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Carol Thompson
Carol Thompson
Director, White House Office of National AIDS Policy

June 23, 2004

Carol Thompson
Hello to all,

I am just back from Philadelphia where the President made several announcements regarding his international and domsetic HIV/AIDS agenda. We are all excited that there was such a terrific response. I am glad you are interested in HIV/AIDS and am looking forward to answering your questions.

Bill, from Pittsburgh, PA writes:
I heard somewhere that President Bush did not spend as much on AIDS in Africa as he proposed during the state of the union address, is this true? Also if it is ture, does this money make up for those cuts?

Carol Thompson
Bill, thanks for your question. I am excited for the opportunity to set the record straight. The President is spending as much as he promised in the 2003 State of the Union. He promised to spend $15 billion over 5 years. Some people thought that that meant that he would spend $3 billion per year in each of the 5 years. However, there is a significant need to build human and structural capacity through the continent of Africa. For example, in the country of Mozambique there are 18.6 million people and only 400-500 doctors and 1.1 million people are infected. Because AIDS treatment is very individual, clearly we need to build a sustainable healthcare structure to ensure that the life-saving medications those people need are properly administered for the rest of their lives.

The President is spending $2.4 billion this year and will ramp up funding to more than $3 billion toward the outer years of the program.

Steve, from Houston TX writes:
Can you please tell me when the president is going to look at ADAP funding and find a way to ease the burden on those on waiting list here at home?

Why get tested if there are no medications accessable for long periods?

Carol Thompson
Hi Steve, we too are concerned about a way to ease the burden of those waiting for medications. I am pleased to tell you that today, the President announced that $20 million in new funding will be made available immediately to deliver life-saving drugs to the men and women in the United States living with HIV/AIDS who are waiting for HIV-related medication. The President also announced that we are going to look at your question exactly as we renew the legislation that funds the ADAP program. We want to be able to have the flexibility to target resources to those most in need.

But the other message is also clear - we want you to and others to know that if you are at risk, you should get tested.

Kevin, from Columbus, Ohio writes:
Currently, under the Ryan White CARE Act, there is significantly more money available for services for people living in Title One EMAs and than for services for people living outside Title One EMAs. Will this disparity be considered during next years reauthorization process?

Carol Thompson
Kevin, you make a good point. This point will be considered during the next reauthorization. Today the President announced that he will use the following three principles when looking at the legislation. He wants us to focus Federal resources on life-extending care and a core set of clinical services, provide greater flexibility to better target resources to address areas of greatest need - that means the possibility of addressing areas outside a title one EMA.

He also is encouraging the participation of any provider, including faith-based and community organizations that show results, recognizing the need for State and local planning, and ensuring accountability by measuring progress.

Through all these ways we want to reach those in greatest need.

Thank you for your question.

Jillian, from Chicago writes:
What advice would you give graduate students who want to join the global fight against HIV AIDS? I have one year left in my masters program, and in the fall of 2005 I begin work on my PhD in biostatistics and epidemiology, but I cannot seem to focus on one HIVAIDS topic for my thesis (rather I want to study all of them, which is just not possible). Can you give me your opinion on which HIVAIDS topic(s) most need academic research?

Carol Thompson
Jillian, the global fight against AIDS needs you! Thank you for wanting to contribute your talents. One of the initiatives that the President recently announced is a Global HIV/AIDS Vaccine Enterprise. This is a virtual consortium to accelerate HIV vaccine development by enhancing coordination, information sharing, and collaboration globally. This concept has been proposed by an international group of scientists to prioritize the scientific challenges to be addressed in finding an AIDS vaccine, coordinate product development efforts, help align and channel existing and new resources to the needs at hand.

The President also announced that we will establish a second HIV Vaccine Research and Development Center, in addition to the one at the U.S. National Institutes of Health. The new center will become a key component of the Global HIV Vaccine Enterprise.

Maybe this would be a great fit. Thanks again and keep up all your good efforts.

