Good morning. First, I would like to thank CSIS for helping to coordinate this event, and for all the good work on HIV/AIDS and other key global challenges. Additionally, I want to extend a warm welcome and my sincere appreciation to the other Members of Congress and guests who have spoken at this morning’s conference. It is exciting and inspiring to be in the company of so many distinguished experts and advocates, all of whom have contributed distinctly to fighting the HIV/AIDS pandemic.

I am pleased to have you all as partners as we work together to explore how the United States can do more -- and do so efficiently, effectively, and sustainably -- to contribute to international efforts to prevent, contain, and combat the HIV/AIDS pandemic and other related diseases that continue to plague populations, economies, and essential infrastructure around the globe. I know that a great number of you have been devoted to this issue and its victims for many years in varying capacities, so your experience and expertise are invaluable for my colleagues and me as we consider the next steps for the United States government in this arena.

Clearly, we are no longer in the early, fact-finding, trial-and-error phase of global HIV/AIDS, malaria, and tuberculosis programs. Thanks to the substantial investment of the President’s Emergency Plan for AIDS Relief and the Office of the U.S. Global AIDS Coordinator, the Global Fund, UNAIDS, and the hundreds of implementing partners working to prevent, treat, care for, and cure these deadly diseases, we are building a body of knowledge about what works best in different circumstances. Now, as PEPFAR’s initial five-year stage draws to an end, we have a unique opportunity to collect, compare, and consider these lessons learned to inform the next phase of U.S. and international global health efforts.

For example, I spent part of Congress’ August recess in Uganda, where I met with many HIV/AIDS experts to hear what they had to say about PEPFAR and the United States’ support for AIDS-related programs in general. As I sat down with some of these experienced and knowledgeable individuals in Kampala, their appreciation of U.S. funding and PEPFAR was evident. At the same time, however, they had a lot of suggestions for how U.S. efforts could be improved to be even more helpful.

As most of you here are aware, Uganda has been seen as a rare example of success on a continent facing a severe AIDS crisis. The government’s prompt recognition of the crisis and comprehensive policies to address it – including a well-timed and successful public education campaign -- are credited with helping to bring adult HIV prevalence down from around 15% in the early 1990s to just over 5% in 2001. Unfortunately, in late 2005, UNAIDS estimated that 6.7% of adults were living with the virus, and in 2006, scientists suggested that Uganda’s HIV prevalence rates may be rising again. Indeed, I heard that same concern from most, if not all, of the individuals I met, as well as from the Ugandan President himself. U.S. HIV/AIDS programs and funds – Uganda is a PEPFAR Focus Country – have been criticized as at least partially to blame for this disappointing reversal. So while Ugandans are grateful for U.S. HIV/AIDS funding, this support would be more effective if it corresponded more closely to national needs, conditions, and initiatives.

The first message, which came up again and again in my meetings with Africans, was that more needs to be done with respect to prevention. Given the rising infection rates in Uganda – as in many other parts of the world – the emphasis on treatment fails to address the principal drivers of the epidemic. It has become a common refrain that we cannot treat our way out of this global pandemic. In the global context, the organization Family Health International reports that for each new person who received antiretroviral therapy in 2005, another seven people became infected. As long as infection rates are rising, treatment and care costs will increase, as will the disease’s burden on key vulnerable populations as well as their families, communities, and countries.

Treatment and care are essential reactive measures, and in many cases, treatment services are an important entry-point for prevention –an opportunity that should be capitalized on significantly. But the future of HIV/AIDS will depend upon our ability to proactively restrain its spread. A related issue is the importance of ensuring adequate flexibility so that U.S. programs can be adapted to meet local needs and cultural standards. Rightly or wrongly, critics have accused the U.S. of encouraging a shift in Uganda's HIV prevention policy towards promoting abstinence only, and away from promoting condoms, causing a severe national condom shortage. This was a major point for discussion when I was in Kampala and in fact shifted the conversation to heated debate about the shifting public face of the campaign -- a shift they characterized as a disservice to the full ABC programs. We clearly need to expand the scale and scope of our prevention efforts and reach out to critical populations more effectively, since the continued spread of HIV now threatens the longer-term sustainability of global efforts to combat HIV/AIDS by the U.S. and others.

