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March 8, 2000, Wednesday

SECTION: CAPITOL HILL HEARING

LENGTH: 33725 words

HEADLINE: HEARING OF THE HOUSE BANKING AND FINANCIAL SERVICES COMMITTEE

SUBJECT: THE GLOBAL AIDS CRISIS

CHAIRED BY: REPRESENTATIVE JAMES LEACH (R-IA)

LOCATION: 2128 RAYBURN HOUSE OFFICE BUILDING, WASHINGTON, D.C.

TIME: 9:30 AM. EST DATE: WEDNESDAY, MARCH 8, 2000

WITNESSES:

RICHARD C. HOLBROOKE, U.S. AMBASSADOR TO THE UNITED NATIONS;

TIMOTHY F. GEITHNER, UNDER SECRETARY OF TREASURY FOR INTERNATIONAL AFFAIRS;

BODY:
REP. JIM LEACH (R-IA): The committee will come to order.

As the committee meets today, the world confronts one of the most serious public health challenges in the history of man. While the bubonic plague of the 1300s and the flu epidemic of 1818 and 1819 each killed 20 million or more, already 16.3 million people have died from AIDS, and more than 33 million are living with this ultimately fatal disease.

Many of our colleagues on both sides of the aisle have been deeply concerned about this crisis. In this committee, we're privileged to have leadership of Congresswoman Barbara Lee, who has been unflagging in her dedication to bring the matter to the attention in Congress. Her bill, the AIDS Marshall Plan for Africa Act, enjoys over 80 co-sponsors, including the ranking member, Mr. LaFalce, and myself. She in turn is the lead co-sponsor, along with Mr. LaFalce, of the bill I've introduced, the World Bank AIDS Prevention Trust Fund Act, which our witnesses may comment upon today.

The statistics in the global AIDS crisis particularly in subsaharan Africa are dismaying. While the continent is only ten percent of the world's population, it has 70 percent of the world's HIV AIDS cases. It has some 10 million orphans as a result of the AIDS epidemic. Life expectancy is falling, along with GNP, in a number of countries.

Silently, relentlessly, the disease is exacting a deadly toll on millions of Africa's working adults, children, mothers, soldiers, teachers in virtually all sectors of society, but it should be understood that while the epicenter of the disease is now in Africa, it is currently moving towards Asia, and nothing would be a greater mistake than to think that oceans are boundaries capable of containing the spread of diseases of this nature. At this time, for instance, there's an alarming HIV AIDS infection rate in the Caribbean and in parts of Southeast Asia, as well as the former Soviet Union.

Today the committee meets to hear expert testimony defining the scope of the challenges facing Africa and other parts of the developing world and to identify the strategies and programs necessary to curb its devastating humanitarian and economic consequences. We hope to learn about the difficulties confronting certain countries, as well as what has accounted for the successes enjoyed by Uganda and Senegal in curbing the HIV AIDS infections rates and whether any best practices gleaned from these cases can be applied to other hard hit developing nations.

We hope to hear about partnership prospects between international organizations, local governments, communities organizations and religious institutions. Witnesses have been invited to comment on H.R. 3519, the World Bank AIDS Prevention Trust Fund Act, which seeks to leverage a modest U.S. contribution of $100 million a year to a $1 billion trust fund for AIDS prevention.

Although donor nations already provide an estimated $300 million a year to address the HIV AIDS in Africa, World Bank estimates suggest a need for vastly greater resources to be applied.

Let me just conclude by saying that the United States should do everything within our power to prevent and ultimately eradicate the disease. Mortality is part of the human condition, but all of us have an obligation as people of the world to put an end to those conditions that precipitate death, particularly at young ages.

At this point let me turn to Mr. LaFalce and ask if he has an opening statement.

REP. JOHN J. LAFALCE (D-NY): Thank you very much, Mr. Chairman.

Today's hearing is on an extremely important subject, and I look forward to hearing the testimony of a very impressive group of witnesses on how best to address the AIDS epidemic.

Before focusing on this extremely important subject, however, I'd like to emphasize the framework that the United States and other countries will necessarily use to provide the kinds of assistance we discuss today. There is a substantial bipartisan commitment within the Congress to assist the developing world with both immediate crises, like the AIDS epidemic, and longer term economic development efforts, and we do that of necessity through the network of international financial institutions, in this case most especially the World Bank.

We have no other effective tools. It's therefore imperative to work constructively together to make this network of international financial institutions effective and responsive to the legitimate concerns of policymakers in both the developed and developing world.

The pending International Financial Institutions Advisory Commission report could have helped us do that. Instead, I feel compelled this morning to express my serious disappointment with some of the commission's recommendations which will be released later this morning.

While that report will contain some legitimate criticisms and a number of important recommendations that I could support, some of the principal proposals are extreme and ungrounded in thorough analysis. They are at the very least impractical and at worst potentially destructive of the only tools we have.

Certainly the function of these institutions can be improved, but on balance they have contributed substantially to the alleviation of poverty and economic development, to the benefit of the developing world and of the United States.

As Secretary Summers has emphasized, assisting the developing world is a moral imperative and a good economic investment, but we cannot render assistance unless we work constructively with and through our international financial institutions.

The secretary issued what I believe to be more practical and viable reform suggestions last year. I would hope we can build on those and work constructively to achieve meaningful reforms that will improve our ability to render exactly the kind of assistance we will be discussing today.

And now let me turn to the topic of today's hearing. Worldwide, HIV AIDS has infected tens of millions. Last year, almost five percent of all deaths in the world were directly due to AIDS, and AIDS accounts for 20 percent of all deaths due to infectious diseases. It's a global epidemic, and it's not subsiding.

Five point six million or almost 17 percent of those infected with this dreaded were infected only last year.

Even putting aside humanitarian concerns, the economic, social and cultural devastation wrought by this disease are of such an enormous magnitude that we must allocate far more resources, United States resources, international resources, to fight this disease.

In reading and researching the subject, I was struck by many points, but two in particular. First, so little is spent to deal with the problem. Worldwide, only about $300 million was funded from external sources, and only roughly $150 million was spent on programs in Africa, which is bearing the huge brunt of the epidemic.

Secondly, while there is presently no known cure for this dread disease, please consider the following. Based upon empirical evidence, if a country reaches a prevalence rate, that is the number of people infected divided by the population, of five percent, the prevalence rate will rise dramatically to around 20 percent of the entire population, but if the prevalence rate is contained to around two percent the epidemic is likely to remain contained.

We can make real progress, therefore, but we must provide the resources to do that, so I'm pleased to be a co-sponsor of this important legislation. I believe that using a World Bank trust fund is probably the best approach to efficiently and effectively convey funds to multilateral efforts to fight the epidemic. We best leverage U.S. funds that way.

I applaud Ms. Lee strongly for her legislative leadership on this important issue. She has offered constructive approaches that I believe will be reflected significantly in any manager's amendment that's produced.

The administration has called for concerted international action, working largely through the World Bank and other multilateral development banks, to combat infectious diseases, including AIDS, in developing countries and to accelerate the development and delivery of new vaccines and other basic health services.

We all share common goals; more resources and better health care delivery systems. We can and we will reach agreement on the details of how we achieve them.

Mr. Chairman, I thank you and I applaud you for beginning what I know is going to be a very constructive dialogue. Thank you.

REP. LEACH: Thank you, John.

Mr. Castle?

REP. MICHAEL N. CASTLE (R-DE): Thank you very much, Mr. Chairman.

It is an undisputed fact that something has to be done to solve the spread of AIDS and IV infection in Africa, and I welcome this opportunity to listen to all of your testimony today.

Clearly, the United States will play a critical role, and I hope that today's testimony will go a long way toward pointing Congress in the right direction. As you all know, AIDS has caused enormous human suffering in Africa. The numbers are staggering; more than 23 million adults and children infected with the virus; 13.7 million AIDS deaths to date with 2.2 million in 1998 alone. Infection rates in some countries are in the 20 to 26 percent range.

I recently visited Zimbabwe, Nigeria and South Africa with Congressman Houghton and others. An important part of the trip was learning firsthand about the AIDS crisis in those countries. I came away from that trip with the realization that the AIDS problem was too big for the United States alone to solve and that it was in our best interest to promote an international response. Simply, the developed world must act now before even more become infected and the crisis cripples the already fragile economy of subsaharan Africa.

But, the critical question is what can we do to help and not make matters worse? Already the United States has dramatically increased funding for the issue from $67 million in fiscal year 1998 to $81 million in fiscal year 1999. U.S. Aid is projected to spend more than $133 million in fiscal year 2000 to fit AIDS in Africa. HHS will spend another $35 million on the issue, bringing total U.S. spending close to $170 million.

Congress needs to make sure that these funds and any additional funds it allocates are going to projects that are effective and relieve the suffering that far too many are experiencing. The magnitude of this problem requires us to do the best that we can.

I want to thank all of you for being here today and for your interest in the subject. I am very interested in hearing what you have to say. I look forward to working with Chairman Leach and the rest of the Banking Committee on finding a meaningful response to the United States, and I yield back the balance of my time, Mr. Chairman.

REP. LEACH: Thank you.

REP. BARNEY FRANK (D-MA): Thank you, Mr. Chairman. First, I congratulate you and the gentleman from California for the initiatives you are both taking, and I am hopeful that this will see some beneficial results.

I look back on the results of last session, and for me one of the most useful expenditures of time was within the context of this committee under your leadership and that of the ranking minority member in putting together an excellent package on debt relief for the heavily indebted poor countries, and I hope we will build on that.

In fact, I want to make that linkage very explicit. We should go forward now with significant increases in what we do with regard to aid, but that must not come at the expense of the effort to relieve the debt of the highly indebted poor countries. I see Mr. Geithner talks about that in his testimony. We left the job uncompleted. We didn't. Other elements of the Congress did. It is essential that we go forward early with full funding for that.

That leads me to a substantive point. We will be in one of these paradoxes now. There are actually two paradoxes I want to talk about. The first one is the paradox of the morality that governs us collectively and that governs us individually because there is this unfortunate tendency to reverse it.

In our own lives, we sometimes are doing things for selfish reasons, and we try to create unselfish justifications for what is in fact motivated selfishly. Paradoxically, as a nation we are sometimes driven to do the opposite.

The main reason for us to substantially increase the resources fighting AIDS is a humanitarian one. Innocent, helpless people are dying, and they shouldn't die. Children and others who are very vulnerable are in terrible peril. We are the richest, most powerful nation in the world. We have it within our capacity to go to their aid. Shame on us if we don't.

For some perverse reason, humanitarian responses are somehow out of favor, so there will be a great effort in the reverse of what we would do as individuals to try and come up with a selfish rational for what's essentially a humanitarian impulse.

Yes, I think it is in our interest for Africa not to be destabilized. Yes, I can think of a lot of reasons why if there were more people in Africa they will ultimately buy more American goods, but that's secondary. The primary reason is humanitarian.

Let's not debase our own good instincts, and let's stand up to what's become a very unfortunate tendency in American politics to denigrate our own best responses and to try, as I said, to find a selfish response because it's exactly the opposite. As individuals, we are often trying to find unselfish rationales for selfish actions.

Today we will have people trying to hook up during this debate selfish rationales for what's essentially an unselfish act. Let's do it, and let's be proud of it. Let's say that as a wealthy nation we have it within our capacity to go to the aid of people.

Africa in particular is a continent which has been ill treated by the west. Colonialism and other forms of exploitation are there, so if we need some kind of justification maybe it's a combination of humanitarian resources and a little guilt. Yes, I think there are some other good reasons, but the major reason is humanitarian.

The second paradox will be this will be one of those issues where people will get yesed to death and then in the end maybe very little will happen. People wonder. They go around. I know people come to see me. They want more money for this research. They want more money for this education program. They want more money for this veterans medical thing. In the end it isn't there, and the reason is that the whole cannot be smaller than the sum of the parts.

You cannot consistently talk about government as a terrible thing, advocate cutting government as a wonderful thing, talk about putting arbitrary caps of an unrealistic nature on government spending and then be surprised when individual pieces of government spending fall short.

This is going to cost money, money we can well afford as a nation, money which our economy allows us to expend at no significant distress to individuals, but if we continue an unrealistic view that all government spending is a bad thing and anything that cuts overall government spending is a good thing we will not have the resources available when we come to cutting up our budget fully to fund the highly indebted poor country debt relief and this.

Let's couple our support for this with a willingness to put the resources overall together because otherwise we will come to an appropriations process at the end where there will be an allocation that gets very technical. Right now we're on the high moral plane, and everybody is for fighting AIDS in Africa, but that high moral plane doesn't mean anything unless people are prepared in technical terms to give the appropriate allocation under the Budget Act to the Subcommittee on International Financial Affairs and Foreign Operations so they can fund it adequately. It is very important we do that.

Last point. I am glad that many of us are joining today in what is an implicit, maybe almost explicit, repudiation of that special commission which is calling for a very drastic reduction in the World Bank's activity at the same time that most of us here believe that among the ways effectively to fight AIDS is to expand the World Bank's activities.

Thank you, Mr. Chairman.

REP. LEACH: Thank you, Mr. Frank.

Mrs. Lee?

REP. BARBARA LEE (D-CA): Thank you, Mr. Chairman, and good morning.

First, I'd like to begin by thanking you and our ranking member, Mr. LaFalce, for your diligent efforts in organizing this hearing today and also for your commitment to address this pandemic in a very real and substantive way.

In particular, I'd like to thank you, Chairman Leach, for introducing your bill, the World Bank AIDS Prevention Trust Act. I applaud your leadership in making today's hearing on AIDS in Africa your number one priority.

This is truly a historic day for Africa and for America. The World Health Organization has proclaimed that HIV and AIDS is the world's most deadly disease. It has ravaged subsaharan African, claiming 13.7 million lives in recent decades. Still, 23.3 million adults and children are living with HIV AIDS. This pandemic has cut life expectancy by 25 years in some countries.

AIDS is really a crisis of Biblical proportions in Africa and puts the very survival of the continent at stake. AIDS is decimating the continent and leaving behind millions of orphans in its wake.

To bring this point closer to home, by the year 2010 the number of orphans in Africa will be equivalent to the total population of children in America's public schools. This is staggering. It's no less than a moral outrage.

This is not only a humanitarian crisis. It is a potential economic crisis. Some countries now must hire two employees for every job because they know that one of them will die from AIDS. Teachers are disappearing from classrooms. Skilled workers are vanishing from production plants.

In Congress, our commitment to attacking this issue is growing. Today we all are stepping up to the plate and taking on this challenge. Chairman Leach's leadership by introducing the World Bank AIDS Prevention Trust Fund Act is one example of this commitment. As many of you are aware, there are currently approximately 11 proposals now in both the Senate and the House which seek to address the AIDS crisis in Africa and globally.

As Chairman Leach indicated earlier, I introduced H.R. 2765 last August, the AIDS Marshall Plan for Africa, and it has currently over 85 co-sponsors. This bill commits $1 billion to fight HIV and AIDS in Africa.

I am pleased to say that Congressman Leach and I are working now together to try to develop and effective bipartisan strategy to assist many of the countries hardest hit by HIV and AIDS. I, too, am pleased to be a co-sponsor of H.R. 3519, Chairman Leach's bill.

One principle that we have both agreed upon is that our legislation will establish public and private partnerships to assist African government, non-governmental organizations and other agencies by providing significant funding for over five years for HIV AIDS research, education, prevention, infrastructure development and treatment.

It is estimated that 6,000 people die of AIDS each day in Africa. That's mind boggling. It's hard to even fathom that. Since I introduced my bill last August, for example, 1.2 million people have died. As you can see, the survival of the continent is at stake, so today we will discuss a wide range of topics on this issue.

I want to leave and close my statement with one important thought. It's from an old proverb in Swaziland which says that there is a poisonous snake in our house, and if we do not get it out it will kill us all. Congress must pass legislation to address an AIDS crisis in Africa.

Thank you, Mr. Chairman. Thank you, Ranking Member, LaFalce, and thank all of you today for being here and for your commitment to addressing this in a real way. I look forward to your testimony.

Thank you.

REP. LEACH: Thank you, Mrs. Lee.

We will now turn to two witnesses from outside the committee. We're honored to have their presence. The first is Senator John Kerry of Massachusetts, who's a member of the Senate Foreign Relations Committee and a strong advocate of the need to address this particular crisis. He's a sponsor on the Senate side of the World Bank AIDS Prevention Trust Fund Act, and he's also sponsored legislation to develop vaccination approaches.

Our second witness is our good friend Amo Houghton, who represents the 31st District of the State of New York, who's a member of the International Relations Committee and a senior member of the Subcommittee on Africa and one of Congress' experts in many fields, not the least of which is the continent of Africa and the problems that inflict it.

We will begin with Senator Kerry.

SEN. ROBERT J. KERRY (D-MA): Mr. Chairman, thank you very much for holding this hearing. Thank you for allowing us to testify, and I appreciate very much the eloquence of each of the statements that we heard from your members, who have really summarized the legislation very adequately.

I think what I'll do is I would ask unanimous consent to put my comments in the record as if read in full and just share a few thoughts with you for a moment.

Senator Durbin has joined me in sponsoring the companion bill in the Senate, which is now referred to the Foreign Relations Committee, and we are in discussions with the majority on that committee to try to expedite these efforts on the Hill. It's my hope that this hearing and action by the House, swift action by the House, can inspire the Senate to try to move.

As you know, Mr. Chairman, our Subcommittee on Africa held a hearing on the AIDS epidemic about two weeks ago. You referenced the bill a moment ago that Senator Frist and I have introduced, and I'd just like to say a word because it fits into the overall approach that we need to employ in dealing with this.

The chairman of the subcommittee, Dr. Frist, whose obvious skill and knowledge in the field of medicine is an important and valuable asset to all of us on the Senate side and I think to the Congress, he's joined me in co-sponsoring the effort to spur the development of vaccines.

No one quite knows what we could accomplish, but most people believe that if we put a legitimate effort into developing a vaccine we can accomplish a great deal, just as we have in diphtheria or whooping cough or polio, other diseases.

The problem is there's no market. Pharmaceutical companies aren't going to put the money into the investment because unlike Prozac or Viagra or other drugs, the wonder drugs of our society where the market returns billions of dollars, nobody knows who's going to pay to buy these.

I think the reason I cite this -- it's not the bill we're talking about here today, but it underscores the global nature of the response that is necessary to deal with the problem of AIDS and the multifaceted approaches that are necessary.

There's no one approach that is going to deal with this crisis, so you need to move on the front of trying to develop the vaccine, trying to develop the market to be able to distribute the vaccine, but also clearly we have to continue to make efforts on the prevention front because all of us understand the contagion doesn't know any borders. The contagion obviously needs to be fought on every front because it is evident on every front.

You're going to hear from some experts on the scope and the epidemiology of the AIDS in Africa question. You're going to hear from our distinguished ambassador to the United Nations, whom I think we all salute for his effort to put this issue on the world agenda, a unique effort within the Security Council and the United Nations to deal with this kind of issue, and I think it's leadership that is appropriate for the United States. You're going to hear from Sandy Thurman and from one of the nation's most compelling and articulate advocates in the fight against AIDS, Mary Fisher.

