus around what needs to happen is remarkable. This is not a community the set in deep controversy and division. I was at times a little irritated. This is really a sign of success. There was embedded within it, a palpable realism and focus on results and implementation. There was a spirit of constructive forwardlooking progress to this. And a sense of advancement and a sense of realism that all came together around those five or six key things. I didnt fully appreciate the degree to which that convergence had happened. Is a real testimony to the maturity of the leadership and the continuity of leadership when we look at the people that were up and eloquently making the case. You realized how long they had been in leadership positions. It is a very unusual that we have. Im going to say a few words about the implications