MALE SPEAKER: Okay. Good morning, we are going to start the press conference and the last plenary session of this conference.

Personally, I would say that this has been one of the most challenging sessions I have attended in this conference. We have spoken about the main issues that we tried to push in the Barcelona conference, which is programming, scaling up, challenges, access to care, treatment and prevention for poor results countries.

And we are very honored to have highest-standing speakers this morning. We have had Paul Farmer from the United States, who have talked about introducing antiretrovirals in resourceful settings, expected and unexpected challenges and consequence, Paolo Teixeira from Brazil, who has talked about program implementation and scaling up, barriers and successes.

Graca Machel from Mozambique, who has been talking about reversing development. And Julio Frenk, the Economical Ministry of Mexico, who has been addressing the talk on the follow-up of (MS?) and responsibility, and who unfortunately, already left to Mexico.

Since Mrs. Graca Machel is going to leave in 10 minutes or 15 minutes from now, I propose to start with her. And after her, I will give you a few overall remarks about the conference, because I know that some of you might not be here tomorrow for the final press conference.

And at the end, I would be happy also to answer global questions regarding the conference.

So it’s my honor to introduce Ms. Graca Machel. If you want to make a short summary about your talk, and then we open the floor for questions. Thanks.

GRACA MACHEL: Well, I don’t think really I have much to say, but this morning, my contribution was basically trying to focus on key, really future briefings. One is that despite the knowledge, despite the efforts which are being made, despite even the great deal of expertise which now has been developed around the HIV/AIDS pandemic, our response collectively is not aggressive enough, it’s not broad enough. It’s not comprehensive enough.

So that in fact, may be important in isolated manner, but global cities from national to region, and even globally, we are terribly ineffective. And because we have the knowledge, and because we know resources are available, because we also expertise is there, apparently I think we need two things.

One, we need to connect better from family, community, nations, regions, and globally. Second, we haven’t searched enough the levels we have the power to make the bigger impact.

Many of the people who are around here at this conference are practitioners, are academics, are professionals, are the convertive community, which is working again HIV/AIDS.

Those we need to be converted have not been cast in yet. We are not engaged yet. So my second message was exactly to say, we have to go there and patch with bigger change, which has to be made, which is the political will, which resounds those who are heads of states, those who are heads of government, those who are ministers, those who are heading (MS?) institutions to take up to their responsibilities to say more than anything else, today is the moral question which has been posed to us. There’s no explanation for us to keep on moving like – while we have the capacity to stop it.

All of this basically what I was – I would like to say that I think we have a moral test when we are told that millions and millions of people are under threat. And we seem to be doing business as usual. We don’t take offense of urgency, offense of emergency, actually in a comprehensive manner.

I think I’ll stop there.

MALE SPEAKER: Thank you very much. Questions, please? Is the microphone here? It’s coming. Thanks.

LAURA VAN VERNE (MS?): Good morning, I’m Laura Van Verne of “Christianity Today” in the U.S. I’m really interested to how important the religious community is in the fight and the battle. What can and however they may not be converted yet, I should get to mention, to be fully engaged, what do things like this governments, policymakers, community leaders do to engage the church even further?

GRACA MACHEL: I think we are at a time where those who are, how do you say this in English, those -– the believers have to turn and question actually our spiritual leaders. To ask them how much they are using the power of convincing, which they have. I mean, they can’t be the beliefs of everyone of us. Sometimes there are things we cannot explain, but we believe.

So they can enter into those levels where probably an activist cannot go, but also as a spiritual leaders, they can also raise exactly the moral issue, which I’m concerned with, that human life is precious. Human life has to be protected at all costs. And we have no explanations of philosophical, whatever it is, which can justify that we are not engaged enough. I think we have to go and question this, and to engage them.

Secondly, I was saying also that in some communities, some nations, religious groups actually, they are the biggest network you can find. They go even deeper into rural areas, where sometimes NGOs and other organizations have no institutional capacity.

So they can reach much more in terms of extension. And they can reach much deeper in terms of believable people. So we really have to engage them. They have to be part of this process, because they can give us huge amount of contribution.

MALE SPEAKER: Mic, please?