We're all probably going to duplicate each other a little bit, but let me just try to pick up on what my congressman, Barney Frank, said and underscore why we have to do this. Barney talked about the humanitarian need here. It is really hard in this modern age for whatever reasons -- none of us can adequately completely describe it, and if we did we'd be inappropriately describing some other fellow citizens' reaction to this.

I've actually heard people in this country say well, it's the product of their sexual practice, so there's not much I can do about it. I mean, there's a capacity for people to be dismissive, even of a crisis of this proportion, even of something that has all of the humanitarian demands, compelling factors of this issue. This is not something that any decent, rational person can be dismissive of on humanitarian terms, on political terms, on cultural terms, on economic terms, on historical terms. No one should dare to be dismissive of this.

We are tied and linked to everything that is happening in Africa back into our earliest history, and we are tied by the new forces of globalization and technology, and I hope, listening to what Barney Frank said, we will always be tied by who we are, what we are as a nation. This really tests the fiber of our country in a sense and whether or not we're prepared to step up and offer leadership in order to try to deal with it.

The statistics sort of befuddle. The statistics, you know, they're hard for anybody to grasp. I mean, it's hard to imagine 40 million plus children, all of whom in the next ten years are going to lose a parent. It's hard to imagine what a society is like that's losing its teachers, its infrastructure of people, its human infrastructure, through a disease like this and what that means for future generations who may not have somebody there to teach them, may not have a leader, may not have a capable somebody within a community who can help pull that community together.

It obviously just like AIDS itself, which destroys the immune system, in a sense it destroys the immune system of a community of the whole fabric of society. We're going to see as a result of that in a place like Tanzania there will be a 15 to 25 percent drop in GNP because of AIDS. In South Africa, business owners often hire two employees for one job, knowing that one is probably going to die from AIDS.

Up to 80 percent of the urban hospital beds in Malawi are filled with AIDS patients, and every day in the Cote d'Ivoire a teacher dies from complications associated with AIDS. Zambia is a nation of 11 million people, and next year half a million of them will be AIDS orphans.

So it seems clear that if an entire continent, if an entire people, are going to remain linked to the rest of humanity and tied to that rest of humanity by the kinds of values that matter to us, we need to respond on a global basis.

Now, how do we do that? Well, Mr. Chairman, there's a sign over there that says "Prevention Programs Work", and I'd ask unanimous consent that an article from January 2 from The Economist be placed in the record, and I'd just reference very quickly.

There are three examples in this article, Senegal, Uganda and Thailand; one very developed, one undeveloped and one that hadn't been hit by AIDS. Each took major preventative efforts to break down the myths, to deal with the problem of migrant labor, to deal with problems of religion.

Myths, I might say, play an extraordinary role in this. I mean, there are literally people who believe that -- women who believe that having unsafe sex is somehow going to make them beautiful; men who believe that they can be cured of AIDS if they have sex with a virgin. I mean, these myths are powerful.

You need education. You need outreach. You need major efforts in order to change that type of belief structure. It's happened in those countries that I just cited where government efforts, non- governmental efforts, major media efforts reached out to people and changed behavior, and so this prevention trust that we're talking about is in addition to other wonderful efforts by people like Bill and Melinda Gates, who have put $750 million into the vaccine effort, or the Elizabeth Glaser pediatric AIDS effort that's trying to help mothers use the available ability to prevent AIDS from being passed on to children.

We can do a better job of making certain that all of subsahara Africa where the principal problem lies can be reached by information and opportunity, and that's our obligation. This effort to have the World Bank be the trustee in a sense to use the best of its ability as a global institution to bring donations together, to bring together the resources of the world, to bring governmental funds together and to distribute them in a way that will maximize our best prevention efforts is a significant component of the full mosaic of what we need to do this.

Mr. Chairman, I close just by saying the developed world spent $250 billion to try to deal with the Y2K bug. This is a real disease that is far more damaging to the structure of society and to the long- term interests of this planet, and it behooves us to try to find a few billion over a period of time much more stretched out than we spent the $250 billion in order to deal with the realities of this disease.

Thank you very much, Mr. Chairman.

REP. LEACH: Thank you very much, Mr. Kerry.

Before turning to Amo, I want to do two housekeeping things. One, I'd like to ask unanimous consent that all members be allowed to put opening statements in the record, including one by Congressman Gephardt that Mr. LaFalce has been presented. Dick apologized, since he hoped to be with us today. He has a very powerful statement.

Secondly, I'd like to ask unanimous consent to put the two charts we've put on the board in the record. One shows the extraordinary incidence of AIDS and how it is spreading, and the second that prevention programs do have some effect in dealing with the problem.

At this point, Mr. Houghton, please proceed.

MR. AMO HOUGHTON (R-NY): Thank you very much, Mr. Chairman, and thank you, Mr. LaFalce and Ms. Lee and Mr. Castle and everyone who's been involved here. It's great to be with Senator Kerry.

Are you going to leave? Okay.

Also, you know, there's so many other people. Ron Dellems (ph) and Sheila Sasulu (ph) of the South African embassy and obviously Barbara Lee, what she's done. I am totally in agreement with your bill, 3519, and I hope it can be passed this year and maybe even the Lee/Dellems (ph) bill. We'll have a chance to do this. I think right behind that is, of course, the Crowley/Pelosi bill, but they're all moving in the right direction.

Mr. Chairman, you know, it's very tempting to sort of cite statistics and horror stories and things like that, and I don't really want to overdo that, but I want to give just a little bit of personal background here.

I've spent a lot of time in Africa over the years. I went there first in 1950, and I went intensively in the early 1980s when I was in business. The place that I spent most time with is Zimbabwe, and I think it sort of is a microcosm in a way of the subsaharan problem.

I was interested in working very closely with the church before I got into politics, and there was a fellow called Peter Atendi (ph) who was the Bishop of Harare, the capitol city of Zimbabwe. We used to --

REP. LEACH: Amo, could you bring the mike a bit closer, please?

REP. HOUGHTON: Yes. Can you hear me better now?

We used to talk about AIDS and what was happening. Of course, those were in the early years when AIDS had really just be recognized in the 1980s. It was an affront to him as a religious leader, as a member of that society, to really acknowledge this problem. My wife and I used to distribute comic books describing things so that people could see in pictures rather than in words. He fought this.

Dick Gephardt and I had a congressional delegation in December where we met Ambassador Holbrook, and I had a talk with Peter Atendi, this bishop that I referred to, and his son had just died of AIDS. His son's wife has AIDS. Their only child has AIDS.

The mission that he got me involved in, a tiny little mission about two hours south of Harare, not many people. There's a school of maybe 1,000 people and little villages around. Every single day there's a funeral for AIDS, and it really is a startling issue down there because in many cases it's not just what you can do for them, but what they can do for themselves in terms of acknowledging this particular problem.

One of the most interesting experiences we had in our December trip was going to the largest hospital in the world, which is in Suwato (ph). The statistic I best remember, and Congressman Castle was there with me, was that in 1987, of 1,000 women who had just came in just before they were to give birth to their children, three were tested positive for HIV. Last year, out of that 1,000 instead of three, it was 250. This was from 1987 to 1998, so in 11 years they've gone from three to 250. If you take another 11 years, it goes right off the chart. It's infinite.

You know, I could go on and cite story after story, as we all can. The question really is what do we do about it? I know General Marshall always used to say two things. Don't get involved in the minutia and, secondly, don't fight the problem. We tend to fight this problem, and I think what you're trying to do is to solve it.

I think that there are a variety of issues here. First of all, there's the medical issue and the education issue. You know, there's just not very much of that around. Mary Fisher and I were talking earlier that there are United States drug companies who are willing to give drugs away. They can't distribute them. The hospitals don't have the physicians to handle them. They don't know what to do. So it's not just the fact that an HIV drug is $200 a shot or something like that. It's just that the whole structure is difficult for the distribution of these drugs.

Another thing that I've found was that it's really important to not just concentrate on the medical issue of AIDS or even the educational issue. It's sort of a lifestyle issue, and that is jobs. You know, there are three things that we came up with there. One was horrendous crime, big on employment and the AIDS issue.

You know, so many times in the rural areas people go from the rural areas to the city to get jobs, and that's exactly the wrong thing for them to do, and so part of our responsibility not only in terms of what we do as individuals, but in terms of legislation, is really to find a way to encourage investment over there. That's hard.

These people in many cases don't know what to do. I mean, having been in business for 40 years, they don't give you a plan where you can get your teeth into it. They don't know how to ask for economic help. They want it. It's necessary. It's part of the whole picture of keeping people in the rural areas rather than having them gravitate towards the city where they get into trouble.

Another thing, Mr. Chairman, I think is very important is the attitude of the leaders over there. I'm not going to mention names or even countries, but there was one very, very distinguished person that we talked to, head of his country. He kept talking about tuberculosis and diphtheria and measles and things like this, I mean, as if AIDS really wasn't the problem.

Unless leaders of some of these countries, and I think we could help this, are willing to acknowledge this fact that they've got a problem and will handle it like Uganda, then I think we've got an uphill battle.

One of the problems is that they don't want to scare away investors. It's the old question of foreign money coming in and building a plant or building a business to be able to help in their unemployment, so those are very important.

However, having said that, absent the money and absent the things you're doing, nothing is going to happen, so I applaud you and I think you very much for letting me be part of this discussion.

REP. LEACH: Thank you very much, Amo. We're honored you've been able to join us, and I personally want to thank you for your enormous concern and advice on the subject. Thank you very much.

REP. HOUGHTON: Thank you.

REP. LEACH: Our second panel is composed of the Honorable Richard C. Holbrook, who is the United States ambassador to the United Nations. Dick has been instrumental in getting the U.N. Security Council to convene a special section on Africa in January, by the way, an unprecedented way, and to bring national attention to the horrific suffering occurring in the region because of the HIV AIDS virus.

He's had a long and distinguished career in the diplomatic service, including stints as ambassador to Germany, assistant secretary for European and Canadian affairs and special envoy to Bosnia and Kosovo.

Our second witness will be Ms. Sandra Thurman, who's director of the Office of National AIDS Policy at the White House. A long-time advocate for individual suffering of HIV AIDS, Ms. Thurman was a member of the Presidential Advisory Commission on HIV AIDS and a founding member of Cities Advocating Emergency AIDS Relief.

Our third witness on the panel is the Treasury under secretary for international affairs, Timothy F. Geithner. Mr. Geithner has served in a variety capacities at the Treasury Department for the last 12 years and is responsible for issues relating to U.S. policy toward the World Bank and other international financial institutions. We welcome Secretary Geithner.

We'll begin with Ambassador Holbrook.

AMBASSADOR RICHARD C. HOLBROOK: Mr. Chairman --

REP. LEACH: Before beginning, let me say that without objection all statements will be presented full in the record, and panelists may proceed in any manner as they see fit.

AMB. HOLBROOK: Mr. Chairman, I have a prepared statement I'd like to present to you and make a few very personal comments because I think everyone who is in this room by definition already knows the dimensions of the problem. We're here to do something about it.

First of all, let me just thank you and your colleagues enormously for bringing this issue not only before the public's attention, but for making it part of the activities of this particular committee.

Just as we expanded the dimensions of the problem by bringing the issue to the Security Council of the United Nations in January, as you just mentioned, you add a new dimension bringing it before your committee, and in that regard to have a representative, a very senior representative, of the Treasury Department joining Sandy Thurman and me here today I think sends an additional signal, and that signal is unambiguous. AIDS is not just a health issue.

Congressman Frank's admonitions at the outset are ones I totally agree with. I think he's warned us that we can get caught in a self- congratulatory rhetoric and not do anything about the issue. Our goal here is to make people aware of the fact that although many other illnesses are serious, this one has a unique quality to it and that it threatens not only the health of people, as all diseases do, but in this case threatens the very fabric of society and economy itself in many nations in the world and particularly in the southern part of Africa.

My own involvement in this issue began seven years ago when I visited Cambodia as a private citizen and visited the United Nations and found, to my astonishment, that United Nations peacekeepers were coming to Cambodia to bring peace to the area, but were in fact spreading AIDS. In other words, they were solving one problem while creating another.

I found in my hard disk on my personal computer last week the letter I wrote to the U.N. in Cambodia, which I hadn't seen in seven years, and I would like to submit it to you, Mr. Chairman, for your files. I submit it to you because I am struck by something re-reading it last week for the first time in seven years, and that is that nothing has changed. The U.N. is still spreading AIDS while bringing peacekeeping missions to other areas, and that is one of the main reasons we've brought it to the United Nations.

We have stated, Mr. Chairman, that we will never again support a peacekeeping resolution in the U.N. that does not contain a section on AIDS, and I would also like to submit for the record this morning a letter I received late yesterday afternoon from the under secretary general of the United States, Bernard Miae (ph), outlining the steps he is taking up to this point to increase AIDS awareness among U.N. peacekeepers in order for you to peruse it. It's a step in the right direction, but again it does not go far enough.

REP. LEACH: We will be happy, Mr. Ambassador, to put that in the record.

AMB. HOLBROOK: We'll supply those to you later.

In addition, Mr. Chairman, of course our concern goes far beyond the U.N. peacekeeping connection. You mentioned and several other people mentioned the historic Security Council meeting of January 10 chaired by Vice-President Gore.

We were told in advance we'd never be able to have a health issue in the Security Council, but we did it. Several of you in this room joined us at that meeting. We were honored you were there, and subsequently we've had continued discussions with many of you about what to do about this issue.

I can only say to you that this administration is fully committed. President Clinton is personally seized of the issue. The vice-president's commitment is self-evident from the time he has spent on it in recent weeks and months. I am very proud that the effort on this has been bipartisan. I am delighted to see several people in the room I've been working closely with.

We stand ready to work with you to increase our efforts, and I'm honored to be part of this panel at this time and, above all, Mr. Chairman, for the initiative of you and your colleagues for you to bring this into the Banking Committee because again you're showing that it is an issue that is more than a health issue.

Just as we said it's a security issue, you're now spreading the dimensions of it again, so the fact of the hearing in this particular form transcends the substance, and I thank you enormously. It will be echoed in New York, and we will bring it to the attention of all U.N. Security Council members once you have reached the conclusion of your deliberations.

Thank you.

REP. LEACH: Thank you, Mr. Holbrook.

Ms. Thurman?

REP. KAREN L. THURMAN (D-FL): Thank you, Mr. Chairman, members of the committee. I'm delighted to be with you today to have the opportunity to talk about the global AIDS pandemic with a special focus on AIDS in Africa. Your leadership and your commitment to addressing this crisis is very much appreciated and, it goes without saying, very much needed.

I'd like to use my time with you today to lay out a vivid picture of the scope of this tragedy, particularly as it impacts the stability of families and communities and, in my instances, nations. I'd like to share with you some of my personal experiences with the faces behind the shocking facts, and I would like to outline for you some key components of our enhanced administration response to this global pandemic.

By any and every measure, AIDS is indeed a plague of Biblical proportion, and it's claiming more lives today than all of the wars waging on the continent of Africa combined. AIDS is now the leading cause of death of all people of all ages in Africa, and the progression of this pandemic has outpaced all of our projections.

In 1991, the World Health Organization predicted that by 1999 there would be nine million people infected in Africa and nearly five million deaths due to AIDS. The resulting numbers are two to three times that number, as you have heard, with 24 million infected and more than 14 million deaths already, and yet this war rages on.

Each and every day, Africa buries nearly 6,000 men, women and children as a result of AIDS, and that count will more than double in the next few years. By the year 2005, it is now projected that more than 100 million people worldwide will have been infected with HIV. Unlike other wars, it is increasingly women and children who are caught in the cross fire of this pandemic.

In Africa, an entire generation is in jeopardy. As you've heard already, in several subsaharan African countries between one-fifth and one-third of children have already lost at least one parent as a result of AIDS, and the worst is yet to come.

Within the next decade, as Congresswoman Lee has pointed out, we'll have more than 40 million children orphaned as a result of AIDS, and that is about the same number of children living in the United States east of the Mississippi.

In just a few short years, AIDS has wiped out decades of progress and hard work in improving the lives and health of families throughout the developing world. Infant mortality is doubling. Child mortality is tripling. Again, as has been previously stated, life expectancy is plummeting by 20 years or more.

AIDS is not just a health issue. It's an economic issue. It's a fundamental development issue, and it's a security and stability issue.

AIDS is having a dramatic effect on productivity, trade and investments, striking down workers in their prime, driving up cost of doing business and driving down the GNP.

AIDS is also affecting stability in the region. As Ambassador Holbrook has discussed, the U.N. Security Council just in January held a day long meeting on HIV and AIDS. I think it's very interesting to not, not by accident, that a recent report by the National Intelligence Council documents that this pandemic is much worse than we thought and much work than we had ever predicted.

Yet my message to you today is not one of hopelessness and desolation. On the contrary, I hope to share with you a real sense of optimism, for amidst all of this tragedy there is hope. Amidst the crisis there is opportunity, the opportunity for all of us working together to empower women, to protect children and to support families and communities throughout the world in our shared struggle against HIV and AIDS.

It's important to remember that what we're talking about today is not numbers, but names; not facts and figures, but faces and families. Let me tell you one quick story about an inspirational grandmother that many of us in this room met in Uganda.

Bernadette is a 70-year-old widow who has lost ten of her 11 living children to AIDS. She is supporting on her own 35 grandchildren. With a loan from a village banking system, Bernadette is now raising pigs and chickens and raising corn and other crops, and with the money she earns she has 15 of those 35 grandchildren in school and is able to provide modest treatment for the five of her grandchildren who are HIV infected.

In her spare time, she told me she participates in an organization called United Women's Efforts to Save Orphans, which was founded by the first lady of Uganda, Mrs. Museveni. She unites in that effort with thousands of women across Uganda who have a shared concern about their children.

This women are not alone. From young people doing street theater in Lusaca (ph) to women who are HIV positive forming support groups in Suwato (ph), these people are coming together and creating ripples of hope all across the subsaharan Africa. These are the faces of children and families living in a world with AIDS, and their spirit and their determination and their resilience lead all the rest of us who have seen them and had the privilege of meeting with them.

The good news today is that we know what works. With our partners in Africa, we've developed useful knowledge and effective tools. Together we've designed model programs and already proven that they work, and today we know how to stem the rising tide of new infections, how to provide basic care for those who are sick and how to mobilize communities to support the growing number of children orphaned by AIDS.

As you've heard, Uganda has demonstrated that you can cut the rates of infection in half. Senegal has been able to keep their infection rate very, very low as a result of effective and sustained leadership, but there's much more that we need to do to bring all of these success stories to scale. I mean, it's a very big challenge for us.

The U.S. has been engaged in the fight against AIDS since the early 1980s, but increasingly we've come to realize that when it comes to AIDS, both crisis and opportunity have no borders. We have a lot to learn from the experiences in other countries. It's just amazing. We've done a lot, but there remains much more that the U.S. and the other developed nations must do to combat AIDS.

During the past year and a half, I have had the privilege of going to Africa four times, visiting eight countries. Together with members and staff from both parties and chambers, many of whom are in here today, we went to bear witness to both the tragedy and the triumph of AIDS in Africa.