Michael, from Pennsylvania writes:
The greatest successes controlling AIDS in Africa are those countries teaching abstinence, mostly with the help of Christian missionaries or other faith-based organizations. Can President Bush continue helping those types of programs and why are not their successes plastered all over the media?

Carol Thompson
Michael, thank you for your question. You are correct. Faith-based organizations have made, and continue to make, incredible contributions to the fight against HIV/AIDS. Combined evidence suggests that religious organizations and other opinion leaders in African nations who advocated abstinence and fidelity have had a significant effect on the overall decline in the HIV infection rate. Uganda has been very successful in implementing the "ABC" approach, Abstain, Be faithful, use Condoms. In Kenya, 40% of the health care is delivered by faith-based organizations.

The President will continue helping faith-based organizations.

Gary, from New York writes:
This question regards the FDA's accelerated process for reviewing HIV antivirals to be purchased under PEPFAR. Has the FDA received inquiries from companies that provide lower cost generic fixed dosed combinations?

Is there any indication that these companies will be applying for review under the new process?

Carol Thompson
Gary, your question is timely. The FDA has had educational meetings with a number of international generic companies to answer any questions they have about the process. There have also been follow up conversations to further educate them on specific regulatory processes.

There is definitely strong interest in this program and the FDA is hopeful that in the next month one or more generic manufacturers will apply.

Stay tuned!

Cliff, from Brimfield, Ohio writes:
Director Thompson: It use to be you could not watch tv,read a newspaper or a magazine that you didn't see something about AIDSHIV But over the past several months if not year. You hardly see anything. It's as if the situation is not that big of a problem anymore. That somehow we have conquered the issue. But after reviewing the facts on your web site. It appears that there still is a world wide war going on in the area of AIDSHIV and I'm not sure we are winning after looking at your stat sheet. It appears that the issue has become a back burner issue. Now that we have several front burner issue. In the United States the sheet says 40,000 new cases a year. And world wide the numbers are in the millions. The death count alone exceeds the wars we have fought. What are your thoughts? Are we stepping forward or falling behind?

Thank You

Carol Thompson
Cliff, we are not just stepping forward we are charging forward.

The President is committed to succeeding in this battle. The President launched his Emergency Plan for AIDS Relief last year, which has provided much needed funding to 14 countries in Africa and the Caribbean. As a result of this initiative, as well as other efforts, there have been many success stories. The Reach Out clinic in Kampala, Uganda received funding only 6 weeks after the Congress appropriated the money and the Mbuya parish has now more than doubled the number of patients it is treating with life-extending antiretroviral drugs. Uganda has also cut its AIDS infection rate to 5% over 10 years.

The Administration is also working domestically to get help to those living with HIV/AIDS. In the FY 2005 budget, $17.1 billion has been allocated towards domestic AIDS research, care, prevention, and treatment. Additionally, in May the President announced an expedited process for reviewing applications for new, easy-to-administer HIV/AIDS drugs.

We are making great strides and are moving ahead in our fight against HIV/AIDS.

Dan, from Kansas writes:
I remember President Bush announcing an AIDS initiative for Third World countries awhile back. What positive effects has this initiative had so far?

Carol Thompson
Dan, he certainly did. He announced a five-year $15 billion plan with a specific focus on helping some of the most afflicted countries in Africa and the Caribbean.

Let me give you one or two examples of the great work that is being done to give people hope and save lives.

In the Mbuya Parish in Kampala, Uganda, the ARVs have arrived on a big scale. Reach Out received the funds for 500 clients on ARVs from the Presidents Emergency Plan for AIDS Relief on the 9th of March, 2004. Four days later, 13th March 2004 the first client started on ARVs provided through these funds. Here is a direct quote from their staff, "We are experiencing something very beautiful – our clients will have a chance to continue to live!!"

Here is another story that the President talked about today. This will give you a real look into the lives that are being changed for the better.