MALE SPEAKER: (MS?) Press. Ms. Machel, you made a very strong appeal in your speech just now for countries to do more to fund the global AIDS pandemic. And you said that there are some people who remain to be converted. Without wanting to impose a classic journalistic trap of asking you to name to names, whom – which country should do more? And how much should they contribute to – in this effort?

GRACA MACHEL: Well, for those countries, I know they are doing well. And then the rest, they have to check themselves.

You know, so far, as far as commitments made by the international community to release resources, both for development, you only find four countries who have reached 7% of GDP, which is Sweden, Norway, Denmark, and (MS?) -- Sweden, Norway, Denmark, and there’s another country. Netherlands, the Netherlands.

These ones have been exemplary. And actually, the Norway government has announced even more that from now on, they are going to give 20%.

So if you have a government who have made pledges, but they are fulfilling the promises, what’s happening with the others? You can ask them all, except these ones. And of course, I know what you are talking about. And you asking about the United States.

I mean, the United States claims to be the leader of the globe today. To be a leader, you have to show by example that you meet your responsibilities and your obligations. That’s all I would say.

MALE SPEAKER: A question?

JOHN DONNELLY: Hi, my name is John Donnelly, with “The Boston Globe.”

I wonder if you could turn your focus from global, to looking back at home, and ask you about the best ways to attack the political problems in South Africa, and move ahead in fighting AIDS?

GRACA MACHEL: Well, actually, we are moving ahead. I think the good news in South Africa is that we have a very dynamic civil society. In the continent, actually, I think we have the most powerful civil society organization.

And if you have followed things at home, you know that once – there are already civil society organizations to reach are giving matter to child transmission programs. They are doing it.

Second, we’ll be aware that civil society organizations worked hard, even to help the government to change its position. You’ll be aware that one of the – I think it was yesterday, Zachi Armud (MS?), who is leading the TAC group, I mean, just to give one example. But we have hundreds, if not thousands of civil society organizations at home, who have been doing a fantastic work.

The difference is that they don’t have the visibility and the platform to show how much is being done within the country. But I think we are working hard. And even our governments, it has, it has shown many indications of change, if you are being very careful to follow what’s happening.

So we are fine. We are there.

JOHN DONNELLY: Okay.

GRACA MACHEL: Mm-hmm?

FEMALE SPEAKER: How we convince politicians to take up this unpopular issue before people start dying in the streets?

GRACA MACHEL: What I was trying to say is that it is the responsibility of each one of us here. You know, we all go back home. And we have our politicians, whether they are in parliament, whether they are in government, whether they are local government. It’s up to us, I mean, to bring them to terms that they can do much more than they are doing.

And this is not something which any individual alone can do. That’s why I also insist that we have to work hand-in-hand, even if to the society organizations, to be of a national movement, which we have done to build the regional movement, and naturally, the global movement, too.

So your question, actually, I will give it back to you. You in your own country know how better to approach your politicians. I know how to approach mine in my country. Each one of us has to do that.

FEMALE SPEAKER: I apologize. I would like to know if I can make a question in Portuguese? I’m from RDP Portugal and ask you a response in Portuguese because Mrs. Machel has no time? Sorry, would it be possible now?

MALE SPEAKER: (MS?).

FEMALE SPEAKER: No? Well, anyway, I’ll do it in English. Mrs. Machel, what would you like this conference to bring to the fight against AIDS, mainly in southern Africa and especially Mozambique?

GRACA MACHEL: Well, I think this conference really is, as I said, it’s composed of converted people. So I’m not here to convert anybody. I’m just saying we can be stronger and we can do better. That’s what – that’s my message for those who are attending this conference.

And if I want to take back home, really, I look in the – I found too many people here who are coming from southern Africa. I was just questioning how much do we network ourselves, I mean, to learn from one another? This is one, but the other thing is that yet our governments have to set up clear strategies.

That (MS?) the most severely affected region in the globe, then the international community has an obligation towards how to help us, one, to improve our health network. Second to train me, retrain our own people to be able to tackle the pandemic. And third, to help us to build the institutional capacity, especially at the local level, at the community level, because that’s where the fact has been felt in everyday basis.

Communities, organizations needed to be strengthened, needed to be given much more tools and the instruments of how to work.