In response to the findings of these trips, the administration requested and the Congress granted last year an additional $100 million to combat HIV and AIDS around the world, with a particular focus on Africa. The new initiative, which includes AID and CDC, provides a series of steps to increase U.S. leadership through the support of some of these extraordinary community based programs and to provide much needed technical assistance to these poor countries who are struggling to respond in the face of this overwhelming pandemic.

The initiative focuses on four areas. The first is prevention, including basic education, voluntary counseling and testing, the prevention of mother to child transmission. The second is home and community based care to help begin to provide some basic care and treatment both at home and in hospitals and clinics, care for children orphaned by AIDS and the all-important infrastructure that everyone keeps talking about to be able to engage in all of those other activities.

It has other components as well that I think are important, and that includes expanding our foreign policy dialogue to promote the use of resources freed up by debt relief to focus on HIV and AIDS prevention and to engage all sectors, including business and labor and foundations, the religious community and other non-governmental organizations in a broad-based mobilization.

While this new initiative greatly strengthens the foundation of a comprehensive response to the pandemic, U.S. Aid has estimated that it will take at least $1 billion to begin to lay the foundation of a real effective prevention program in subsaharan Africa. Currently with public and private donors combined, we're spending a little more than $300 million there. In addition, it will take another $1 billion to begin to build the infrastructure to deliver basic -- just the most basic -- health care to combat HIV and AIDS.

In the face of such tremendous needs, the administration has requested in the president's 2001 budget submission an additional $100 million to enhance our expanded efforts to combat AIDS in Africa and around the world. That includes additional money for CDC, additional money for AID, but it also includes a request for money for the Department of Labor and the Department of Defense to expand our multi- sectoral approach and make sure we're using every vehicle possible to reach folks where they need to be reached.

Let me repeat, however, that the U.S. cannot and should not do this alone. Chairman Leach, your initiative and the one put forward by Representative Lee clearly recognizes, as we do, that this crisis will require the active engagement of all segments of society working together -- every bilateral donor, every multilateral lending agency, the corporate community, the foundation community, the religious community. It goes on and on, but it can be done, and it must be done.

The bottom line is this. With no vaccine and no cure in sight, the sad fact is that we're at the beginning of an epidemic, not at the end. What we see in Africa today is just the tip of the iceberg, and as goes Africa, so will go India and the rest of Asia and the newly independent states. This is not an African issue. It's not an American issue. This is a global issue.

We look forward to working closely with each and every one of you and are so grateful that this issue is receiving the broad-based, bipartisan support that it supports. AIDS, as we all know, is not a Democratic issue or a Republican issue. It is a devastating human tragedy that cries out to each and every one of us to come up with creative solutions to help.

Thank you, Mr. Chairman, for having us here today.

REP. LEACH: Thank you very much, Mrs. Thurman.

Secretary Geithner?

SECRETARY TIMOTHY F. GEITHNER: Thank you very much, Mr. Chairman. Let me just make a few brief points.

Our compliments to you and your colleagues for the series of compelling and creative proposals you've put forward to try to mobilize more resources in a creative way for this initiative, and we're very much interested in trying to work with you to try to shape a comprehensive approach that is going to actually achieve some reality on the ground as we go through the appropriations process.

This is a huge, formidable, compelling issue.

It's bigger than Africa, and it's bigger than HIV AIDS. People are dying at an alarming rate, an extraordinarily alarming rate, outside Africa as well, and they're dying of diseases -- of century old disease at a rate that exceeds the rate people are dying from AIDS.

This is a complicated -- brutally complicated issue to approach and to solve. The pace at which vaccines get developed cannot exceed the pace at which basic science evolved. Vaccines will not be delivered and put into clinical trials, unless there are resources available to purchase them. You can purchase vaccines and nothing will happen, unless there are health care delivery mechanisms that will allow vaccines to be delivered to a significant fraction of the population in these countries. And you can have the best system in the world and still have fear and ignorance and stigma preventing anything meaningful from happening.

Resources are absolutely critical and the challenge we face is how to expand the highly constrained and highly threatened existing pool of resources the United States provides for development issues more generally. I think the key question for us as a country is whether we can find the capacity in this period of extraordinary fiscal wealth and extraordinary economic prosperity to make a modest small investment in these issues now, that exceeds the relatively small pool of resources we find it our will to do each year for these broader causes.

You can't do this ala carte. You cannot be for vaccines or for HIV prevention and not be for development assistance. You can't be for vaccine development and prevention, generally, and not be for debt relief. And you cannot be for vaccine development and HIV prevention without being willing to support and work through the only institutions we have that are able to make investments in basic health care competently and on a meaningful scale.

It is obvious, but you have to say over and over again, the government cannot do this alone and the problem is complex enough that you have to have sensible public-private partnerships and they have to be done on a broad multilateral scale. The challenge we face -- because this is going to take a very long time, the challenge we face is how we can create a framework that is going to be enduring with a set of financial commandments and a set of incentives that will transcend administrations and transcend individual congresses and will lock us in to a credible mobilization of resources on a scale that can be meaningful.

I want to summarize just very briefly the broad -- the key elements of the broad -- the president's broad millennium vaccine initiative that he laid out two months ago, to try and deal with these challenges, and I'll just do it very briefly. The first is a modest U.S. contribution to the global alliance for vaccine and immunization, to support the delivery of vaccines that now exist to deal with diseases that kill millions of children a yet today.

The second is a significantly expanded investment in basic science, because without that, nothing is going to be possible in dealing with HIV AIDS, with malaria, with TB, that now kill people on such an extraordinary scale.

The third is a substantial redirection of resources in the concessional lending operations of the World Bank and the MBBs, into basic health care. We propose to expand by between -- expand to between -- you know, it could be roughly $1 billion a year the money these institutions invest in lending at highly concessional rates to countries, to make these basic investments in health care.

The fourth, if I haven't lost count, is a debt initiative that Congressman Frank referred to. Unless we are able to find the capacity to finance this initiative fully, we will be foregoing the capacity to free a significant pool of resources that could amount to hundreds of million dollars a year in these countries from debts they cannot afford to pay, to things like education, basic health care, vaccine purchase and delivery.

And, finally, we've laid out a relatively innovative tax proposal, which we hope will help provide a more compelling set of incentives to the pharmaceutical industry, give them more confidence that there will be resources available at the end of the day to deliver vaccines they actually succeed in developing.

We're very interested in trying to work with you, Mr. Chairman, and everyone else up here, to try to put together a comprehensive approach that can deal with each of the many constraints that exist on effective responses to these problems and we complement you on your initiative.

Let me just close with -- by citing something that Larry Summers said recently. I heard him say it, which I found particularly compelling: if you're a kid in America today, you learn very quickly that there are compelling environmental problems the world faces that may threaten future generations; and you learn very quickly that there are species of animals around the world, who are dying at alarming rates; and you learn early on the importance or recycling and why it matters to us, as a people, that dolphins are threatened and that biodiversity is important; but, what you don't learn, as an American child, is how many kids like you in so many countries around the world do not have enough food to eat, cannot plausibly see a doctor in their life time, and are going to face a greater risk of dying of preventable diseases than they may have the opportunity to go to high school. And unless we can change that reality and raise the profile of these broader imperatives around the world, it's unlikely that we're going to find a will to devote the resources necessary to these compelling problems.

Thank you.

REP. LEACH: Let me thank you all for your thoughts and testimony and I appreciate it very much. I'd like to raise a contextual issue that relates to a report that's going to be issued today, and that is there's going to be a report of the Meltzer (sp) Commission that casts some doubts about some approaches of the institutions, particularly the IMF. And I would only like to stress two things: one, there will be some constructive ideas in this report; there will also be some things that many of us in this panel are going to object to. But, I've had a long talk with Professor Meltzer (sp) and he affirms to me that he sees a worthwhile role in the World Bank in the AIDS prevention endeavors, and that I'm hopeful to have whatever debate relates to the Meltzer (sp) report to be outside the context of this particular initiative.

Secondly, one of the unique features of the Brentenwood (sp) Institutions, the World Bank, and the IMF, is that they involve international sharing of obligations; that is, any approach that's adopted by the World Bank or the IMF involves an obligation of the United States. It also involves collateral obligations of other countries and, implicitly, whatever decisions are made, the United States is a minority, not a majority participant, and, therefore, all of the institutions in the world scene that can more quickly develop substantial resources, these two are uniquely fitted. And I raise this simply in the context of the fact that past programs of any nature can be credibly criticized; by the same token, there are a lot of pluses to these institutions, both in past programs and in terms of future opportunities.

And I particular want to turn to the Treasury, in this regard, and just ask, as carefully as I can, if the United States government, led by the department that has the greatest responsibility for the World Bank, concurs in the whole precept that this is an institution that is uniquely fitted for this kind of mission?

SEC. GEITHNER: Absolutely. You know, the problem we face is that no one can look at the experience of development assistance over the past 50 years and not basically believe there's got to be a better way to do it. And nobody can look at these institutions today and not believe that reform is going to be imperative to deal with the challenges of an evolving world. And we are going to a thoughtful look at all the recommendations of that commission and I'm sure there will aspirations we can embrace and I'm sure there will be specific prescriptions that may make some sense.

But, our focus is going to be how to make sure that in the core mandate that is so central to us, as a country, in promoting development and reducing the risk of financial crises, that we are left with institutions that are able to competently address those challenges. And we're going to have the obligation, of course, to report to the Congress in 90 days on the specific recommendations in the commission and we're going to have an opportunity before your committee on the 23rd, I believe, to try to respond in more detail.

I think there is no doubt, as I tried to say in my remarks, that any effective credible response to HIV AIDS or to malaria, TB, or the range of other diseases out there, which are so deadly now, is going to have to based around an effort that will probably inevitably be centered in the Bank, to deal with health care delivery systems, which are so central to this. And that's true not just because of the potential pool of resources that are available, as you put it, with good burden share in a multilateral basis to deal with this problem, but because there is no alternative source of expertise and sort of leverage in how to focus political commitment on these challenges and how to focus credible efforts to build the kind of health care systems that have to be at the core of any effort.

REP. LEACH: Thank you, Mr. Secretary. Mr. LaFalce?

REP. LAFALCE: We, the Chairman and I, the Republicans and Democrats are common mind, I believe. The question is: how do we get from here to there? What is the best approach?

Let me just ask a few questions that trouble me. Is utilizing the World Bank the most effective mechanism? Mr. Holbrooke, as ambassador of the United Nations, would the United Stations, with the World Health Organization, be a more effective instrumentality? Would -- what should the working relationship be? We can't just have entity involved in it, to be sure. But, are there multiplicity of efforts that are created in, you know, waste and inefficient delivery of services, etc.? Why should we not be trying to get the nations of the world to increase more significantly to the United Nations, the World Health Organization, as opposed to the World Bank? I don't argue for that. I posit the question.

AMB. HOLBROOKE: Well, let me answer you in broad brush terms, because a detailed answer is something that requires days and weeks of conferences. This is a war, as we all know. We wouldn't be here today, in the banking committee, discussing a health issue with a State Department official. If it weren't, I dare say, Mr. Chairman, this combination has never been seen before in the Congress -- Treasury, White House, and the U.N. Ambassador before the banking committee, talking about a health issue.

So, what we're dealing with here is a war. Wars have to be fought on every front. One of those fronts is DFDs (ph) and I consider them enormously important. Larry Summers (sp) and Tim Guidner (ph) and their colleagues are fully engaged in this process.

As for the U.N., Kofiana (ph), who, by the way, has been a fantastic leader on this issue -- the Secretary General of the U.N., who, in my view, is the best U.N. secretary general we've had since Dag Hammarskjold, and his passion in this issue and has been trying to raise consciousness on it for many, many years. Kofiana (ph) created UN AIDS precisely, because he didn't think the existing bureaucracies were adequate. UN AIDS were headed by Peter Piat (ph), who many of you know, who has been with us in New York lately and many of you came to New York to meet with him, based in Geneva, the man who discovered the ebola virus, I might add, one of the most distinguished medical researchers in the world, has this organization, which, in itself, is not entirely structured globally. So, it's kind of a coordinating mechanism. And the U.N. can and should do more. And UNICEF has a role. Harold Bellamy (sp) feels that UNICEF can do a central role.

But, I'm going to be frank with you, there is no single international institutional answer, anymore than there's a single U.S. government answer, anymore than there's an African government answer.

REP. LAFALCE: I accept that fully. We do what we can do. The banking committee has this particular jurisdiction, let's do what we can do. Others can do their thing in their committee; let them do it, we'll support them. That's my position.

Ms. Thurman, legislation passes. The country makes a contribution. We're now at the World Bank. We've got country x and country y: country x, 5 percent prevalence rate; country y, 2 percent prevalence rate. We can only ask aid one. Which one do we help, the 5 percent prevalence rate or the 2 percent?

REP. THURMAN: Well, I don't think there's an easy answer to that.

REP. LAFALCE: I know.

REP. THURMAN: Obviously, I think we have to focus, at this point in time, on our efforts into areas, and that is to keep prevalence low. You look at areas where we think there's very high risk. Senegal was a very good example. See if we can't invest in some primary prevention programs up front, to keep the prevalence low. We know that that works.

At the same time, this can't be serving either or. At the same time, we have to do something in the countries that are already --

REP. LAFALCE: I realize it was an unfair question. I did posit it either or, and we can't. We're going to have to do both. I think I should have more artfully asked the question: where should we put the bulk of the money, our resources, our priorities?

REP. THURMAN: Okay. I think right this minute, we have to continue to invest the bulk of our priorities in prevention, because that's the only --

REP. LAFALCE: That means the 2 percent?

REP. THURMAN: (Mm-hmm) and we have to make sure that we're keeping prevalence low; that we're stopping infection in its tracks. And then, secondly, I think --

REP. LAFALCE: Is that going to have -- create some difficulties? Might that mean that we'd favor India over Africa?

REP. THURMAN: No, I don't think so. I mean, again, we have good surveillance to guide us. You know, we know what countries are most at risk. We know where the epidemic is spreading fastest. We know where we have infrastructure, where we think that we can get the best bang for our buck, in terms of our investment dollar and prevention. So, we have some good guidance on where we know where we can have an impact, and I think that's where we need to prioritize first.

And then having said that, I think we really have to take a good look at this whole treatment issue. We struggled with this early in the days of the epidemic here in this country, whether we invested in prevention or treatment. But, we can't continue to invest only in prevention. We've got to begin to grapple in some meaningful way with this whole treatment issue, with 35 million people infected worldwide. But, I think prevention still has to be our first line of defense.

REP. LAFALCE: Thank you. Mr. Geithner, to what extent should we focus exclusively on AIDS? To what extent should we broaden it for all infectious diseases, given relative priority to relative need?

SEC. GEITHNER: I think that's a terribly difficult question. I don't think I can give you a good answer. I think it's important to recognize that a lot of what you need to do to design an effective approach on the prevention side for AIDS and on the treatment front, generally, probably is applicable and probably substantially improves your capacity to address the problems associated with these other equally deadly diseases.

So, I think as long as focus on the need for resources in basic science, on the need for investments in health care systems to make it work, on incentives to promote development by the pharmaceutical industry of vaccines, and on mobilizing resources generally --

REP. LAFALCE: Does the administration have a preferred approach, the World Bank AIDS trust fund or World Bank infectious diseases trust fund?

SEC. GEITHNER: Well, I think there's two questions, in some sense, about this. One is this particular device we use to try to mobilize the maximum scale resources from the rest of the world, and a trust fund is one vehicle for doing that. And then there's a separate question, which you began with, about where do you want to see the priority go. I think I'd defer to -- a little bit on how you think about how you key your priorities on health care targets, generally.

I think the challenge we face is how to figure out a way to invest other donors, whose resources are going to be critical on scale to this, in an approach they want to support, and a trust fund associated with the Bank is one proven practical vehicle for doing that and it may in the end prove to be the most effective vehicle for doing that. But, we want to have the capacity to spend a little more time talking to the other donors and to the World Bank before we commit vocally to that specific device.

REP. LAFALCE: Ms. Thurman, did you want to add to that?

REP. THURMAN: No.

REP. LAFALCE: I saw you -- okay. Thank you, very much, Mr. Chairman.

REP. LEACH: Thank you, Mr. LaFalce. Mr. Frank?

REP. BARNEY FRANK (D-MA): Thank you, Mr. Chairman. I want to go back to this theme of money, because I read in today's Congress Daily a debate is raging and we shouldn't pretend that it's not going to have an impact on this. And that's a debate -- it says, "Senate budget Republicans meet to set discretionary spending limit." And there is a debate now, as to what the overall spending limit will be.

And I think we ought to be clear, and I'm going to ask you to address this, you're here, obviously, as three responsible officials of this administration, talking about one very important program; but, all of you have multiple responsibilities. Ambassador Holbrooke has the responsibility of getting the U.N. dues paid. He's done good work on this and we hope many of us here tried to help that. Ms. Thurman has responsibility for domestic, as well as international aids programs; and Mr. Geithner has international financial responsibility, Treasury, I think, in general.

The problem is this -- I mean, the question the ranking minority member asked is tough, but it's an example of the kind of questions you are all going to have to deal with, if we don't get more money into this federal budget, and that's why I think it was very useful that he did that. No one wants to choose and the natural instinct is to say we'll do both. But, we won't do both, if the overall budget allocation is too low. If we get to the floor of the House with a budget allocation for foreign operations that is very low, we have a problem.

And there's one other aspect to this problem. It isn't simply that Mr. Geithner is going to have to choose between relieving the debt of countries in general, so they can do poverty programs or help them with AIDS; the Ambassador would have to decide between U.N. dues, backlogs, and other important programs, peacekeeping programs, etc., AIDS prevention, the fact that he says -- and then the peacekeeping.

Or Ms. Thurman, it's not just that, but we will run into the worst dilemma that we run into around here, which is efforts to respond to an international humanitarian crisis will be criticized by people who will say, but there are Americans going without. There are Americans who can't pay for their AIDS drugs. There are Americans who aren't getting the Veterans medical care they ought to get.

And I just want to stress this again, if we do not have adequate funding overall, our ability in the end to vote the kind of funds that are necessary for this program aren't going to be there. And I would say I have no particular expertise about how best to do this. I consider my job to be to try to fight to get the resources to the well intentioned people who have expertise, both in our administration and elsewhere. But, I want to stress it again, it's easy for us to all say everybody here is sincere, particularly this group. I mean, if this group was Congress, we would take care of everything and go home in an hour. But, when we get to the actual cutting up of the funds, we are going to face this terrible problem.

And, you know, let me ask you, Ms. Thurman, what happens if we substantially increase funds to fight AIDS in Africa and don't provide funds that meet demands for drug programs here? What would you anticipate the reaction will be, as far as the people you deal with?

REP. THURMAN: Well, we've actually seen increasing support on the part of the AIDS community domestically, to support AIDS funding around world and I think it's because for a couple of reasons. The first reason is that we only spend -- we spend less than 1 percent of all of our AIDS funds on international programming and we've seen dramatic increases in our domestic AIDS spending with your help, and we're really glad to see that.