One key aspect of prevention is family planning, which includes reproductive health and mother-to-child transmission. In many parts of Uganda, Africa, and the developing world in general, there is widespread demand for modern birth control methods, but these are not always available. How can HIV/AIDS be combated if these demands can not be met? Equally relevant, what effect does the rapid population growth occurring in many of these countries have on their HIV/AIDS epidemics and efforts to combat the disease?

My sense is that we must incorporate family planning into overall HIV/AIDS plans since the two are clearly inter-related Country-specific indicators should be vital factors in designing and adapting U.S. assistance programs. Domestic, political, and religious concerns should not preempt U.S. or multilateral support for life-saving supplies and programs. Family planning is a valuable service in and of itself, but when provided in the context of broader HIV prevention, such programs can have far-reaching health and livelihood benefits.

One of the central themes of this conference, as well as numerous reports and seminars on PEPFAR and HIV/AIDS, has been the disproportionate impact of the disease on women and girls. I met one of these girls at the Joint Clinical Research Center in Kampala. She was diagnosed with HIV at a very young age and had also lost her parents to the disease. I was so pleased to see that because of thorough treatment -- which included not only the necessary drugs but also more general health care, solid nutrition, and counseling -- she was able to a live a strong, healthy life. In Uganda, as in other parts of Africa I have visited, I have been reminded that without developing more specific strategies to address the vulnerabilities of women and girls, we cannot hope to turn the tide of the pandemic.

Congress recognized this reality when we passed the 2003 Leadership Act, which called for the U.S. Global AIDS Coordinator to develop specific strategies to meet the unique needs of women. Ambassador Dybul and his able team have initiated several such programs intended to empower women in interpersonal situations; to encourage the reduction of sexual violence and coercion; and to increase women’s access to employment opportunities, income, productive resources, and microfinance programs. Now we need to consider how to expand and improve the effectiveness of these initiatives by integrating them with other programs.

PEPFAR was designed to be very results-focused, which has helped demonstrate the effectiveness of its programs and solicit support within Congress and other key constituencies essential for its continuation. On the other hand, the program’s emphasis on a narrowly defined set of observable indicators overlooks key dimensions of the epidemic beyond the health sector. For example, the preservation and enhancement of household livelihoods, fulfillment of basic nutrition requirements, interactions with other diseases such as tuberculosis and sexually transmitted infections, and the functionality and adequacy of national health systems need to be considered and reflected in HIV/AIDS plans and programs if our investment is to have a substantial and sustainable impact. We should also explore the role of the private sector in these efforts to maximize resources and reach.

Something else that was made very clear to me in Uganda is that sending a proper and pragmatic message through our HIV/AIDS programs is essential. Our efforts must be consistent and focused if we are to overcome complacency and contribute to long-term behavioral change, which is the only enduring solution to this health crisis.

Yes, the past four years have taught us a lot about how we can and must work together to contain and combat HIV/AIDS, malaria, and tuberculosis around the world. But this battle is ongoing. There is no quick fix or shortcut to success, but the papers presented and ideas expressed at this morning’s conference offer many valuable suggestions for ways to learn from the recent past to guide the next few years of this national and international campaign.

I am committed to maintaining and expanding the United States’ response to the HIV/AIDS pandemic in the short- and long-term. Thank you again to all the individuals and organizations in this room that are doing so much to advance this objective. I look forward to continuing to work with you all as Congress supports the continuation of U.S. leadership to prevent, contain, and combat HIV/AIDS, tuberculosis, and malaria in a way that advances a wide range of global health and development objectives.

Thank you.