Jennifer is a 36-year-old widow with two children 13 and 15 years old. She has no education nor has her children ever been to school. In February 2004, her CD4 count was 2 (norm 400-1600) and she started on ARV drugs (individual sponsorship) end of February. She developed severe headache a few weeks later and came to the clinic where she was diagnosed with Cryptococcal meningitis and started on treatment with Diflucan.

Two days later we see her on home visit. Her Community Supporter and the Central volunteer had visited her already the day before and even the same morning – just to check on her.

She is much better now. She is both on TB and ARV treatment and now Diflucan. She is illiterate, but her blue TB card and her pink ARV card are beautifully filled out. All the tablets are taken as they should – none forgotten. Her marks in the card are beautiful – a bit shaky as they are when you don’t know how to write – but they are correct!!

Her house is about 3x3m MAX, and there is one foam mattress with three small pieces of cloth to cover the foam. No pillow, no blanket. A bag of WFP food in the corner, a few pieces of clothing and three cups and plates. She lives here with two teenage children.

After going through all the medicines etc, she asks with a smile, whether it would be at all possible to get a blanket – there is none for the kids or for her. With the help of the Indian Women’s organization we can give her two blankets. She grabs my hand with gratefulness and her smile lights up the room – I am left humbled but grateful as her smile is such an encouragement to keep our work going.

She is on ARV’s now and she wants to live – does all she can to follow her medication. She has many other needs – clothing, food, love and care - and later on help and training to provide for herself and the kids. They are all important in order to succeed getting back to life.

Joshua, from Lincolnton, NC writes:
Why was Philadelphia, the center of the American AIDS movement, chosen for the President's comments on AIDS, after having spent only several hundred million dollars to fight global AIDS, despite a $15 billion promise?

Carol Thompson
President Bush has embodied the leadership, compassion and generosity of the American people in his bold Emergency Plan for AIDS Relief - the largest international health initiative dedicated to a single disease in history. The President's Plan commits $15 billion over 5 years, including $10 billion in new money. By September 30, 2004, the President's Plan will have provided $2.4 billion to service providers and other partners in the fight against HIV/AIDS, including $550 million for the Global Fund to Fight AIDS, Tuberculosis and Malaria. As a result, given current funding projections, the U.S. will provide twice as much funding for global HIV/AIDS as all other government donors in the world combined. Funding for international HIV/AIDS under the current Administration has increased by 3 and one-half times compared to the previous Administration.

The President's Emergency Plan is moving faster than any major international AIDS Initiative. Today, President Bush announced the second round of funding that will become available following Congressional Action. With this round of funding, $865 million will be on its way to 15 focus countries in Africa, Asia and the Caribbean that are home to nearly half of all HIV-infected persons in the world. That represents nearly a tripling of U.S. Government resources for these countries. Those funds are dedicated to scaling-up integrated prevention, treatment and care programs for HIV-infected persons and AIDS orphans.

On February 23, 2004, the U.S. Global AIDS Coordinator, Ambassador Randall L. Tobias, announced the first round of funding - $350 million dedicated to the focus countries. Within two weeks of that announcement, and within six weeks of the first funding for the Plan, a clinic in Kampala, Uganda had doubled the number of patients receiving antiretroviral therapy because of the Emergency Plan. In multiple sites in several countries, antiretroviral therapy is reaching those in need, care is being provided to AIDS orphans, and prevention messages are being disseminated. But because of limited trained personal and physical infrastructure, the President's Plan is also focusing on building the capacity to expand prevention, treatment and care as rapidly as possible. And so, with each year of the Plan, the resources will increase. President Bush has requested $2.8 billion in his 2005 Budget.

Americans can be very proud of the bold, rapid and compassionate action of President Bush's Emergency Plan for AIDS Relief. Together, we are leading the world in fighting this tragic disease.

Carol Thompson
It has been great to get your questions. I appreciate you taking the time to discuss HIV/AIDS, one of the most critical issues of our time. Looking forward to another interesting exchange again soon.