This is sort of not -- again, not an either or situation. First of all, this money comes out of two different pots of money.

REP. FRANK: But, excuse me, here is the problem: stop saying that, because you're wrong and you're going to give people a false sense of security. Senate budget Republicans meet to set discretionary spending limit. It is easy work. There was an overall discretionary spending limit. What this Congress passed and the president, God knows what he was thinking, signed, the bill of 1997, put an overall limit on government spending. Fortunately, it was so stupid that even the people who voted for it began to violate it about an hour later. But, when you get that kind of overall restriction, it becomes either or, and we should not pretend that it isn't.

The problem is it is too easy to be for cutting government in general and then be an advocate for this, that, and the other good government program. The whole can't be smaller than the sum of the parts, and we have got to understand that. And we -- what I am trying to say now is let's not simply advocate increases here; let's use this as an argument, to make sure that we are not into that unfortunate either or situation. Ambassador Holbrooke, you want to say something?

AMB. HOLBROOKE: I think what you said is of transcending importance and let me address it from the national security point of view, because Congressman Leach more or less has a line up here, financial, the issue, itself, and I'm supposed to wear a national security hat.

I think what you said needs to be really thought hard about by you and your colleagues. We have here an undeniable emergency. No one, not even the most hard- hearted trilogist (ph) is going to object to the proposition that we're here discussing an emergency. If we then get caught inside budgetary ceilings, which require us to choose between this issue and the other issues of national security importance, and I will just pick the two I've been working on this morning, Mr. Chairman, Kosovo and Congo, where we have major peacekeeping operations, and, in one case, American soldiers at great risk and both with the AIDS -- ironically, with an AIDS connection, we are going to be forced to make a choice, which is against our national security interests.

We took this issue to the Security Council and you're hear today, because we agree it's more than a health issue. So, let's say, it is a national security issue for the U.S. We have other national security issues. I think what Congressman Frank was saying, and I could not agree more with him, is fundamental. If we are forced to take money out of peacekeeping, in order to deal with AIDS in Africa, it is a terrible deal, because there are going to be wars in Africa, as a result of that decision, which would pull us back in, let alone the fact that AIDS will spread, too.

So, Mr Chairman, I hope that you and your colleagues will find a way to address the core issue. There's a supplement up for peacekeeping in Kosovo and East Timor and Congo. There is a war that could explode in Central Africa, not only spreading AIDS, but causing great tragedy. We have American and other NATO soldiers at risk in Kosovo. And simply to have to choose between those issues and AIDS, when we're the richest country in the world, at the apogee of our wealth, strikes me as a very dangerous thing to do.

REP. FRANK: Thank you, Ambassador. I will close now, Mr. Chairman, although I did, on a somewhat unrelated topic, but you did mention the NATO troops in Kosovo. I want to say I will pursue this in another form, but I just -- I'm finding every public opportunity to say it, for the United States executive branch to appear to be unhappy, because the Europeans are finally getting together their own defense force is the dumbest single thing I have read all year. And those of us who have been trying to get Europe to pick up some of that burden -- I read that article yesterday and it was appalling.

But, beyond that, I just want to close and say not only that I agree with you with regards to the international aspect, but let's understand the politics of this place in an election year, an important election year. If it appears that domestic programs, Veterans health, housing, etc., prescription drugs for elderly Americans, let's just take that, if people think you can, in this country today, ignore the need of older Americans for prescription drugs and get the kind of resources we ought to be sending to Africa, I think they are wrong. And one of the smartest things John Kennedy ever said, when he talked about Franklin Roosevelt's good neighbor policy regarding Latin America, was, frankly, Roosevelt could be a good neighbor abroad, because he was a good neighbor at home. And it very important to us to have adequate resources to deal at least in a minimal way with all of these needs; otherwise, we're going to see a lot of the kind of very sincere rhetoric today wind up with people being frustrated.

REP. LEACH: Well, I appreciate the gentleman's comments. And as Chair, I'd like to make just a brief intervention. When you have issues before the Congress, not infrequently, there are tradeoffs; and not infrequently, there are issues that each of us, as individual members, think are more important than other issues. But, if there's any issue in the world of any kind that should be considered of an emergency dimension beyond all other normal kinds of emergency, it has to be this one. And I don't think there's any doubt whatsoever that we have a moral obligation to make a difference where we still can, because there's -- one of the great questions is, if you lengthen this out, our ability to make a difference will decrease substantially for those that are going to be affected and that those that are going to be affected are high proportions of the world's population.

And so to deny a special emergency status and, as Mr. Frank has indicated, to put this in the context of normal tradeoffs, would be irrational. And that doesn't mean that the normal tradeoff approach does not make some reasonable sense in other context, but not in this one.

The gentleman from Texas.

REP. KEN BENTSEN (D-TX): Thank you, Mr. Chairman. First of all, let me commend you for calling this hearing and while this may transcend beyond the jurisdiction of this committee, I'm glad that this committee is doing this. I am relatively new to this issue, but I have to say it is extremely startling to me when you look at the statistics of AIDS in Subsaharan Africa. And Mr. Holbrooke, I think you addressed the point correctly, that this goes beyond -- it is a moral issue, but it goes beyond a moral issue. This is a -- I think, in the post-cold war world, this is potentially the biggest foreign policy crisis affecting the United States and the industrial nations.

You have a civil war raging in the Congo Republic affecting, what, five or six other nations right now. We now have a large U.N. peacekeeping operation there. If you start to have -- if we allow the AIDS epidemic to continue, the economic costs that seem to be associated with that will only make the situation worst, which ultimately will draw in greater peacekeeping troops, will ultimately draw in industrialized nations, possibly even the United States, and that's why I think this is an emergency and should be addressed as such.

I would say the gentleman from Massachusetts is absolutely correct. I sit on the budget committee and we had a hearing the other day and we already totaled up an extra 15 (billion dollars) or $17 billion that members want to add to the bill. And we have proven that the whole can be larger than the sum of the parts through some creative bookkeeping. And I would argue that this is truly an emergency.

But, he's also right that politically, as serious a crisis as this is, it will never fly in an election year, compared to domestic concerns that are out there. If it would, you would see more members here today listening to your testimony. But, unfortunately, that is not the case, at this time. So, we are going to have to work much more -- much harder on this.

It is unfortunate that it does not have the same strength that the HPIC (ph) proposal and the Jubilee (sp) 2000 proposal had. There are groups out doing it. And I would just add, and I don't want to sound critical of the administration, but I think there are a lot of people, who believe that it was the religious organizations in this country pushing the Jubilee (sp) 2000 that was far out in front of the administration on this issue and far out in front of the United States and pushed us to the forefront. And since we do, in effect, lead the G-7, we lead the World Bank, and, quite frankly, the IMF, perhaps more so than the Germans would like right now, but, nonetheless, we do need to take the lead on this.

And I would like to ask, particularly Secretary Geithner, the administration proposes in its 2001 budget a $100 million. Is that an assumption of this trust fund? Second of all, I believe Mr. Frank raise, and I was not here when he spoke earlier, but the question of whether or not we are tying this in and absorbing some of our efforts in the HPIC program, or do we assume this is in addition to the HPIC program?

And the third question would be: to what extent do you believe or know that our partners in the World Bank are going to contribute, if we -- if the U.S. is successful in getting the World Bank to set up this trust fund and we are successful in getting up to $100 million in the annual authorization and funding for it, to what extent will our partners come in with that or are they ahead of us, in that regard?

And the final question is: in your testimony, you talked about the administration proposing transferring -- multilateral development banks transferring between 400 (million dollars) and $900 million in concessional programs to health programs; are we robbing Peter to pay Paul, in that regard?

SEC. GEITHNER: I'll defer to Sandy the specific questions on the administration's AIDS request. I'll say in general the following: the request that we have on the table for the Dent initiative, the request for HIV AIDS prevention and treatment, the request for a contribution to the broader vaccine purchase fund, the Global Alliance for Vaccines and Immunization has proposed, are all requests above and beyond the existing concessional resource envelope for development assistance, and that's why Congressman Frank's point is so important. Unless we're able to increase the overall envelope of discretionary spending by some prudent level, unless we can increase the overall envelope for research we put at these broader initiatives, then we're not going to be successful.

It's very hard to tell, I think, where the other donors are going to be, at the moment. But, it's important to recognize one basic fact, which is these countries on a whole contribute far more to development assistance efforts, far more to poverty reduction in poor countries, far more to this whole range of issues we discussed today in per capital terms than does the United States. And though -- although it's obvious that we cannot bear a disproportionate cost -- a share of the cost of this kind of thing, their basic view is we love you to come join us. And unless we're able to be credible by putting more resources on the table and getting it through the Congress, we have no credibility or moral authority with them, in trying to get them to come to the table.

The proposal we put on the table to redirect a substantial part of the concessional resources the World Bank and other banks lend each year for poverty reduction, to basic health care, we believe can be accommodated easily -- relatively easily within the existing constraints that apply to those resources for two reasons. One is that we've fought very hard to make sure that these resources go to countries that can use them most effectively, and so that has left some resources that are available that we can redirect to these -- resources that are now not spent on the pace they're expected to be spent, that we can use to redirect to these efforts. The other reason is that we think that -- you know, this is all about choices and priorities, and we think it's perfectly appropriate for the bank to put and for IDA (ph) to put at the top of its priorities basic health care, primary education, and those core development imperatives and make that the center of what they actually do.

I think that covers most of your questions, but I'd be happy to come back to you on any of them.

REP. THURMAN: The president's request for 2001 includes another $100 million on top of the 100 million (dollars) that we got last year, to expand our existing programs at CDC, at USAID, and to create new programs at the Department of Defense and the Department of Labor, to do outreach.

REP. BENTSEN: But, it does not envision the trust fund, as in the chairman's bill?

REP. THURMAN: No, sir.

REP. BENTSEN: And my time is up, but where were to enact the chairman's bill or Ms. Lee's bill, would you, then, seek an additional $100 million or would you assume transferring the 100 million (dollars) of the 200 million (dollars) you've requested.

REP. THURMAN: We certainly wouldn't transfer the money that we're currently requesting, so we would have to talk, you know, about additional funding, at that point.

MR. BENTSEN: Thank you. Thank you, Mr. Chairman.

REP. LEACH: I think the gentleman has raised this point, if we pass this bill out of this committee, am I right that you will support it?

SEC. GEITHNER: Can I --

REP. LEACH: Is the Congress well ahead of the administration and the administration would -- or will you actively support, if we pass this out?

SEC. GEITHNER: I'll tell you, we will actively support any effort we see, as providing a reasonable prospect of increasing the pool of resources available for these objectives and any effort we think is going to be -- give us the maximum potential of leveraging resources from other donors and other institutions. And I'm saying that just because I want to stop just one step short of being specifically committal to the vehicle, just so that we have the capacity to engender the kind of broad support and ownership internationally we need for any of these things to be successful.

REP. LEACH: I appreciate that, Mr. Secretary. Mrs. Biggert?

REP. JUDY BIGGERT (R-IL): Than you, Mr. Chairman. Is there a way or have we been able to measure how the monies that we have already given for the AIDS HIV, that we have really seen -- do we measure the results from that?

REP. THURMAN: We can. We have -- we've been looking at programs and evaluating programs since the very beginning of our investment in the epidemic, both domestically and internationally. I think our best example is probably Uganda. With ongoing sustained commitment from the United States and other donors and the active participation of the Ugandan government, we've been able to cut the rates of infection in half in Uganda in less than 10 years. It's probably our best success story. But, there are others, like Senegal, which has a very low incidence and with sustained investment and commitment from both the U.S. and other donors, we've been able to keep the infection rates very low. So, we have some good data and I'd be happy, at any time, to share that with you or your staff.

REP. BIGGERT: If, then, there also would be a way to measure the results of setting up in this bill the trust fund that would -- we would be able to estimate the increase in results from that also then?

REP. THURMAN: Yes.

REP. BIGGERT: Okay. Just one other question, then. Have the other donors in the international community responded to the crisis? Have they already committed more money or do we have any way to know if we've put in this amount of money, that they will also respond in kind, if they -- and what would be their projected donations?

AMB. HOLBROOKE: You know, as soon as Vice President Gore made his historical appearance in the Security Council, other nations started coming forward, led by the Japanese. And that goes to a larger issue that so many of us believe, which is that the U.S. cannot do it alone, but the rest of the world will only respond to American leadership. Now, it's up to the Congress to decide the appropriate resources and the ratios, and this is an across-the-board issue. But the short answer to your question is, yes.

Mr. Chairman, I'd like to add one other point here, because the beginning of your question is so critical. There is one point that the three of us have not sufficiently underline today, because we all had it internalized, but your question triggers it, and that is the issue of whether this is hopeless. Everywhere Sandy and I go, I can't speak for Tim, because he spends a lot of his time in other areas, everywhere Sandy and I go, we encounter the same line, it's hopeless. But, Uganda, Thailand, and Senegal show the contrary. Your charts show the contrary. You have in this room ambassadors from Africa, Swaziland, Uganda, and others, who are here to tell you it isn't hopeless.

Triage by continents is, obviously, not only immoral, it won't work, it's not economic, strategic, it fails on every level. But, I want to underline this: in the end, the solution must rest with the leadership of each individual country affected. There is a reason Uganda reduced its rate from 30 percent to 9 percent, while its neighbors went from 9 percent to 30 percent. The reason was with a leadership, led by President Lusavene (ph), that de-de-stigmatized the issue, that spoke frankly and bluntly, in terms that you're not always culturally appreciate in this country, as well as in Africa, about how the disease is caused and spread. Many of the leaders of Africa, who wear the same ribbon Sandy is wearing today, refused to be honest about what causes them to be wearing that ribbon. De-stigmatization, which means, by the way, that if you get tested positive, you don't lose your job, the family doesn't throw you out on the streets, leadership is essential.

So, our bottom line here today is that resources, in conjunction with the right leadership in Africa, will make a difference. This is not a bottomless pit and I cannot stress that too highly, Mr. Chairman, because I think, in our opening presentations, we perhaps inadequately addressed the fact that this is not only an emergency, which we agree, but it's also not hopeless.

REP. LEACH: Thank you, very much. Mrs. Biggert?

REP. BIGGERT: Thank you, Mr. Chairman.

REP. LEACH: Mrs. Lee?

REP. LEE: Thank you, Mr. Chairman. Let me just first say, with reference to the issue that Mr. Frank raised, when I first introduced my bill, H.R. 2765, that was the issue, the debate, is why -- is this a priority, given the huge domestic needs, given the fact that prescription drug coverage, preserving social security, domestic aid, housing, all of those issues should be a priority. My response, Mr. Chairman, and members, is that here, we have a time of unprecedented surpluses. We have an increasing amount going into our military budget. So, if we can't do this now, then when? I mean, this is the moment that we need to rise the occasion and lead the world in addressing this enormous pandemic.

Let me just say to Ambassador Holbrooke, first of all, I want to acknowledge your leadership in declaring that this is a war and then bringing it to the Security Council. This truly was a defining moment, in brazing the level of awareness of this pandemic to the world. And also just as an African American, I am very proud of that moment and very proud that you did that.

You know, given the conflicts that we see on the continent in Burundi and Sri Leone and the Congo, we know that many of the young men in Africa are orphans and many have been orphaned, as a result of AIDS. Their parents died of AIDS. And what I'm wondering is now, given the huge numbers of orphans in the militias and in the military in Africa, have we looked at how we're going to address the whole HIV AIDS crisis within that population of individuals, or what do we need to know or what do we need to keep in mind, given the fact that this is not one dimensional, that we do have to deal with the conflicts and the individuals serving in those wars?

AMB. HOLBROOKE: You've raised an incredibly tricky problem and before I comment on it, let me acknowledge your own extraordinary role in this. You've been frankly well ahead of most of us and we are in your debt and praise from you means a lot to us, who have arrived more recently on the scene.

Look, let's be frank about this and use some of the real words and realities of the region, which are rarely mentioned in the Congress or the Security Council. The highest male spreaders of this disease in Africa are the police and the military.

The pattern of infection is the reverse of what people think it is, because the higher the rank, the more likely they are to be infected, because they have money, which gives them to access to prostitutes.

When you're putting together a peacekeeping force -- I'm not addressing your orphan's point, because I think the orphan cohort is still too young to be a factor here. The orphans with AIDS -- or AIDS orphans are kids, who have been orphaned, because their parents died of AIDS, are not yet of military age. But, of course, in five to 10 years, you're going to have this. But, they're not going to get in the military anyway. The military is an elite organization, with a job. This is worse than this. The orphans are one problem; the military is another. But, I am profoundly worried, Mr. Chairman, by the fact that the governmental structures in many countries in Africa are very reluctant to pursue or encourage testing -- voluntary testing, because if people test positive, they're going to be ostracized, dead men walking, dead women walking, and their deployment in peacekeeping operations will be similarly circumscribed.

You know, the United States government policy is that if a person takes -- in the military, tests HIV positive, that person will be treated, but not deployed overseas. That seems to be a correct policy. But, African countries are not likely to do it. And when you're filling up a 55,000 person peacekeeping operation in Congo, that's an extra problem.

On your problem on orphans, Sandy and I have both had the same vivid experiences I know you have and others of your colleagues, which is that the orphan population, as it grows, is also unemployed, undereducated, and very vulnerable to becoming, themselves, if they don't -- if they're not already HIV positive, very vulnerable to either spreading it or being spread to them. We saw -- my delegation saw really heart wrenching scenes in Kampala (ph) and Lusaka of orphanages, which didn't have enough room for the night for the kids, so they were going right out on the streets and sleeping in the gutters, and that has to be dealt it.

One point that needs to be asserted here, in terms of cost effectiveness and breaking this iron chain, Mr. Chairman, is that if you look at the chain of how the disease is spread, some parts of approach it are really tough. But, one area is really quite easy to define, and that's the mother to infant line. If you -- if women, who are HIV positive, don't breast-feed, you will immediately cut the rate in that transmission belt by over 50 percent. But, Sandy and I have both seen clinics, including some of the best clinics in the world, the ones in Uganda, where even there, the women are still reluctant to be tested.

So, I want to be clear, we are here to raise the alarm, but there are practical ways to cut into it. Mother-child transmission, at the point of birth through breast-feeding, is really within reach and simple. And here, efforts like those you're considering funding can be directly applied to the problem.

REP. THURMAN: May I add to that, Mr. Chairman?

REP. LEACH: Of course.

REP. THURMAN: I wanted to just talk a little bit about this whole military issue and why we think it's so important that we've requested $10 million and the president's 2001 request to do military to military training and other kinds of activities, because we need to address, number one, the issue of HIV infection in the military in Africa and elsewhere; but also to use that infrastructure, which is stronger in many African nations than any other infrastructure, as a vehicle to provide both education for prevention purposes and some basic treatments. So, I think it's really important that we focus some much needed attention in that particular area.

REP. LEACH: Yes, please, Mrs. Lee.

