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Hearing of the Senate Foreign Relations Committee's International Development and Foreign Assistance Subcommittee: AIDS, Tuberculosis and Malaria

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Location: Washington, DC

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SEN. JOHN F. KERRY (D-MA): Mr. Chairman, thank you. And thank you very much for having this important hearing.

Obviously, dealing with this issue is not a partisan issue, as the record of this committee well displays. As we know, over 90 percent of all the children infected with HIV live in Africa. So that's 2 million out of 2.3 million kids that we know are infected. And 1,800 more become infected every single day. And more individuals are becoming infected than are being treated, which is the challenge, obviously.

I just came back from South Africa and Botswana and got an up- close and personal reminder of how devastating it is and the threat that it poses to an entire continent's stability. I had the privilege of visiting the Umgeni primary school and talking to people in Kwankalosi (ph) and KwaZulu-Natal near Durban, and I saw a very inspiring but at the same time heartbreaking situations.

I remember one woman in a mud hut, a tiny mud hut, cooking some with a caregiver. A caregiver who was trying to help her comes once a week. She has three kids. They are in school. Her sister's already died of the disease. And it just -- you know, you can just extrapolate that, you know, thousands upon thousands of times.

I was inspired by the work of the Valley Trust caregivers. But I also met orphans who at a young age have become the caretakers of their whole family, assuming adult responsibilities. And again and again, I heard from those on the front lines of this pandemic that their greatest challenge is the public relations battle to educate their communities.

I was struck also in a session that I had with some of those folks responsible for educating and care giving, as I tried to elicit from them the figures because there were some press around and some other public people. They just were very clammed up. They wouldn't want to talk about it. They were fearful of retribution for telling the truth about what's going on.

And privately, they pulled me aside later and sort of told me why they were fearful and couldn't tell me sort of the real numbers of kids in the school. I asked, how many kids here are infected? Or how many kids are orphans? And so forth.

We have to work incredibly hard -- and we all know the problem that existed with President Mbeki and the government itself in South Africa in getting this truth out. But it reaffirms for me the fact that while AIDS has done the killing, the disease's best allies have been denial, indifference and ignorance. And that's what we have to sort of fight here, partly in whatever we structure here as the follow-on.

Let me also nitpick for a tiny moment, if I may, on a personal level. As I was walking out of one of those locations, I saw this poster up on the wall and it said, "The President's Emergency Program." And it sort of hit me, to be honest with you. I said, "What do you mean, 'the president's'"? First of all, which president?

But secondly, that legislation was written right here in this committee by Bill Frist and myself. And Jesse Helms joined into writing that.

Remember, Senator Lugar? And Senator Lugar and others put that together.

And it's not the president's; it's the American people's. It's the United States's. And it would do us a lot more good, frankly, if more people knew what the United States of America is doing and what the American people are doing with respect to this.

And so, Mr. Chairman and Mr. Ranking Member, I hope when we redo this, we're going to clarify that. I think that's important as a matter of policy.

Equally importantly, if I may say, that -- you know, when -- we did that in 2002 and we proposed the figures at $15 billion. And so we were delighted the president came and picked it up. And we're delighted -- without his leadership and involvement, obviously we wouldn't probably have gotten the money in the end. But I think we ought to sort of see this for what it is in its reality.

But what I want to focus on with the panel that's here right now as we think about this and sort of -- we're all aware of the 2-7-10 goal for 2008. My fear is that unless we can break through more effectively on this education -- my daughter, incidentally, went over for summer as a medical student. She's now an intern, but she went to Ghana and she went to Rwanda. And she worked in AIDS for the entire summer. And she wrote her paper -- graduate paper on the truck routes and how that is.

You were speaking, Dr. Smits, about knowing where the last thousand cases is. Well, that's where the last, how many tens of thousands of cases have come through is the truck routes. And obviously, there are other causes.

But it seems to me that there has to be a much more intensive focus on coordinating the prevention/education breakdown in mythology and engagement of the governments themselves. I mean, the leaders have got to go out there and have these tests, not just guests. And they got to do it regularly. And they've got to really prove the importance of this.

And otherwise, these dollars are just going to kind of go incessantly at this increasing population of people that we're not treating. And I -- you know, I don't think we want to make this like Sisyphus pushing the rock up the hill if we don't have to, and I don't think we have to. So my hope is that we could do that.

One of the things I heard at the university at Witwatersrand, where we met with the public health folks, was there concern about PEPFAR being a separate track completely and not integrated enough into the health care delivery system. Now, to some degree when you started up, that may have been necessary. But at this point in time, it strikes me we may want to try to create a greater integration.

So I wonder if you'd just take a moment -- I've exceeded my time and question -- just as the one question: What do each of you see in terms of that potential of integration? And how do we frame this better to deal with this ad infinitum added population and breakdown the mythology and get greater accountability in these countries?

Dr. Kazatchkine, you want to start? And then we'll go right down the line.

DR. KAZATCHKINE: Yes, I'll say very briefly, and then, Mr. Chairman, I regret but I'll ask the committee's permission that I leave. I have to fly back to Geneva right this afternoon.

Thank you for your question, Senator Kerry. Right before you came in, I had a question from Senator Menendez on integration between PEPFAR and the Global Fund.

Actually, in countries where PEPFAR and Global Fund are both present -- that is in fact in the 15 focus countries -- there is a very strong integration of both programs around the national priorities.

The Global Fund itself that is in the other countries -- and we're currently funding grants in 137 countries around the world -- is, as I discussed in my remarks, a country-owned mechanism. We're funding what the countries request us to fund. So in fact, we do align, by definition, on the national program.

So there is full integration of Global Fund grants with national programs. And we're currently moving into, as I also very briefly discussed in my remarks, going to fund national strategies rather than pieces of national strategies in the future.

DR. SMITS: I only did -- the committee visited in small groups, so I only --

SEN. MENENDEZ: Before you continue, Dr. Smits, I'm -- Doctor, we're going to excuse you. We were told that you had a flight. We appreciate your testimony. There may be questions submitted for the record that we'd ask you to respond to subsequently. And have a safe journey.

DR. KAZATCHKINE: I will be pleased to. Thank you very much.

SEN. MENENDEZ: Thank you.

DR. KAZATCHKINE: And I'm sorry.

SEN. MENENDEZ: Dr. Smits?

DR. SMITS: I only visited three countries on a formal basis, but I would say that the degree of coordination that I saw in all of those was really quite good. And the response of PEPFAR to government priorities was very good.

For example, in Mozambique, the ministry responsible for orphans said: "It's so wonderful to have you here; we've had all these plans for these programs, and PEPFAR's commitment to orphans will make a huge difference. And I want you to promise to come back in two years and see how much we've accomplished because I'm just starting now."

In Nigeria, we visited with the ministry of defense, which is doing some very exciting things, particularly -- as you know, Nigeria earns money by sending its soldiers into other countries and must send them out HIV-negative and protect them when they're away, and they've done a marvelous job. That ministry told us that they believed that PEPFAR was the result of divine intervention. I thought maybe the Congress would have something to do with it, but that sense that we had come --

SEN. KERRY: We are very divine these days. (Laughter.)

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