So whoever is here, who can help us in southern Africa, if you are community organization, you are welcome. If you are from a pharmaceutical, yes, please cut down medicine so that we can get them for the poor. If you are government, please, you know what to tell your government to do. And if you are researcher, yes, please, help us to understand better our own situations, to know how to act. So we welcome any officials.

MALE SPEAKER: The last question for Mrs. Machel? Very last one?

FEMALE SPEAKER: I think you mentioned in your speech about –

MALE SPEAKER: Go ahead.

FEMALE SPEAKER: I think you mentioned in your speech about corrupt regimes. Can you comment on what is the possibility of bringing either treatment or preventive measures to countries that have repressive regimes or political anarchy, other problems to deal with?

GRACA MACHEL: Well, you know, I would like really to make a distinction here. Yes, we have governments, some governments, which are corrupt in Africa, but it’s wrong to look at Africa as we are all corruptive governments. It’s not true.

And if you want to go and look very carefully, you’ll find clean -– and at least cleaner governments than others. This is one.

The second point I want to make is that, even in those situations, why these communities, why these mothers, why these young ladies, why these youngsters have to pay the price, and not be assisted because they happen to have a government which is considered to be corrupt?

I mean, there are key levels of how we have to tackle these problems. We can’t keep our eyes blind to the best of people on the ground and to punish them, because they happen to have a president who is corrupt.

Of course, you can tell me that well, we have to remove those governments. But while we don’t remove them, don’t you really have the civil society organizations which can work with us at the community level? Don't you have research institutions which can work with our universities to be tackling the problem? Can’t you channel some of your resources through religious groups, community-based organizations, local government institutions?

So they least space -- even where you say there is a corrupted government, there is space to work with people. With people for the people. So we shouldn’t generalize things, first of all. And we shouldn’t punish those who need most, because we have one or two people on the top who are corrupt.

And if you allow me, I think now I should just skip away and disappear. Am I allowed to? Thank you. Thank you.

(applause)

MALE SPEAKER: Okay, does it work? Yes. If I should say something or to today’s session, does it work, Susan? I would say has been a session coming from reality. That different speakers have very different level of responsibility, and coming from different disciplines, they have give a real picture of what HIV in different context.

Paul Farmer has put antiretroviral treatment in the context of poor results settings, and has been arguing about what does it mean. And I think if it was not clear enough, at least for me after his speech, it was clear that, apart from the theoretical dilemma between intervention and treatment, we should also include the global development in order to be and to have effective both preventive and treatment interventions in a sustainable way.

And if I should use one of the sentences he presented, I will choose the one that says, “that we need operational research, but to have them, we need operations in the field.” So I would like Paul Farmer to comment a little bit on his speech, and then we open the floor for questions.

PAUL FARMER: Thank you very much. I have to say, I understand very well Mrs. Machel’s comments about the converted, but actually, I think from inside our community of medicine and public health, we know there is not consensus. And if there is consensus about what to do, it’s being borne now.

It is not – we are not a community of converts who have already agreed to help each other. In fact, we have been driven by internal debates, which are now finally, it seems to me, coming to a close.

So I would like to say that even though it was possible to underline the unity, I think what is important about the Barcelona conference is that it’s opened up a new space for people who want to talk outside of the box of conventional international public health logic, which unfortunately, has not proven effective in any case at stopping HIV transmission and HIV deaths.

So the biggest rebuke to optimism here or to self satisfaction with what we’ve done so far, has to be HIV incidence and AIDS mortality. That the numbers have to tell us we have to tell us we have failed miserably at our tasks. And now we can open up a new space for asking, again, how can we provide a continuum of care under adverse conditions? Because these are the conditions in which people live with HIV, live and die. And they are also the conditions which generate risk for others.

My own remarks this morning were to present a modest project. But again, we didn’t want this to be a project that generated a lot of international commentary. That’s not why we did this project. We did this project in Haiti to respond to local demands for equity and access to care.

It is somewhat shocking to me to find seven years after the development of more effective therapies, no real evidence, big evidence of mature like pilot targets from across the most effective continent. It is very difficult to find them, because they don’t exist yet. They’re just now being born.

In Latin America, we find in one of the Latin American powerhouses, Brazil, economically, certainly can call it a developing country, but an economic powerhouse, the ninth largest economy in the world. With breaks internal inequality is inside, still, in spite of all this, has managed to put in place a comprehensive, accessible, national HIV program.