REP. LEE: Thank you, very much, Mr. Chairman. Let me ask -- well, let me just say to Sandy Thurman, I want to thank you for being the lone voice oftentimes on this issue. And I did -- I had the privilege to participate with Sandy and her delegation last year and we looked at the whole orphan crisis in Southern Africa and it was staggering. And I think because of your leadership now, we're seeing some light. And thank you, Sandy.

Let me ask Mr. -- is it Geithner?

SEC. GEITHNER: You got it.

REP. LEE: The question with regard to the whole issue of debt relief and emergency health funding, of course, you know, oftentimes, we think of the World Bank, as it relates to the developing world as a debtor and we're trying to say no more debt. We want debt relief. We know what that has done to our country. How do you envision any type of either emergency funding or any new efforts with the World Bank and how do we ensure that this is debt free money and that the country, which badly needs its resources, don't get somehow encumbered by additional debt?

SEC. GEITHNER: I think that's a very good point. The concessional lending windows of the World Bank and the other banks lend at a highly concessional range. It's roughly 85 percent grant finance. So, it's relatively little risk. If you lend money -- if you lend at this highly concessional rate, it's mostly grant financed to countries that can prove they can use the resources effectively. There's relatively little risk that that will create a problem down the road, which will make their financial situation unsustainable. And one way to reduce that risk is to make sure that we move quickly now to reduce the debts they now owe to both the Bank and the IMF and to the other bilateral creditors. So, I think if you do both together and you try to make sure that the assistance you provide has as much grant element as possible, you can help reduce that risk.

REP. LEE: So, you're -- the World Bank understands we don't want to see another loan --

SEC. GEITHNER: Well, the World Bank can only -- you know, its capacity to provide grant finance is constrained by what countries like the United States and other donors are willing to give them. And so what it does is try to maximize the grant element, minimize the loan element, and get as many resources as it can be prudently used. But, the only way you can deal with -- eliminate even the small amount of credit in these what are largely grants is to put more resources on the table.

REP. LEE: Thank you, very much, Mr. Chairman.

REP. LEACH: Thank you, very much, Mrs. Lee. Mrs. Schakowsky?

REP. JANICE D. SCHAKOWSKY (D-IL): Thank you, Mr. Chairman, and thank you for your passionate leadership on this issue. I am happy to join you as a cosponsor of H.R. 3519, as I am now a co-sponsor and have been of H.R. 2765, sponsored by Rep. Lee. I wanted to make a special and public thank you, Ambassador Holbrooke, to you for inviting me to join you, when the United Nations considered for the first time the international AIDS crisis and to be there with Vice President Gore, as he chaired that Security Council meeting. At that time -- and let me thank the other panelists, as well, Sandy Thurman and Secretary Geithner, for your longstanding work on this issue, as well.

At that Security Council meeting, there were representatives from countries heavily impacted by AIDS, who talked about what Senator Keary (sp) mentioned today, that we spent $250 billion to prevent devastation by the Y2K bug and it seemed to have successfully done that; and, yet, there is so little being contributed to this -- what the chairman has called a crisis in a class by itself, which it really is. They say it's AIDS pandemic. And even the money that we're talking about today, we know really is a drop in a bucket in what is needed to address this crisis.

But, I'm concerned that there are other players ad I have raised this endlessly at various meetings.

And I want to talk about the role, and I hope it's finally been clarified, of the pharmaceutical companies and what, in the past, I believe, has been the United States conspiring, in some ways, with the pharmaceutical companies to keep them out of countries that need them at a reasonable price, by invoking the WTO and Tripps (ph) agreement and saying that it's a violation of intellectual property -- that's one. And let me just say that while I was happy that the president announced at the Seattle conference in Washington on December 1st, that the United States would no longer stand in the way of cheaper medications for AIDS victims, but still in January, according to Newsweek, this is their Web exclusive, so why in late January was the administration still pursuing its hard line policy of protecting corporate patents in Thailand, one of the worst hit AIDS countries? A few days after the U.N. appearance on January 14th, an official with the U.S. Trade Representatives' office reminded the Thais that they could face U.S. trade sanctions, if they a compulsory license to manufacture a drug called DDI, which fends off full-blown AIDS.

I know that a correcting letter has not been sent, to say that the Thais could, in fact, produce this drug, but I wonder what -- do we have two operations going on here or is there consistency now, that we will do everything to assure that those drugs get there? That's what I want to say.

One other thing, the United States government, itself, holds patents on some AIDS drugs. Why -- and I wrote a letter to the president on October 14th, have not received an answer, requesting -- and this was actually co-signed by Rep. Lee, Maxine Waters, Jessie Jackson, Jr., requesting that the U.S. use existing authority to give the World Health Organization the right to use HIV AIDS patents, where the United States government has rights to those inventions, and we do have on a number of these AIDS drugs. Are we doing anything to make those drugs on which we hold the patents available around the world? Those are my two questions.

REP. THURMAN: Well, first on the issue of consistency around TRIPPS (ph) and how we engage with developing nations, who want to do either compulsory licensing or parallel importing, I think we are consistent and that what the president said in Washington holds true today, but certainly was at issue in Thailand. As you said, a letter has been sent. But, I think people are much clearer that we want to do every single thing possible to get drugs to people, who need them. And I think everyone is committed.

Secondly, I know that HHS and WHO have been engaged in doing a feasibility study around its issue of patents that are for drugs developed with U.S. support. I don't -- I haven't talked to them in the last few weeks about that; I don't know exactly where their feasibility study stands or when it's due to be released, but I will make sure that I speak with them, when we get back this afternoon, and get right back to you with an update on exactly where they are. But they are engaged in the process of a feasibility study, to see if we can't move those drugs.

REP. SCHAKOWSKY: Let me just conclude by saying, you know, the vice president's office intervened on the Thailand issue, to get a clarifying letter. It should not have to be, though, that we're fighting among ourselves. And I hope that we're not going to see any future situations where the speedy production of these drugs -- and I understand there's infrastructure that needs to be there, to deliver these drugs, but we could save lives and we don't want to be, in any way, complicit in efforts to do anything but that.

REP. THURMAN: And I couldn't agree with you more.

REP. SCHAKOWSKY: Thank you.

REP. LEACH: Well, thank you, very much, Ms. Schakowsky. Ms. Carson? (Off mike.) No questions.

Well, let me just then conclude by thanking the panel. I will say that the United States of America has been well served by the ambassador at the United Nations, who has taken on this cause; by a member of the White House staff, who has given great effort; and by the United States Treasury, and I want thank you. This is an issue that has to be considered on a bipartisan basis and with as much executive legislative cooperation as possible. Thank you all.

PANEL II: Thank you.

REP. LEACH: Our third panel is composed of Ms. Mary Fisher, who is the founder and chair of the Family AIDS Network. Ms. Fisher is well known to most of us, particularly members on the Republican side of the aisle and has one, been a courageous champion on behalf of those suffering from HIV AIDS. The foundation which she chairs has undertaken initiatives to teach AIDS prevention and care among women and children, and in communities of color. Ms. Fisher also serves on several other boards, including the Harvard AIDS Institute and the Betty Ford Center. We're particularly honored that she is accompanied today by our former colleague, Steve Gundersen (sp), who is a member of Congress, that we hold in the highest regard.

Our second witness if Ms. Mpule Kwelagobe from Botswana, who carries the title of Ms. Universe 1999. She's a spokesperson for AIDS issues and is active in AMFAR, which means Americans for AIDS Research; Hale (sp) House, a home for children born with HIV and drug addiction; and God's Love We Deliver, an organization that provides meals for home-bound AIDS patients. She is also working with the Harvard AIDS Institute and, in that capacity, assisted the opening of a research lab in her home country of Botswana.

Our third witness in the panel is Her Excellency Mary M. Kanya, ambassador to the United States, from the Kingdom of Swaziland, a country bordered by South Africa and Mozambique. Although Swaziland is a small country, it's been hit particularly hard by the HIV AIDS epidemic. We are honored that Ambassador Kanya has joined us today and hope to learn much from her about the impact the disease is having and what can be done to curb it.

We'll begin with Ms. Fisher.

MS. MARY FISHER: Chairman Leach, esteemed members of the committee, I was honored by your invitation and I'm grateful for this moment of your time. Let me say to you, Mr. Chairman, that I'm proud, as a Republican, that you have shown the courage to hold a hearing which may discomfort some of us. You are meeting at an unusual moment in the AIDS epidemic.

Despite 40,000 new infections of HIV each year in America, funding for AIDS prevention appears to be yesterday's concern. A word search through campaign speeches and literature of our parties presumptive presidential nominee, George W. Bush, cannot turn up the word AIDS. Congress stalls at reauthorizing the Ryan White Act. Contributions from philanthropies and corporations have fallen off. And where once there were headlines, we now have quiet obituaries.

In the U.S. AIDS has gone underground in communities of poverty and color, communities of youth and women. It's gone the same place globally, to those people, who have the least social standing and the fewest economic resources, typically the young and always the women.

In January, I visited four African nations with national AIDS policy director Sandy Thurman and others. I stood with a grandmother that Sandy spoke about, raising her orphaned grandchildren. Where once she had a garden next to her home, now she has a graveyard. Grave after grave, she lined them up, as she buried her children one by one, as they fell to AIDS. In Rwanda, the genocide of 1994 left a legacy of AIDS. A full 60 percent of those who survived torture and rape were left HIV positive. When the killing was over, 100 doctors were left to care for the nation's seven million people.

But what dominates the African landscape is orphans, acres of orphans. Orphans raising orphans, because there's no one else to do it. Tough children take to the streets. Weak children die of starvation. Seeing the orphans, thinking of my sons, Max and Zachary (sp), I barely heard the local government leader. I said, I'm sorry, what did you say? And he said, again, "I would like your advice, Ms. Fisher. If we should somehow get the money, do we put the orphans through school or do we feed them?" It was my stunning inability to respond that fueled my desire to be with you today.

I've labored for nearly a decade with the label "the lady who told the 1992 Republican convention that she has AIDS." They remember it, because they were surprised. Some of them didn't know women could get AIDS. Some of them didn't believe Republicans could.

Neither belief is any sillier than today's commonplace belief that AIDS in Africa or Asia can be kept out of the United States.

I want not to be harsh, but I must tell you that I cannot risk being too sweet or too mild or I risk going to my own grave with an unquenchable guilt. So, if anything that follows seems harsh, please forgive me. If the purpose of this legislation or this hearing is simply to justify a claim of openness or a show of compassion, you must stop. Such theaters simply raises false hope among those crying for hope. There is no reason to taunt the AIDS community, in America or in Africa, with false hope.

The most significant impact of this legislation might be the message it sends. It would signal our recognition that AIDS is devastating not only populations, but whole economies. This is why your committee and the World Bank are appropriate arenas to be discussing AIDS today.

In the written testimony I'll leave with you,

Mr. Chairman, I offer additional suggestions regarding actions that could be taken immediately and would have a vast positive impact. I will not trouble you with each of them now. And if there were a theme to my suggestions it is this: government cannot win the war against AIDS and the war cannot be won without government.

I realize that Americans hate death. We like to deny our own mortality and defeat every evidence of death among those we love; and if we can't defeat death, then Americans conclude that there's nothing we can do. If we want to help fight AIDS in Africa, we need to confront death. Some of our best options will be helping people die with greater comfort. Given science, this is the best that we can do today. Given morality, this is the least. And we, all of us, need to be willing to do what we have not done before. I've learned that speeches without research saves no lives and the solution for AIDS cannot be waiting for a vaccine. To accept that premise is to consign 33 million people and probably more like 50 or 100 million people to a death sentence, because we are already infected.

I came home from Africa in January with photographs of the women I'd visited. But I don't wake in the night to my photo album; I wake to the sound of a Rwandan woman's voice. Like me, she is a mother, and like me, she has AIDS. We embraced and told each other the truth. We are sisters. Her final words to me were, "What should I hope for, Mary?" I did not know what to tell her. If you would act with courage and compassion, I could answer her question. I could become your messenger to women in Africa, your ambassador of compassion. And I could tell my own children that the virus is powerful and that illness and death do haunt us all, but those with the power are doing all in their power to give us life and hope. And all your wrestling with these issues and all of your considerations, I assure you of my appreciation. I pray that you will be sustained to that, which the judge of all will have us do.

To that end, grace to you and peace.

REP. LEACH: Thank you very much for that very thoughtful statement. Ms. Kwelagobe?

MS. MPULE KWELAGOBE: Thank you, Mr. Chairman. I am from Botswana, one of the countries in Subsaharan Africa that is hard hit with AIDS. And I have seen firsthand over the past couple of years, and more importantly over the past year, the terrible toll that this pandemic has taken on my country: the loss of lives; the massive social and economic disruptions; an entire generation that has been robbed of its future; and the thousands of children that have been orphaned. I speak without exaggeration.

According to the World Health Organization, one in every four people in Botswana between the age of 15 and 49 are HIV positive. Over 43,000 people have already died. Twenty-eight thousand children have been orphaned. Right now, approximately 40 percent of all pregnant women in Botswana are infected with HIV. A staggering 75 percent of the children will not live past the age of two, because they will contract the disease from their mother during pregnancy or breast-feeding. Simply put, AIDS is destroying my country and much of Subsaharan Africa.

The reasons why the AIDS pandemic have spread so quickly across Botswana over the past years are still very complicated to me. To start with, it is a cultural taboo for women, who have been considered to be second-class citizens, to ask men questions about their sex lives or even request their partners to use protective methods to stop the spread of sexually transmitted diseases, even when they know their partners have been promiscuous. Making this worse, our culture promotes polygamy, which thus elevates promiscuity. And poverty and lack of educational and recreational programs has driven many young women into the arms of older men.

There are other reasons, too. A code of silence surrounds sex and HIV. Parents feel embarrassed to talk openly with their children about sexual activity and teenagers do not feel -- do not talk about this topic for fears of upsetting their elders. As a result, children grow up without a basic understanding of the affects of AIDS and when they are confronted with the challenges, they have no one to turn to for advice. This lack of education about HIV is even worse in the rural areas, where some people believe that AIDS and HIV is witchcraft and that people that are HIV positive are possessed with evil spirits and that women are using witchcraft to curse men.

And still the stigma that is attached to HIV AIDS in Africa is terrible. Can we all forget Gugu Draminia (ph) of South Africa, who was stoned to death just about a year or two ago, by people of her own community for coming out about her HIV status.

In this time of darkness, Botswana has emerged as a beacon of light for the sick and I think an example to our neighboring countries. Instead of denying our problem, the government of Botswana has shown courage and leadership by directly confronting this crisis. Politicians and civic leaders are speaking out. Artists, musicians, and entertainers are working to raise awareness.

There is a surge of activism and concern throughout our country. I will just share with you a few noteworthy programs that are saving lives and giving us hope for a better tomorrow in Botswana. The Botswana Howard HIV Reference Laboratory, which was opened just last month, is a state-of-the-art facility, which is devoted to studying the HIV 1C subtype, along with methods to prevent the transmission of HIV from mother to child. This is the first laboratory of its kind in Subsaharan Africa that is actually devoted to studying the 1C subtype, which is found in Subsaharan Africa.

The covenant, which was signed between the Botswana National Youth Council, the Ministry of Health, the government, the AIDS-STD unit, churches, music groups, and myself, as a representative of the young people of Botswana, which is an educational initiative, which encourages teenagers to first and foremost abstain from sex and alcohol and stay monogamous, if they are in a relationship, and still use protection. The Community Home Based Care System, an outreach program for those who are terminally ill and want to stay with their families, instead of in a hospital or a hospice, and my children's center, the Kulaquelong (ph) Children's Center, which is a haven for 420 children that have been infected or affected by HIV and AIDS, and this is run by the Ministry of Health in Botswana.

While I am proud of what we are doing in Botswana, the truth is we are still standing at a pivotal moment in time. We need the support of the international community, if we are to turn the tide in the war against HIV and AIDS and make this disease nothing more than a sad and distant memory. With the assistance of a nation like America, we can expand educational and behavioral modification programs. We can make sure that pregnant women with the disease receive AZT, so that they stop mother-to-child transmission. This is one such area where Botswana has been an example, being one of the first countries to offer AZT to every pregnant woman in Botswana who tests HIV positive.

We can fund important pilot programs that identify other promising drugs for pregnant with HIV, like Zydovidan (ph) and Averipin (ph), which in clinical trials reduce the transmission by 50 percent or more. Perhaps more important of all, scientists can race faster toward finding a vaccine, which would strike at the roots of the virus, protecting the uninfected. This is just the beginning of what we could do with the help of our friends around the world.

It is human nature to forget the trials of others, especially when those who are suffering are strangers on the other side of the world. Can we forget the Rwanda genocide? But I will never forget what I have seen, the children who have been orphaned, the women who have been widowed, and some who have been abandoned, the empty eyes of young people in our hospitals and hospices, and the funerals that are constantly taking place every single weekend.

I hope that you, too, will not forget what you have heard and remember the plight of my people, by making the World Bank AIDS prevention trust fund a reality. The United Nations population fund, which I am pleased to serve as its goodwill ambassador, has been an important force for HIV AIDS prevention in my country and in other areas across Africa. The United Nations population fund works closely with the World Bank, the World Health Organization, UNICEF, and others to prevent the spread of HIV and AIDS.

As goodwill ambassador of the United Nations population fund, I would like to take this opportunity to thank you, Mr. Chairman, and the entire Congress for restoring U.S. contributions to the United Nations population fund for Fiscal Year 2000. I have witnessed some of the programs that are run by the United Nations population fund in Botswana, one of which is called PACT, which stands for Peer Approach to Counseling for Teenagers, which I was a member of since the age of 14 and which has been very effective in our schools throughout the country.

I pray that you will find it within your hearts to lend a helping hand to those who are trying to pick themselves up and build a new life. By doing so, you will give the greatest gift of all, the hope for a better tomorrow. Thank you for giving me the opportunity to be here and to speak for those who have been silenced by AIDS. Thank you.

REP. LEACH: Well thank you very much, for that thoughtful testimony. Ambassador Kanya?

AMBASSADOR MARY M. KANYA: Honorable Chairman -- REP. LEACH: Excuse me, if I could interrupt for a second. If you'd pull the microphone very close, I think you'll find that it allows people in the back to hear you better. Just pull the whole mic up as close as you can.

AMB. KANYA: Honorable Chairman Leach, I would like to thank you for having invited me to speak on the impact of the HIV AIDS crisis in the poorest nations of the world, particularly in the hard hit Subsaharan Africa. May I congratulate you on bringing this topic to the table.

In my submission, I would like to dispel the misconception that African leadership is not committed, that Africans are still in denial, and that the Africans are not helping themselves. You have already heard about the progress that has been made in Uganda, Senegal, and other countries. These successes, I'm sure, would not have come by if there was no political commitment. The statistics that we have just heard to us are just not figures. We see the negative impact that the epidemic is having on our society. We personally experience it.

Those statistics represent people we know: the teacher, the banker, the engineer, and the politician, who have to teach our young, move our economy and community forward. How can we then not care? What we do, we do what is within our very limited resources that are available to our countries and our people. It will take a long time, though, to see the reversal in the severity of the epidemic, because all the causes that fuel the AIDS epidemic are not yet fully understood. This does not just apply to us, as Africans; this virus respects no quarters. It travels easily throughout our global village.

What other African countries are doing, let me give you a glimpse of what some countries are doing, either individually or as subregional groups. I am best able to speak about Southern Africa -- the Southern African part. We have five countries where the Subsaharan Africa's highest HIV infection rate are very high, including my own country, Swaziland. Swaziland is a very small country the size of New Jersey and with a population of 970,000 people. But this country has an incident of 22 percent. Eighty percent of inpatients in our major hospitals are HIV positive. Thirty percent of pregnant women who attend prenatal clinics test HIV positive. About 60 percent of HIV infections occur amongst those 20 to 39 years old. Almost 18 percent of all university students are infected with HIV AIDS. I have seen a graduate that graduated yesterday and there was so much jubilation and two days later, that graduate was buried.

The literacy rate is being reduced. From the pre-independence, the literacy rate in Swaziland was 31 percent. But over the years, this has risen to 78 percent. But with the HIV AIDS, this is going to be dramatically reduced. The life expectancy has been reduced by 20 years. As a result of the above statistics, His Majesty King Msuwati III (phonetic) of Swaziland, in opening Parliament in February, 1999, declared HIV AIDS a national disaster.

If I dare say it, if I could quote, "The HIV AIDS epidemic is an unacceptable situation, whose real effects will be felt only in the coming years, as more and more of the econimcally active fall to the disease and more and more medical effort and resources are diverted to treating the effects. I appeal once more to everyone to take warning and to understand that each and every one of us is at risk. This is already an national disaster and requires a truly national effort to bring about the complete reversal in attitude and behavior."

Zimbabwe has passed into law a new tax, a 3 percent tax on money and by individuals and corporations, to pay for AIDS health care costs. Botswana has already had -- a national AIDS coordinating agency has been created, which is headed by a permanent secretary, and this committee reports directly to a committee headed by the president himself. This goes to show that all the political leaders in the Southern African development community are fully committed to address the HIV AIDS. They are in the process of developing coordinated national action plans for costing and prevention care support of the person infected with the HIV AIDS.

Although it is culturally known that orphans are taken care of by the community, the extremely high numbers of orphans projected over the next few years will require that we consider alternatives, such as children's homes supported through public, private contributions. Our scientists in the region are looking at the use of drugs, such as AZT and Averipin (ph) to prevent the transmission of HIV AIDS from mother to child.

With regard to addressing the issue of the inaffordability of many drugs needed to treat our people, even for sexually transmitted diseases and opportunistic infection, South Africa has passed a law allowing it to import cheaper drugs. Unfortunately, the pharmaceutical industry has decided to put profit before the people.

Our health ministers have undertaken to strengthen the health services infrastructure to support persons with HIV AIDS (and are ?) participating with the international labor organization to implement a code of conduct in the workplace, to protect the rights of workers with HIV AIDS. These will be in support of legislation that some countries have already passed to outlaw discrimination in the workplace. There are many more examples that I can cite.

We therefore welcome the various forms of assistance that better resourced governments like the U.S. and other organizations can provide to us. How can you assist us? As the congresswoman pointed out -- a proverb: we, as African countries, have put this poisonous snake in our house. Please help us kill it before it kills us all. We would like you to share your skills, knowledge, and best practices, allowing us to adapt them to our needs. Support us in strengthening our health care delivery systems. Treatment should not be forgotten in the rush to support prevention efforts. We therefore request you to us assist us get affordably priced drugs for -- from the pharmaceutical companies.

It is also heartening to note that a number of initiatives that involve the U.S. government, the legislators, and pharmaceutical industries, and NGOs with Subsaharan Africa has been launched. Examples of these is the announcement -- other announcements, which were made by the honorable vice president during the U.N. Security Council in January. In the pharmaceutical industry, we have Myers Squibb, which has paved the way for other companies through its Secure the Future program, which will provide $100 million over the next five years to countries in Southern African, including Botswana and Swaziland.

We are grateful to the initiative that has been taken by Congresswoman Lee and we also support the World Bank AIDS Prevention Trust Fund Act. We appreciate what has been done by the NGOs, such as Africare, Quonset Transit(ph) For Africa, and others that have kept this on the agenda.

May I end at this stage and thank you very much for the opportunity that you have given us to talk about this.

REP. LEACH: Well, thank you, Ambassador Kanya.

And before turning to Mrs. Lee, let me just stress that it is not unprecedented, but it's very unusual for a representative of a foreign government to address a committee of the Congress. We're very appreciative that you have chosen to do so and we welcome you in the spirit of as much cooperation as we humanly can.

AMB. KANYA: Thank you.

REP. LEACH: Mrs. Lee?

REP. LEE: Thank you very much, Mr. Chairman. First, I would like to ask for a unanimous consent to insert into the record written testimony of a great actor and human rights activist, Danny Glover, whose brother also has been living with the virus for the last 10 years.

REP. LEACH: Without objection, let me say to the lady, I've read Mr. Glover's testimony. It's a very moving testimony and without objection it will be placed in the record. At this point, I would also then ask unanimous consent that that testimony of Kenneth E. Waig (ph), who is the vice chairman of Bristol-Myers Squibb Company, also be placed in the record.

REP. LEE: Thank you, very much.

REP. LEACH: Without objection, so ordered. Please proceed.

REP. LEE: Thank you, and let me just say to all three of my sisters, thank you very much for your very articulate testimony. I believe the three of you cut through in terms of what the issues really are and what we're dealing with in Africa.

Let me just ask you a question, and any of you can respond to this, with regard to the issue of women's empowerment. What are some of the strategies that we need to look at and focus on? We talked a little bit about the ACT and the issue of mother to child transmission of the virus. But we need to hear a little bit more about what some of the issues are that women are dealing with in Africa that are, that present impediments to moving forward in attacking this crisis the way it should be attacked.

MS. FISHER: I can only speak for what I saw there when I was visiting. The society is a barrier. The more's of many of the villages, of some of the practices that you spoke of when you talk about polygamy. There's wife inheritance. There's so many things, the biggest of which is "we don't talk about this because we don't talk about sex". So we're talking about religion being a barrier as well.

What we were trying to do while we were there, and I would then defer to my sisters here, is to let the government know and to let anybody that was in any position of visibility or power to talk about this disease and to make it safer for people to talk about it. Destigmatize. It's the biggest issue that -- There's the prevention and everything else, but the destigmatization is a major problem.

MS. KWELAGOBE: I would definitely add on to what Mary Fisher said. Really, I think, in order for us in Africa to end this war against HIV and AIDS, we have to put religion and culture aside because I think currently we're putting them forward. And like I said when I was giving my talk, where polygamy has always been viewed as a virtue, so I definitely can say that culture and religion, they're really holding everybody down, but more women. Because it seemed as if for awhile women were second class citizens who were not really meant to speak out about this.

And I think another thing which we need to do in order to end this war, in going into Africa, taking for example the program that I said is wanted by the United Nations Population Fund called PAC. What PAC did is they took young people out of a school, went to teach them about youth problems and how to be positive role models, and then put them back into their communities and schools because they believed that those people could be more effective than if people from the outside came inside to try and address the issue.

So possibly what needs to be done is that women who are strong in these countries need to be identified and these are the women that need to go into their own countries and speak about it because they will be more received than if somebody from the outside came in to speak about this.

AMB. KANYA: I have something to add to that. Culture plays the most important part. We do need assistance, we do need education, but when this is done let's approach it bearing in mind the culture.

Someone has just spoken about breastfeeding. There were so many years we have seen calling for people to breastfeed, and suddenly if you tell people to stop breastfeeding, that would cause a problem. We really need education, we really need to share with other countries where there has been success in approaching the problem.

REP. LEE: Let me ask you then, in putting together for instance a bill, a piece of legislation when we talk about initiatives for women's empowerment, how is that perceived from a cultural point of view in Africa? Is women's empowerment a strategy that we would want to see as an AIDS prevention strategy? And is that acceptable in legislative form?

AMB. KANYA: I guess it would be acceptable. We are opening now. Women have a role to play in society and the legislation would really be accepted.

MS. KWELAGOBE: I'd definitely agree with that. I think it would be accepted. But as we're going into the 21st Century we women in Africa realize that we have, we also have our responsibility to play. And definitely to the reason why HIV has been so high among women is because they've been so dependent on men. And with empowerment on women and women being educated and having jobs and being able to bring in a means of income for themselves, I think definitely this is one of the ways of trying to win this war against HIV and AIDS.

REP. LEE: Thank you very much.

REP. LEACH: Thank you very much, Mrs. Lee.

Mrs. Schakowsky?

REP. SCHAKOWSKY: Ambassador, you had something else you wanted to say. Why don't you go ahead and say it?

AMB. KANYA: I just wanted to say we have been very successful in our immunization program, and this has been helped, was pushed by the women. And if you bring in the woman to play the role then we shall see this moving forward.

REP. SCHAKOWSKY: I wanted to thank all of you for your very moving testimony.

Mary, I read yours, I wasn't here when you gave it, and I don't know if you read this part or said this, that "This is one of the final speeches I will give on behalf of the Family AIDS Network, the organization I founded in 1992. We are closing our doors at the end of this month based on our recognition that we are failing at AIDS awareness and education. We have lost that fight here in the U.S. The silence, the myths and the denial have won. But I can assure you that I am not giving up the fight."

That's a pretty pessimistic view, and I'm not contradicting it. I wanted to get you to elaborate a little bit on that, why you think that we have lost that battle and what we as a Congress then need to be doing, even aside from what we may be talking about today.

MS. FISHER: What we found with my organization is that we have to address AIDS where it stands each year, and each year we have gone and said what is the face of AIDS now?

The face of AIDS now is that, it's in a way more important for us to have the research than to have people out there doing what everyone seems to be aware. We're aware of the disease, we know that it's there, and we're complacent.

That's hard. It's very difficult to get the media to keep writing about it. It's very difficult to tell a different story.

The group that is highly infected in the United States right now are women and people of color and these are groups that have no voice so they're not out there screaming about it.

The biggest thing that we can all do is to do a bill like this, is to keep talking about it, to keep it in the front, and the front as a priority for our country, for Africa, for other countries around the world.

I will focus my attention wherever I am needed to bring this out. I will be raising funds for research. I myself will not stop, but my organization has been -- I'm transferring it to the University of Alabama at Birmingham so that I can directly serve research, because I think that's where we need to be. We need to be able to keep people alive longer. We need to be able to have outcomes research. And all of this is done with our partners in Africa as well.

So I'm trying to make it more direct. It's not hopeless, it's just that I want somehow to be able to say to you please take care of those of us who are infected. Yes, we know we need a vaccine, but that's not going to be here for another ten years or whenever. In the mean time, we will have millions and millions and millions more people die.

REP. SCHAKOWSKY: We still do need to continue to educate our young people about the threat of AIDS, don't we? And --

MS. FISHER: Oh, absolutely.

REP. SCHAKOWSKY: Here and around the world.

MS. FISHER: Absolutely we need to educate, but we need to do it in a different way now. Because we are so stopped everywhere, it's like running into brick walls. We need Congress to say it's okay to talk about it. It's okay to go into the schools. It's okay to go everywhere to do it. We need people that have the opportunity and have the bully pulpit to say that it's okay. Destigmatize it here as well as in Africa.

REP. SCHAKOWSKY: Thank you. All of you.

REP. LEACH: Let me thank you all very much for the eloquent testimony of three extraordinarily impressive women. Thank you.

Our fourth panel consists of Dr. James Sherry who's the Director for Program Development and Coordination of the Joint U.N. Program in AIDS from Geneva, Switzerland. Dr. Sherry received doctoral degrees in biochemistry from Melon Institute of Carnegie, Melon University, and in medicine from the University of Michigan. During his career he's worked for USAID and UNICEF and in an earlier incarnation as Chief of Staff for Congressman Sandra Levitt. We very much appreciate the effort he has made to be here and give us a critical, multilateral perspective on strategies to fight AIDS.

Our second witness in this panel will be Dr. Gary Slutkin who is a professor of epidemiology and international health at the University of Illinois School of Public Health. Dr. Slutkin was formerly Chief of Prevention for the World Health Organization's global program in AIDS; in the early '80s was the Medical Director for PB Control in San Francisco. During Dr. Slutkin's seven year tenure with WHO he assisted in AIDS control programs in a number of African countries including the now renowned success story in Uganda.

Our third witness is Dr. Catherine Wilfert who is the Scientific Director for the Elizabeth Glazer Pediatric AIDS Foundation. The honorary chairs of the foundation's executive advisory board are the former President, Mrs. Ronald Reagan, and board members range from Mrs. Kitty Dukakis to Michael Eisner to Mrs. William Brock. Dr. Wilfert has had a distinguished career in the area of research in infectious diseases and is currently a professor of pediatrics and microbiology at the Duke University Medical School.

Our fourth expert witness, and I'm not sure he's yet with us, is Dr. Thomas Welty who is a medical epidemiologist and a member of the Cameroon Baptist Convention Health Board. Dr. Welty has had a distinguished 26 year career with the Indian Health Service and now volunteers his medical services in Cameroon.

Let me begin with Dr. Sherry.

DR. JAMES SHERRY: I thank you Congressman Leach, distinguished members, and thank you for the opportunity to testify before your committee.

As the Chairman mentioned, my first congressional hearing that I attended was 17 years ago in this room as Chief of Staff to a then freshman member of this committee. So it's with particular pleasure and a great respect for this institution, particularly the members and staff who stay along late into the hearings, that I address you today.

For the last 13 years I've been involved in health around the world, too much of that time wrestling with this epidemic.

With your permission I will abbreviate my written testimony.

REP. LEACH: Without objection, all the statements will be fully placed in the record. You may proceed as you see fit.

DR. SHERRY: And I will focus a bit more sharply on seven specific points.

First, on the status of the epidemic. You've heard many of the numbers, I won't repeat them. But just to remind that Asia, and in particular South Asia, are under considerable threat from worsening epidemics. The Caribbean falls only behind Africa in the rate of epidemic growth. In Subsaharan Africa, as we've heard, the AIDS epidemic is not as bad as everyone thought. It's much worse. And to highlight that, of the 23 million infected individuals there now, over 90 percent do not know that they're infected with the virus.

Almost all of the major downward changes and declining life expectancy in Africa can be directly ascribed to AIDS, and within the next five years we expect life expectancy at birth in Southern Africa, which rose by a third from the '50s to the '90s, to plummet back to the levels of 1950.

The poverty and stigma that fuel the epidemic in Africa are now beyond all rhetoric the major threat to the future of the continent.

My second point, Mr. Chairman, relates to the false dichotomy that we often create between primary prevention and care approaches. It is as difficult as it is unwise to separate these two sides of the same coin. Care and support are critical to piercing the stigma of AIDS. The traditional economist distinction between a private good and a public good break down when because of such profound stigma we're thwarted in our efforts to mount effective prevention efforts, in particular, voluntary counseling and testing. This was true here in the United States and in Europe. It was true for leprosy and for tekunkuliasis (ph), it was true for tuberculosis and cancer. It's true for AIDS.

Access to palliative care and treatment to prevent mother to child transmission and the treatment of opportunistic infections such as TB are essential components to successful HIV programs.

Mr. Chairman, my third point relates to children and young people -- their place in these statistics, and increasingly, their place in the leading edge of this epidemic.

As you may be aware, child survival rates have been fully reversed in a number of countries. Eleven million children have lost their parents to AIDS, and as you've heard, that number will likely be trebled or quadrupled within the next decade.

In emerging epidemics such as we're seeing in Eastern Europe, the appropriate focus of our response is with commercial sex workers, IV drug users, men who have sex with men, and men who's occupations keep them away from their homes, such as truck drivers and the military.

In the generalized epidemic where five or ten or 25 percent of the adult population are affected, it's young people who are out on the leading edge. In a number of African cities, girls aged 15 to 19 are five times or more likely to be infected than boys their own age. More alarming still, as many as one in five 15 year olds, in some cities -- 15 year olds -- are infected.

Mr. Chairman, when we advocate for an expanded response, getting out ahead of the epidemic rather than chasing after the virus, we're talking about getting out in front of these kids. It's not simply their individual behavior regarding sex, it's about societal behavior towards young people.

Certainly access to information about safer sex and to condoms has to be a part of the response, but an expanded response, and effective response, is much more about their access to schools and teachers who respect them and challenge them; youth and sports organizations, the vast majority of which are supported by religious institutions in Africa, that include them and help them build their self esteem; economic policies that include vocational training and an employment opportunity to help build their futures; social policies that include safety nets that keep the most vulnerable young people, in particular orphans, off the street and out of harm's way; and as you heard Ambassador Holbrooke say earlier today, disciplined military and police forces which protect young people rather than infect them.

My fourth and perhaps most important point is despite all the bad news there is very serious progress being made. Politically there's been significant progress in recent months. We've seen many African leaders speaking out in unprecedented ways, confronting the epidemic. In countries where strong political leadership and cross-cutting responses have come together, clear success has been demonstrated.

As you have heard in Uganda, but also in parts of Zambia, Tanzania and elsewhere, the rate of new infections is falling. In other countries such as Senegal, infections have stayed consistently at very low levels.

There should be no mystery about the Uganda success story. Of the $150 million for AIDS prevention spent in 1997 for the most affected countries in Africa, nearly $30 million of that was spent in Uganda. Everyone was involved -- national and local government, religious institutions, community groups, families affected by AIDS. The health sector was certainly a player, but it was not by any means the major player.

In a period of only five years, Uganda cut in half the rate of infections among young girls 15 to 19 and the average age of first sexual intercourse in that group was raised a full two years. No one predicted such positive results looking forward. In hindsight, there are lessons for us all and a moral challenge to do what can be done because it's not impossible anymore.

Fifth, we would caution that the stronger multilateral approach that this legislation will enable must not be seen as a substitute for a stronger bilateral approach. Each has their inherent strengths and weaknesses. Our challenge is to optimize the synergy between them.

The epidemic has already forced unprecedented coordination in the U.N. system. As I'm sure the members of the committee can appreciate, interagency mobilization and coordination can be more contact sports than diplomatic processes. But notwithstanding the rough start, the process is clearly underway, the U.N. is now dramatically increasing its attention and its resources to the epidemic in Africa.

I've included in my written statement a brief summary of the development of the international partnership against AIDS in Africa. I will not repeat it here. The important process brought together for the first time through the personal leadership of the Secretary General, representatives from African and OECD governments, the United Nations systems NGOs and the private sector. The legislation that you are considering today would have a major positive impact on these efforts.

Six, I would like to report that we are making progress in mobilizing resources though we're still a long way short of making our mark.

This past April in London, donor governments were challenged to urgently treble their assistance for AIDS in Africa. The United States has been a leader in responding to this call and in leveraging other donors to increase their investments. Australia, Canada, Finland, Italy, Japan, Norway, the Netherlands, the Republic of Ireland, the United Kingdom, have all substantially increased their commitments.

We would estimate that year 2000 international financing is roughly 2.5 times the 1997 level, largely as a consequence of actions taken this last year. It's a solid start, but there's much more way to go. (sic)

We would also vigorously counter the suggestion that aborsptive capacity in Africa constitutes a major problem or rationale for not further increasing resources.