And I think that a lot of other places want to follow that example, even countries with less than a tenth to the GNP of Brazil or regions with less than a tenth of GNP of Brazil, still want to follow the example for lots of reasons, some of them related to evidence, and others related to the whole equity concept that I think is central, not just to what – how we should respond effectively, but to how we are – reduce risk for new infections.

MALE SPEAKER: Thank you. We can follow Paolo Teixeira and then we open the floor of questions.

Paolo Teixeira has been explaining the experience of Brazil, that is well known, but that he has also provide different approaches on how to facilitate access to drugs from a political to an economical point of view. So Paolo –

PAOLO TEIXEIRA: Thank you very much. I was supposed to talk about program implementation and scaling up. They asked me to talk about this, but it has been a little bit difficult.

In fact, considering the situation in developing countries and poor countries in general, you have few initiatives to scale up. You have to start in the majority of the regions in (MS?).

So will be broadening to (MS?) that strategic plan. It’s – this is not the case now. So I decide to present the results of the Brazilian experience, trying to take in lessons and learn, and to present as recommendations, and then from some messages.

First, to say, (MS?) the universal (MS?) that we signed many times by all our governments in the U.N. assemblies, the special assemblies and the (MS?) team like that. We don’t need a model. We just need to make people to have a right to life (MS?), right to hope, and right to be what they are, drug users and sex – prostitution and so on.

And I think that we are not facing the discussion clearly, particularly in our conferences, in our meetings. Certain governments, our main message is one, we expect accountability and the good use of international funds or in order – otherwise, it will be impossible to mobilize international funds if we don’t trust in the management in the use of the money at the country level.

And we need to face this clearly and try to find ways to other countries. About prevention, it’s crazy. People, young people in particular, is beginning sex activities. Millions, millions, and millions of young people and (MS?) having sexual relations.

We cannot start to take – to discuss about postponement, advancements, hoping that this is real with the present world we have. This is the present. And this is (MS?) that the – as have been said, that they’re the biggest nation in the world, like United States, adopted this as our political or official policy. This is not – this a big and very risky mistake.

About international – and another thing about countries. I think that you have to admit that our countries, developing countries, has not take the commitment, the minimal commitment necessary to mobilize international funds, international funds, and will have to seek clearly the project fund for the global funds, the majority, more than about 60 percent did not have access to (MS?) treatment of people.

More than 340 projects coming from Latin America, (MS?), Asia, (MS?), there was no requests in 60 percent of them to make treatment available.

In all the meetings, we hold all our governments saying about treatment, about our – so you have to face these more clearly. And to the international committee, just one thing. If everybody agrees that we have to treat people, and I think that’s enforceable to discuss this (MS?), somebody have to pay the account.

Poor countries just don’t have money. Poor people just don’t money. The rich countries are rich because they concentrated the weakness of the world.

Part of (MS?) that comes from the poor and developing countries. So we expand to United States, Japan, and the Western (MS?) have to pay the view. There is no exclusion. There is no other way. We’re not – we weren’t talking about pledges that were $300 million or $400 million or less than this for Japan, for example, $150 million. It’s nothing compared to the potential possibility of Japan.

And about the last, we received a lot of (MS?) HIV people. That wasn’t to us (MS?) from Africa from America. And the people (MS?) and professional, asking us to donate drugs to sell them at low price, etcetera, etcetera.

And a lot of pressure from (MS?), and particularly for those two start the export and so on.

And for these people, I have to say, we cannot replace their government. We’re trying to make everything we can at the international level, at the national level, at the WTO, at – with our population projects, but we cannot replace their governments.

So these are the messages we want to send. Okay?

MALE SPEAKER: Thank you, Colin. Questions, please?

EMMA ROSS: Sorry, Emma Ross from the Associated Press. I’m sorry if I missed a little at the beginning, but talking about himself as being born in Barcelona. Can you expand a little bit about what is the consensus?

MALE SPEAKER: Let me ask not a rhetorical question, but why is it do you think that 60 percent of the proposals that came into the global fund didn’t have a treatment component? Is it because people in those countries don’t want treatment? Is it because people living with HIV in the poorer countries so well, it’s not cost effective for us to include a treatment component?