Seventh and finally, Mr. Chairman, it's our view that your proposal for the establishment of the World Bank Trust Fund for HIV/AIDS prevention represents a critical step in raising the international response to a level more commensurate with the magnitude of the epidemic.

The World Bank provides unique capabilities within the UNA's partnership to serve the role as financial administrator. It's what it was set up to do.

We believe this role is best executed while acting in concert with governments and other agencies with comparative advantage in the areas of technical policy development, program design, and implementation support, particularly those most experienced working with NGOs and other parts of civil society.

As a founding cosponsor of UNA, the World Bank has committed itself to work as a member of this multisectoral partnership, and indeed under the leadership on this issue of its president, Jim Wilfinson, the Bank has consistently upheld that commitment. We would hope, therefore, that the Trust Fund would be established in a way that reinforces those commitments.

If I may quickly flag three important details. One, some of the hardest hit countries in Southern Africa, Asia, and the Caribbean are ineligible for IDA (ph) support due to differing definitions of poverty, and we would hope that eligibility criteria for assistance through this mechanism would take this into account.

Second, while Africa by far requires the lion's share of support, there are hot spots in other regions of Asia, the Caribbean, and Central America that require urgent attention.

Third, though the work towards an AIDS vaccine is vital to the hope for definitive control of this epidemic, nevertheless the compelling need in Africa today is to invest in those prevention approaches and technologies that are available today. To this end we would encourage you to give the highest priority within this legislation to programmatic interventions in countries that have developed and are ready to implement national plans and intensified action.

Mr. Chairman, in closing I would reiterate that the full dimensions of the AIDS crisis are now well documented. Collectively we know what must be done. The need to mount an extraordinary response is inescapable.

On behalf of Human AIDS and its many partners, we commend you for your leadership on this issue here today, and again thank you for the opportunity you have provided us to testify before you today.

REP. LEACH: Thank you, Dr. Sherry.

Dr. Slutkin?

DR. GARY SLUTKIN: Thank you, Chairman Leach and other members of the committee. It's a pleasure to follow Jim Sherry, my good friend, in this area, as I preceded him in Geneva.

I'm a medical doctor who has been working on epidemics for about 20 years. I've been associated with Africa for most of those 20 years and have worked -- I left San Francisco to move to Somalia where I lived for three years doing refugee work and got picked up there by World Health when the World Health Organization was first forming the global program on AIDS in 1987.

I stayed with World Health from 1987 to 1994. During those first three years of that program, this issue of AIDS in Africa was treated as a horrendous epidemic and a massively accelerated level of energy was put in.

The Uganda program was one of my responsibilities. The plan and program that had these results was not accident. It came as a direct result of this plan that was formed in December of 1988. The resources to this plan were absolutely central to its being able to succeed.

We carried the Uganda program from a half a million dollar program to four million to ten to 18 million, and it stayed at $18 million for all of these last years of the last decade, and Jim now reports that it's up to $33 million. We did not get the other countries above levels of implementation of $2 or $3 million.

Although there are a lot of people who know that I supported the Uganda program, I also had responsibility for the other 14 countries in Central and East Africa. Almost every one of these countries, with one exception, was also increasing year by year by year. The only difference between Uganda and the rest of these countries is level of implementation. That's the only difference. What Uganda did was massive public education, a very high level of commitment, an extraordinary amount of technical assistance also from the international community.

The government commitment on their side was critical and it's also central to the results that we want to see in the other countries.

I want to say just a couple of things about the things that are needed besides money and about some of your questions about the World Bank mechanism. I've worked with USAID, UNICEF, WHO, the U.N. and the World Bank in trying to implement programs.

The financial mechanisms for distributing funds are central to success. We did not succeed in the countries where we provided money, but the mechanism in the country for distribution of money to country programs was not in-house. In fact in the early days of World Health Organization's response to the AIDS epidemic we used small pox mechanisms.

The mechanisms for a lot of the international organizations are not as functional as we'd like to see to have a good response, but I want to tell you that I think that this World Bank mechanism is the right way to go, and I've spent a lot of time in the last five days after being asked to give testimony here to exploring what the financial mechanisms of the different organizations are. I want to assure that USAID does know how to spend money effectively, and so does UNICEF.

But I think the World Bank is the right answer here. They have several advantages. They have experience in very, very largescale programming and very largescale programming in AIDS, now both in Brazil and in India. They were in the context of loans, and one of the loans being to the range of $250 million. They know how to do largescale programming, and largescale programming is what you need.

They also are the elephant that's needed with respect to commitment, getting the commitment of the high level officials.

Third, they have the ear, unlike a lot of the other organizations who operate with Ministries of Health who are extremely weak, underfunded, and of no importance with respect to the President's own idea, they are rarely, for example, relatives of the President. The Minister of Finance is a very key person in the government of these countries and the World Bank is the counterpart to that organization.

I'm going to close with a few more details that I recommend to you but the big picture here is really that this is on the right track. And to keep in mind also that this is, as you talk to your counterparts in Congress, this is the big show today in the world. There's more people dying of AIDS than I think all of the wars combined on the planet now -- all of them. We have two to two and a half million people dying every year due to AIDS now with the numbers increasing. It's more than all of the wars -- all of them, not just the wars in Africa.

So these are my closing points. We've had massive success in Uganda. There's nothing that happened in Uganda, nothing that couldn't happen in every other country. Sex habits were the same, the myths were the same, the misconceptions were the same, the lack of desire of using condoms were the same. There is nothing that happened in Uganda that couldn't happen in the others.

The level of funding is key. National programming is needed. You need technical assistance at country level in administering the finance and the details of this I know, but you can talk to several people at the World Bank and they'll tell you they know how to do it top down and bottom up, and they can do these mechanisms.

I also recommend that you have a mechanism of reporting. One part of the bill that I did not like at all was the reporting after three years. I think that there is not enough reporting on the response to this epidemic. I think you should get reporting every six months.

There's four things that reporting is required on in my opinion. One is how the country's money is -- Is it being spent? Is money being spent in country or are people fussing around in the multilateral organizations and at the country level? Is the money being spent? How much is being spent? Is it going out?

Two, is it going to country level activities? And three and four, are there changes in knowledge and HIV? And three and four, we have mechanisms for that we set up. I actually had responsibility for setting these systems up 12 years ago.

But A and B you need reporting on, and I would recommend you get them every six months.

Next, I suggest you have a technical panel that gives you some feedback on what's really happening in terms of both finance and in terms of program activities.

Then last, there are certain pieces of implementation that should be tremendously accelerated while all these mechanisms are going in. This includes public information and radio programming.

So last, I would recommend to you that you not just pass this bill and change the reporting requirement, but that you stay with it, that you stay with it. You stay with this clause after passing the bill, and that you get the reporting, you see and help get the other funds in. But don't wait for Europe. This isn't the time for the posturing and the bickering and all of the usual stuff. This is the time for the U.S. to use the U.S. style of proactivity and yes, encourage them to get in, but put it in. Put it in and let the others feel bad if they're putting in. And then help it come from the private sector.

So please stay with it after you pass this.

Thank you.

REP. LEACH: Thank you, Dr. Slutkin. Just one minor thing by way of perspective. Clearly, more people are dying today from AIDS than all the current wars going on, but in the very near future, more people have died of AIDS than the combat deaths of the two principal world wars in the last century.

Dr. Wilfert?

DR. CATHERINE WILFERT: Thank you, Chairman. I would like to express my gratitude to you and the other distinguished members of the committee for inviting me here.

I'm going to select a facet of the epidemic of HIV, and that is the way in which the epidemic particularly affects children. My eloquent colleagues have dealt with some of the broader aspects and I agree with what they have said during the course of this testimony. I believe that the bill which is proposed has a chance of increasing the resources and changing the face of the epidemic in the world. I think that the changes which relate to mothers and children will be very specific, and I'd like to enlarge upon that.

First, I'm a pediatrician. I am at Duke, but I'm the Scientific Director of the Elizabeth Glazer Pediatric AIDS Foundation, and it is in support of that organization that I speak.

Most of you know that the foundation was created by Elizabeth Glazer in response to the fact that she was infected and her two children were infected and she learned that the comparable treatment and care of her children was not available to her in the United States. Her efforts in this House and elsewhere contributed to the creation of the programs designated for pediatric research and have accomplished an enormous amount within the United States.

The foundation is about a decade old and her friends, Susan DeLorentis and Suzie Zegan who founded the organization with her, and now a reasonable staff, have succeeded in raising some $85 million in this decade to devote to trying to increase the research and therefore the care of children and their families with HIV infection.

I'd like to point out that in 1994 we learned in the United States that AZT could diminish transmission of this virus from mothers to their baby. That's a short six years ago. The resources are available in this country to have access to that treatment, and transmission from mothers to their babies has decreased by 75 percent. It is estimated that fewer than 200 babies will have been infected in 1999. That does not diminish the infection in their mothers. The acquisition of infection by women in this country has not diminished, and in fact women constitute an increasing proportion of the infected women.

I tell you this because it has been six years and there is not a single developing nation that has been able to access this kind of intervention to prevent mother to child transmission. There are programs in progress, we heard about Botswana's commitment to a shorter course of AZT. They are in the process of building that program.

In September of 1999 we learned that Nevarphene, another anti- retroviral agent, could be administered in a single does to mothers and a single dose to babies and diminish transmission by 50 percent. The study was done in Uganda, largely because they had developed some infrastructure and they had support to do this study.

This makes a feasible approach. Is it easy? No. But it takes resources. It takes programs that build education into the existing maternal and child health programs. It takes advocacy. It takes access to women who are pregnant. And the administration of the medication is the simplest part.

But imagine if you could diminish the 600,000 infected babies each year by one-half because we succeeded in reaching the women.

Botswana, a small country in terms of population, and I had the privilege of visiting there recently. Indeed, 40 percent of their pregnant women are infected with HIV. This means that in a year seven to nine thousand infected babies will be born -- this is three to five times the number of infected babies born in the United States in one whole year prior to AZT therapy.

I want you to realize that in the four hours of this hearing 300 babies would be infected. Eighteen hundred babies a day. That's the number of babies infected in a year in the United States prior to 076. And if people can walk out of here with the sense of urgency and the magnitude of the infection as it relates from mothers to infants, we will all have taken a great step forward.

The Elizabeth Glazer Pediatric AIDS Foundation and global strategies to prevent HIV infection took an initiative entitled "The Call For Action", and I will not go into it in detail, but the foundation designated a million dollars because we felt that some things had been done very well in this epidemic and we wanted to see if implementation of the available technology could get to the developing world even if what we have to bring to it is a small amount of resources in comparison to what is actually needed.

I expect, since the first applicants will have received their grants and they will be awarded tomorrow, there will be sites in South Africa, Kenya, Uganda, Rwanda, and the Cameroons and Thailand. I think, I have every expectation that what amounts to relatively small dollars placed in the right situations with the existing infrastructure, will make an enormous difference. And if you think in terms of your bill, I believe that the monies and the resources that could become available can be multiplied many times over to enhance and to actually succeed in implementing the available interventions which are now available.

I'd like to address just briefly some of the measurements that you will probably be considering if this bill is enacted. That is that in the arena of mother to child transmissions, you have the opportunity to document that new infections increase. The actual number of babies born with infection will decrease, and it can be measured if the programs are successful. As well as Uganda has done. The seral (ph) prevalence rate of infection in pregnant women remains at 15 percent. Think about the numbers of babies acquiring infections because of the portion of those exposed infants who acquire infection still in a country that has done very well but has not yet been able, will begin to implement the intervention which they described in a clinical trial.

So I think the mother to infant part of this is measurable. Results can be seen relatively quickly, and I don't think anybody has any doubt about that.

The programs have to be sustainable. This is not a vaccine. It prevents an infant from becoming infected, but the mother is infected and additional women are becoming infected. So such a program must be sustainable, and I would enforce the concept that when the bill is, if the bill is enacted it isn't a one time fix. Partners have to come, the programs the countries develop have to be sustainable by those countries, and they will appreciate the results when the programs are in place.

I would also like to point out that I've had the opportunity to observe how well partners can do. Being sensitive to the nations in which these efforts take place, working with the existing infrastructure and organizations should be a high priority with any bill like this, rather than inventing any new bureaucracy, if I can use that word.

I guess in summation I would like to commend you and to thank you once again, and to have you think about the possibility of being sure that part of the designation of these funds will go towards the prevention of mother to child transmission.

I thank you, finally, for including me in this discussion.

REP. LEACH: Thank you very much, Dr. Wilfert.

I'd like at this point, perhaps, to invite a fourth witness, Congressman Dellums who was intended to be on an earlier panel and was unfortunately unable to do that, so we scheduled him later. But I think it might be appropriate. Congressman Dellums is the Chairman of the Constituency for Africa as well as President of the Healthcare International Management Company. I know of no one who has a greater reputation for commitment and gentlemanliness than Congressman Dellums. Ron, you've been one of the factors in my involvement in this issue and I'm very grateful for your leadership.

Would you like to proceed as you see fit.

REP. RON DELLUMS: Yes.

First of all, thank you very much, Mr. Chairman, and my distinguished colleagues. It's a special pleasure to be here. It's one of the very few times that I've faced the Congress looking this way, so that's a unique experience. But I thank you very much for holding these hearings and inviting me to do so, and I'd like to again congratulate my colleagues who are here for your participation in this. And Ms. Lee, I have the great honor and privilege to refer to her as my representative -- I voted for you absentee.

Mr. Chairman, I'm pleased to be with these distinguished members of this panel. I am not a physician. I'm not a scientist. I do not head up a bureaucracy that focuses on these issues. I am a former member of Congress and a political activist and maybe that's appropriate to be the last person, because I see my responsibility as saying to you why you ought to be involved.

I think there are two reasons. One is the moral imperative, and the other is self interest.

Since I was not here earlier I don't know everything that was said, so if I say a few things that have been said before, it's to underscore for the purposes of emphasis. This is my view.

That we are indeed in the throes of a global pandemic. That at this point it's simply manifesting itself most profoundly and most dramatically in the Subsaharan African context, but make no mistake about it, it is a global problem. It is a time bomb ticking in India and other places, in Asia. It is a time bomb ticking in Brazil, other parts of Latin America.

It is a problem in Russia, down through the Balkans and Eastern Europe. The face of AIDS has changed dramatically in America -- 42 percent of the people dying in the United States are African American, 28 percent of them are Latino Americans. Every hour in America two teenagers are newly infected with AIDS. One doesn't have to be a brilliant mathematician to begin to extrapolate that ultimately we're looking at a very significant and serious problem.

As I said, it's manifesting itself most profoundly in the Subsaharan African context which leads me to why I think you need to do what you're doing and even go beyond it. That is the moral imperative.

Since the first AIDS case was discovered in Africa, over 11 million human beings have died. Eleven million and the world has quietly stood by and allowed this to happen.

I would believe that if I were testifying before a committee of Congress and I said 11 million people have died as a result of a war where we had fired missiles and bombs and bullets, that there would be a level of outrage across parties and a political movement evolving in this country, the likes of which the world has never seen. But the reality is that people are dying in a war, a war with infectious disease, a war with ignorance, a war with lack of attention and apathy. It is a war, and people are dying.

They're dying at a rate of between 6,000 and 7,000 a day. They are being newly infected at a rate of over 11,000 a day. It is anticipated that 2.3 million Subsaharan Africans will die in the next year. Extrapolating out, that's 23 to 25 million conservatively, people who will die.

In Sierra Leon the life expectancy has dropped to 35 and falling. In Zimbabwe it's dropped below 45. All over Southern Africa, life expectancy has dropped into the 40s and falling. All over Africa we've lost an average of about 20 years of life.

When I first retired from Congress and ran headlong into this pandemic, there were 7.8 million children who were orphaned. As we speak there are now in excess of 10 million. You've probably heard testimony that says by the end of this year that could even be as much as 14 million. World Health Organization, U.S. aides and others have suggested that the present 10-plus million orphans will become 40 million orphans ten years out. You don't have to be a brilliant social scientist to see the incredible havoc that could be wreaked with 40 million children with no sense of the future.

There is a dynamic evolving in Africa that Africans for the most part have never seen. That is the notion of homeless children. Yet, Mr. Chairman, and I'm sure you've experienced this, on the streets of Africa, in countries in Africa to suddenly be confronted with the stark, harsh reality of thousands and thousands of young children struggling to survive in impoverishment and disease is a life altering experience. It is profound and extraordinary.

So with people dying at such an incredible rate, with children being orphaned at such an extraordinary rate, with life expectancy falling so dramatically, in some places, in some countries in Africa, some employers are employing two and three and four people for one job because they know the first two or three are going to die in several months. That's the reality.

There are places where teachers are dying at a rate faster than their students. This is no longer solely nor singularly a health issue. It is an issue that cuts across every aspect of the human condition. It has the developmental implications, political stability implications, across the board implications are there.

So it seems to me that as elected officials, both Republican and Democrat, because this in my opinion clearly is not a partisan issue -- no party can control death. This is something that goes beyond, and I'm happy that Ms. Lee and you, Mr. Chairman, are working together as a bipartisan team because this is about life and death. It has nothing to do with partisan politics nor petty politics. We have to lift our vision much larger.

So the first responsibility, it seems to me, is that I hope you folks would do this and step up to this aggressively, even more assertively than what is in the bill, for the moral imperative. We cannot allow millions of people to die while the world stands by and does nothing. And I would like to think that we as people can rise to a much higher order of commitment, and that is to the moral level.

But I also think there's another reason why we need to be involved, and this is my sense of this. Again, I'm not an expert, but this is what I think I'm hearing. HIV/AIDS is an infectious disease. It is not a respecter of race, gender, sexual orientation, age, class, border or boundary. It respects none of this. The simple, profound conclusion that comes from that is that this infection disease then is endangering the human family. No one country, no one continent, no one people, no one group on this planet has ownership of HIV/AIDS. It is an infectious disease that is challenging the entire human family and therein lines our mutual self interest.

So this is not simply a sense of noble obligation. It is also in our mutual self interest to come together, to fight as valiantly as we can and as effectively as we can to end infectious disease. Where we have not done that, we have only complicated our lives. Take tuberculosis, gonorrhea as two practical examples. And when we come together and we don't effectively combat an infectious disease, the next infectious disease is complicated by our inability to deal with the last one which means that in many case of HIV/AIDS there are people with tuberculosis, other forms of sexually transmitted disease, all of this. So it's in our interest to deal with this.

Why am I focusing on Africa at this moment? Why should we be focusing on Africa at this moment, is because that's where the need is the greatest and that's where the pandemic is expanding and spiraling out of control. And it seems to me for both moral and self interested reasons, we need to go where the problem is manifesting itself most dramatically, and that is in Africa, and we need to deal with that as powerfully and as aggressively as we can in education, prevention, care and treatment, et cetera.

When African countries or Ministers of Health are forced to call press conferences to say we can no longer spend X amount of dollars on care and treatment because we can't afford it and it's not an efficient utilization of our dollars, we must now put this money in education and prevention, you understand the moral and ethical dimension of that decision. It means that this generation and perhaps the next generation can be allowed to die in order to save the third generation out. And we as a great nation, we as a wealthy nation, in concert with a global strategy have to provide the resources to those countries so that no Minister of Health, no nation has to be placed in the position where they have to make the moral and ethical decision of allowing one or two generations to die in order to save another generation out. And I'd like to think for all those reasons we need to step up to the plate.

I see this as a global responsibility, public and private partnership. But I see this nation as taking an important leadership role and stepping forward to deal with this very significant problem. It is manifesting itself profoundly in Africa today, in India tomorrow, Brazil the day after, and Eastern Europe the day after that, and continuing to spiral up in the United States unless we begin to do something about it.

The whole notion of what is domestic and what is international, when we look at HIV/AIDS, these are labels that make no sense anymore because this disease travels. And human beings cross these borders every day by the millions. That's why we don't live under a bubble, so it's in our mutual self interest to deal with the problem that is out there because if we don't deal with it out there today, we'll be dealing with it here tomorrow. So it's important for us to do it.

People live in this country who have been able to sustain life because they have access to care and treatment. We cannot condemn millions of people in Africa and in the developing world to a death sentence because we haven't figured out how to provide care and treatment. It will be difficult, but there are brilliant minds in this room, in this country and around the world who can help us deal with that question.

The first issue is one of governance. Should we do something? So I'm talking to you as a former elected official, as a fellow political activist.

Yes. Before we answer the question how do we do it -- there are brilliant people like the people here who can help us figure that out, but the first question is are we committed to do something? I think your bill, Ms. Lee's bill, and your combined effort is a powerful and wonderful statement that says yes, we are committed to do something and we're committed at a level beyond the few dollars we've thrown out into this issue historically. This is no longer at the project stage. Millions of people have died. More millions are going to die. Millions of human beings are going to suffer.

I would conclude by saying that I absolutely support any effort that is going down the road ultimately to build the global strategy that is based on a public/private commitment where your first commitment of major resources in education and prevention and care and treatment and training is in Subsaharan Africa because that's where the human misery is beyond calculation.

With those remarks, Mr. Chairman, and the members of the committee, I thank you for your indulgence.

REP. LEACH: Thank you very much, Ron. Your last comments are particularly relevant. We all know that where there is a will there isn't always a way, but if there's no will there's no way.

REP. DELLUMS: Absolutely.

REP. LEACH: So will does precede everything.

I've been impressed, if I could turn to the three scientist members of the panel, I've been impressed with some of the statistics that seem to indicate that when you just look at percentages, that when you have a small incidence of existence of the virus, that the growth looks to be modest until it hits about five percent and then all of a sudden it precipitously, within a year or two, can jump to 30 percent. Have you seen that as you've looked at these statistics in African countries? Is there a point upon which it's desperately important that we keep the rate below?

DR. SHERRY: Let me take a shot at that first.

Mr. Chairman, I don't think there's a particular set point. I think there are countries that have hovered around a couple of percent for a very long time like Senegal. Zaire, the Republic of Congo, had relatively low levels, I think five to eight percent for a very long period of time. I think about ten years now or so. So it really depends on what's driving the epidemic in a particular community.

So yes, the numbers can be explosive. I think we see them explosive where there is this pattern of older men infecting younger women, where that's the most prevalent form of movement of the infection. But I think, I don't think there's any magic to the numbers. I think we can aspire to where we have relatively low incidences, and I say relatively low -- two or three percent incident is horrific. But there's no reason to expect that because a country is at five percent that it's going to shoot up if we do something. There is not an inevitable trajectory of the epidemic. And whatever the trajectory is, it can be fundamentally changed by our intervention.

REP. LEACH: In terms of intervention, one of the direct, that you've talked about, is providing an alternative to breastfeeding for infected mothers. I'm told as an immune system disease that basic vitamins are also helpful, too, particularly vitamin A and E. But vitamin deficiency makes people more vulnerable to all disease, but most particularly immune system ones, most particularly AIDS. Is that valid or --

DR. WILFERT: Yes and no. It is correct that those vitamins have influences on the immune system and the acquisition of disease. Unfortunately, there have been clinical trials attempting -- I say unfortunately because the trials didn't show that vitamin A diminished the rate of transmission of HIV from mothers to their children. It's fortunate there were clinical trials. That doesn't diminish the value of vitamin A for either infants or mothers in other regards.

DR. SLUTKIN: If you'll allow me to just say one thing about each of these two. For the most part, the vitamin issues are a distraction as are in fact even some of the other medical issues. But certainly the vitamins.

On the epidemiology, the main lesson that we keep learning is that we're always guessing wrong. Jim Chen who ran the epidemiology and surveillance section for World Health Organization for about six years was the leading epidemiologist I think in the world. Every time we'd relook at the numbers Jim would say it's much -- Every time we look it's worse than we thought it would be. Every time we make a prediction, we've underestimated it when we go down the line and see what it becomes.

I remember very well in the early '90s, and we were the main rabble rousers about the urgency and emergency of this horrible crisis globally. We really, ourselves, did not think anything like this was going to happen in Southern Africa. In South Africa, Botswana, Zimbabwe, this took everybody by surprise, what's happened in the last five years down there. We were so focused on Uganda, Rwanda, Burundi, Malaui, Tanzania, Kenya, Ethiopia, and Zaire and now everyone's looking down at South Africa -- we thought for some reason it would be less.

I think as Jim points out, there's a fractional complacency happening around some of the Asian countries that have not been so hit hard yet. But I don't know what's so different there than what was in South Africa four or five years ago.

So what you have here is you have a population that have certain behaviors, which is most of humanity; and a virus that gets in and when it gets to a certain point the fire blows. So the behaviors have to change, and we know how to change those behaviors. We absolutely know how to.

Just a reminder, the calculations by people who know, and I've seen these calculations and I believe in them based on what was needed in Uganda, the effort is looking for $1 billion. The effort is looking for $1 billion. And I hope that you all will help beyond this bill in trying to raise toward that level.

REP. LEACH: Let me just respond briefly. This bill is designed to reach a billion dollars per year for a five year period. We are looking at substantial sums of money. Now we're not looking at that as all U.S. congressional. We're looking at leveraging the World Bank and also uniquely for the World Bank, looking at perhaps allowing the World Bank to serve for private sector donations as well. This is something that Congressman Dellums is very cognizant of, of the capacities of the private sector and the moral obligation of the private sector.

But it has struck me that one needs methodologies. That is not only do you have to develop a will, you have to develop a way for the private sector, too. I think the World Bank approach probably has more potential in this regard than other institutional arrangements.

Mrs. Lee?

REP. LEE: Thank you very much, Mr. Chairman.

First, let me just thank the panel for their very clear testimony today. And also to say to our scientists and physicians that it gives us a lot of hope that we have such individuals with your level of expertise and knowledge, but also with your level of commitment to address this pandemic. Thank you very much.

To my former boss, I'm always honored to be able to say that -- Congressman Dellums is my former boss of 11 years. It's good to see you here and thank you for your extraordinary leadership on this issue.

You know, you've been working tirelessly on this, and it's no accident that now the congruence of forces are coming together and this pandemic is beginning to receive the type of public attention that it so deserves, and we know that it's due to a large part of your working tirelessly for several years on this.

Let me just ask you, Congressman Dellums, with regard to the United States international role or role in the global community, you attend many international conferences, and I'd like to hear your perception with regard to what other countries see in terms of the United States role in terms of raising this amount and the leadership initiative that we're talking about today.

REP. DELLUMS: I think we're a lightning rod. We're the last super power standing. We're a very wealthy nation.

We're a nation that the world focuses upon, rightly or wrongly, good, bad or indifferent, that's the reality. And I think that as a result of this prominent role that we play, we have a very important act to perform. That is to assume global leadership.

My colleague mentioned that this is a billion dollar effort at a minimum. If you, for example, put $300 million from the United States into an effort in AIDS in Africa, if you look historically, the global community tends to respond to U.S. initiatives at a rate of about two to one. That's the global aggregate governmental community. Which means that that $300 million then could be leveraged to $900 million, as it were, because of other nations contributing at a ratio of two to one, which has been pretty much flat lined over time.

If this is a public/private partnership and you say to the private sector, we want you to match this. This is a global responsibility, it's a public/private responsibility, you have a responsibility to step up to this both on a moral level as well as your self interest. Marketplaces where U.S. business makes a living. People are dying, and that means the marketplace is dying, so if you can't get their morally at least understand your self interest.

So if you've now got $900 million and you're asking the global private sector to match that $900 million, now you have $1.8 billion of money that began at $300 million with U.S., or doing the math, with $200 million. But if you have a strategy that is a global strategy that is both public and private, you can do it.

While I'm at it, if I can piggyback from you to the point that the Chair made, people often ask how do you -- I'm learning going in and out of Africa. How do you eat a hippopotamus? I don't know. One bite at a time. So how do you confront this incredible reality in Africa? Some people say it staggers the imagination. How do we do it? I believe that it can be done by regional cooperation in the southern region, the western region, the eastern region, the central region, the northwestern region.

The way you can have private sector people involved in the whole process is either the private sector can contribute directly to your fund, if they don't choose to want to be committed on the ground because they have no particular expertise that allows them to make a commitment on the ground. Contribute to the fund.

If a particular constellation of corporations decides in true partnership with African countries -- say take the West African countries of 12 to 15 countries. If they're in a true partnership with private resources on the ground -- I remember Bristol Meyers put their $100 million into Southern Africa. That can be the model that can be used in other regions as well. So that the private commitment would not only have to be give them the option of putting money in the fund, if they wanted to get committed on the ground with their own resources in private partnership so that you could put together this kind of consortium in every one of the regions, use the dollars that you're using, leveraging here to connect all the dots, create the communication mechanism, the coordination mechanism, and fill in whatever loopholes are there as a result of this regional effort, I'm convinced that with that kind of aggressive approach, you can be off the ground, all over Africa, within 12 to 18 months with some meaningful effort going on. Because each day that we don't, several thousand people die.

REP. LEE: Congressman Dellums, oftentimes we hear that the infrastructure's not there, so why would we want to put massive resources into Africa because of that? But what you're saying is that this provides an opportunity to actually get in there now and begin some infrastructure building also at the same time.

REP. DELLUMS: Yes. The other thing I think I'm learning is that I'm finding out you can't treat AIDS in a vacuum. I want to be very straightforward.

We're looking at the suffering and the dying of people, and that means education, that means prevention, that means care and treatment. But how do you educate young people who cannot read? So if you're going to be dealing with the problem of AIDS you're going to be in the education business. How do you engage in sustainable care and treatment if you care about people living and dying without having a healthcare infrastructure, so you're in the infrastructure business. How can you care for people where there are no clinics and no hospitals? How can you provide care and treatment going from one village to the other village if you have no roads?

So my sense of it is is that AIDS is such a morally compelling issue, such an extraordinary issue in terms of self interest that if we engage in addressing the issue of AIDS not solely as a health issue but as an issue that cuts across the human experience, we're going to have to find other ways to come up with other resources to deal with that problem as well, which is why I'm saying that the Chair's approach, your approach, are wonderful approaches.

But at the same time on the other end the Subsaharan African countries are spending over $30 billion a year on debt service, and I think this is unconscionable on a continent of such incredible poverty and such incredible human misery, that we are also, and you're starting to hear that rhetoric in the body politic which I think is a healthy thing, to talk about debt forgiveness, and tie that debt forgiveness into a nation's ability to begin to address these crises so that the monies are there for healthcare infrastructure, education infrastructure, et cetera.

What I'm saying is that what I see is that the AIDS pandemic provides both the moral imperative and the self-interested urgency that allows us to come to the aid of Africa in a way that we've never done in the past.

If I might be brutally frank. We have nickled and dimed Africa for years. The result has been incredible poverty, incredible pain, and now we're looking at a pandemic that is killing millions of people. Well, let's step up to the plate and allow AIDS to be the issue that allows us to do it, not simply out of a sense of noblesse oblige, but because it is in our self interest to stop the problem. But once we get out there, make no mistake about it, once you get into the business of dealing with AIDS you're going to have to go wherever it takes you, and I think that is ultimately going to take you into these infrastructure questions because they can't be avoided.

But my final point would be we cannot allow this to be an excuse. When I first got out there and I said well what this issue needs is a loud mouth political activist. I heard a lot of people saying, but how are we going to do it? We don't have infrastructure. That means all these people are just going to die because we've not sat down to challenge ourselves scientifically, medically and intellectually and bureaucratically to figure out how to come to grips with this problem. I think it's such an important issue that I could not allow those sort of rationale to be just that -- a rationale for doing nothing.

So I felt that we had a responsibility to make the world uncomfortable with this reality so that no one would ever have the right to say, the opportunity to say I didn't know anything about it.

REP. LEACH: I think the other three panelists want to address aspects of that. Why don't we just begin left to right.

DR. WILFERT: I just wanted to say that it's obvious, I'm sure, to everybody that there's a real heterogeneity out there. That if I use my own territory, there are places that have antenatal clinics. They see pregnant women before they have their baby. They're not currently able to counseling and testing. Or they do not have access to the intervention. That's one kind of deficit of infrastructure.

On the other hand, there are places that have everything except access to drugs and with the right kind of help could actually achieve very instant implementation.

So what I'm trying to say is that in each of the areas there will be a spectrum of deficits and the nations are sensitive to that, and with help they can tell us what they need, one piece at a time.

DR. SHERRY: I would hate to have the committee leave with the impression that a billion dollars is going to fix this. And you've seen different ranges on the prices, or the cost of this. You've seen one to two, two to three, for prevention only, some aspects of care, et cetera. The estimates we've done, and I think it also responds to Ms. Lee's question on absorption capacity, what we looked at is the six or seven highest impact interventions and looked at what would be the capacity to scale those up tomorrow.

For example, we include on that life skills education in schools. We don't count, we don't cost for where there aren't schools. We look at it, if there's only 50 percent school coverage, we cost to the 50 percent of the kids that have access to the schools. Similarly with STD treatment or other communications programming. So in terms of programming money tomorrow, you could program by our estimates between $1 and $2 billion just to do that.

Now that doesn't get you the infrastructure that you require to extend. But it doesn't all have to work perfectly in order to get a very dramatic impact.

So I at the same time would not want people to leave with the impression that the needs are so astronomical that $1 billion isn't a significant amount of money. It's, in this setting it's an enormous amount of money. It will have a very major impact, but it doesn't get the full solution.

A second point along that same line. Where we have had major international mobilization, and I think this will dovetail well with Ron's point. Where we have had major international collaboration that the U.S. has led., they've had a leader's share, and that leader's share has usually been closer to 50 percent, and then stabilized down to about a third when the others got on. So in the first expectations, I think that leader's share needs to be a little higher from the U.S. than the international community.

The second point is that if we look back say at our experience with immunization, there was a much simpler task. But in that particular case the total worldwide additional expenditures to get the immunization levels from about 20 percent to 80 percent, over about a six or seven year period in the '80s, that was about $2 billion a year. Only $200 million of that came out of the international community. Ninety percent of those resources become mobilized out of the soil. So when you're in a community, it's the time of the teacher; it's the clergy; it's the community worker; it's the extra time that people are putting in; it's the free television time that you get with the public service announcements; it's that broader mobilization that gets you the much broader range of resource.

So as well as one comes in now with the major effort, you have to think about not displacing that resource. That's why it's critical that in terms of your mechanism, and the emphasis on community partnerships, on civil society -- these approaches, that we don't undermine the leverage capability of these processes. That we don't go in and displace what are the resources that could be coming in from the communities, but rather help to liberate them.

DR. SLUTKIN: If you'll allow me, I want to separate out something for you. The infrastructure problem of Africa has nothing to do with our expected affect on prevention. The infrastructure for prevention is totally there. We're talking about women's groups that go all the way out to the village. We're talking about community groups that connect with each other all the way out in the villages. We're talking about radio that gets all the way out. Talking about schools that go out. The political party has training of trainers and trainers that go all the way out. The infrastructure for prevention education is totally there.

Now what we're talking about from infrastructure problems primarily have to do with issues related to care, which is important and which can be designed to be more feasible, intermediate level. But in terms of prevention, the infrastructure is not a barrier.

Secondly, I've been working on epidemics now for about 18 years and on this epidemic for about, I don't know, 15 or something like this, one way or another. This billion dollars is not a drop in the bucket.

My expectation is what you'll get from a billion dollars a year is you're going to get two or three countries a year turning the corner, starting three or four years from now. If these funds are put at least to the 70 percent level for prevention. That's what this fund should be for, is for prevention.

The last point is, we go to the private sector, they have so many interests of their own. The Squibb money and Bristol Meyers, a lot of this stuff goes to U.S. universities, it goes to a lot of stuff that isn't really going to prevention for Africa, so we have to be aware of that when we're counting the money that's really going in.

REP. DELLUMS: Mr. Chairman, I would just want to make one comment. I appreciate all the remarks about prevention and education, and I'm there. But I'm also saying that we have to care about the people for whom education and prevention are no longer options. And those people range in the millions. And it is both ethically and morally unacceptable to me that we could do anything in terms of our comprehensive strategy that would not address the care and treatment issue as well.

Again, as I said, ultimately prevention is ultimately the answer of the day. The point is, we're not there yet, and there are millions of people who are dying. All the prevention in the world is not going to help them. All the education in the world at this point is not going to help them. The ethical and moral question is what do we do with these people? Do we allow them to die?

I've taken a view that we cannot allow them to die. Which means at this particular point we've got to grapple with whatever the financial resources, the infrastructure issues to deal with these questions. Whatever the affordability issues and the accessibility issues, appropriate treatment regimes, whatever, those issues have got to get dealt with. These issues are on the table, they're controversial, they've got to be dealt with. We've got to step up and answer those issues.

But again, the approach in my opinion -- I'm not here singing a tune for one point. I'm singing a tune that's for a comprehensive approach that respects the totality of the human family and the totality of the human spirit. That means education, prevention, as well as care and treatment because we cannot allow millions of people to continue to die and we do nothing about it. And if all the issue is is about resources, this is a wealthy nation. And you and I know that the resources are there. If the will is there we can put the monies up to get this job done.

REP. LEACH: Thank you, Congressman Dellums. Thank you distinguished panelists.

By conclusion, let me say I don't think I've ever participated in a discussion anywhere in this Congress about more fundamental human condition issues -- life and death, the family. And one is struck in terms of family structure that in many ways, many parts of Africa have more cohesive families than the most modern parts of America. And that there are issues of fundamental decency that apply.

We sometimes note that we're the wealthiest country in the world, which is obviously true, but in a quantum way we are more advanced in basic research capacity than we are even in wealth relative to the rest of the world, and for this, the wealthiest country and the most advanced country in terms of research, as well as in many regards systemic applications of almost every human service delivery, to abdicate our responsibility would simply be to defy moral and historical judgment.

I think this is clearly a time for us to act, and act in ways quantumly beyond anything that any of us have considered. I'm very appreciative for all of your input into this, and hopefully we can advance the goal.

END

LOAD-DATE: March 11, 2000

Document 2 of 17.


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