I don’t think so. I think that came from our community. I think advice on what to include and what to not include did not – it came from our community of international public health and medical community.

So that, I think, is a symptom of the kind of lack of consensus and just go into the, you know, go into the medical journals there, the international medical journals, the public health journals, and see the raging debate in there this past few months. And you’ll see that there is consensus.

So actually, again, I feel very privileged to have been afforded this kind of access to make the argument that it’s not possible to parse apart prevention and treatment. You can’t do it without serious harm to your prevention activities. And it’s not possible. It’s also unethical. It’s not sensible. There’s a million reasons for not doing it, but that’s the (MS?) that’s just being born, it seems to me here.

In Durban, for example, it was a big debate, it seems to me, in Barcelona that some irreversible steps have occurred, that will not make it very difficult to go backwards. I’m not on the technical board of the global fund, but Paolo is. And you know, and you know to have people like that on the technical review board, it means a great deal to those of us working in the field, having to deal with the everyday complications of the longstanding HIV infections.

If we don’t have the tools, we can’t do the work. If we don’t have the operations, we can’t do the operational research. And that’s where we are right now in the poorest communities. We don’t have any clear guidelines, based on years of experience with big, scaled up projects in the poorest communities. They don’t exist.

MALE SPEAKER: Thank you. The back?

MALE SPEAKER: My question is in Spanish? (MS?)

MALE SPEAKER: Well, about the considerable international laws, it will be ethical for developing countries start to produce. I have to say that in Brazil experience, the national production has been the key element to make – for seven years consistent and achievable our program.

There is, on the national production, first, we make (MS?) the (MS?) 80 percent. And we start to use our capacity of production to negotiate with companies. We are not interested in just producing, to be a big producer. We need good prices.

But we have the capacity. And our capacity is a kind of (MS?). But any time you talk in (MS?), some pressure from other governments about what to do about this, we have had a beautiful movement where international movement last year.

And I think that we got a lot of our results making more flexible the troop’s agreement related to drugs. But I’m a little bit frustrated because after two years, I did not see – not only one initiative beside the existence before in – about some kind of strategy.

I mean, I don’t know about any country that decides, except the Brazilian (MS?) transfer technology of production for free. I did not see any country trying to adopt (MS?) under the (MS?).

So I understand that we have to be clear. Of course, you have many (MS?) of international theory. And we are trying to face. And we are trying to fight this. And I think that with the international support, we get to have international laws that allow us to comply with this test.

But we need initiatives from countries. We need governments or bilateral, multilateral or regional cooperation (MS?) and clearly decide to do something. On the other hand, it would be impossible.

MALE SPEAKER: Sorry. Thanks. Any comments?

MALE SPEAKER: I would just add one thing. There are some countries that are highly affected by HIV, who will not likely develop a lot of production capacity. And they should not be made to suffer.

And looking at – I’m – as a clinician, somebody who’s providing services, I want to be spared all the details about drug quality, about drug levels, about testing. I – you can only know so many things. And yet, that’s exactly where we are right now. We’re in the middle of our inside of our project. We have to say, well, can we please get some data on the X, Y, Z drug from X, Y, Z company because we – it will be a big mistake, I think, for the global fund to mandate or other people who support solidarity in prevention and care, it’d be a big mistake to mandate that we get our drugs from any certain type of company.

Like for example, obviously I’m saying we should not be forced to buy our drugs from the big pharmaceutical companies. We should be forced to choose, based on the quality of the drug. That’s our allegiance to our patients. And I speak, I think, for nurses and community health workers. That’s what we care about as providers. And I think that’s what families and obviously, that’s what people living with HIV care about. They want safe, non-toxic and effective drugs available widely.

Myself, having been working at this convention for a long time in a setting where there’s not reliable local production, we use generic drugs to almost all of our patients. I’m not talking about HIV. I’m talking about a full service facility like ours. We buy generic drugs, high quality generic drugs from Europe.

And the Haitian government does not ever give us a hassle about these imports. They want to see, as the point has been made, a lot of ministries of health want to see their population better served. They want to see good, high quality medications being made available.

What we need is the powerful to protect us, to do this work, and not leave everybody shaking about well, what will be the response from the powerful industries or the powerful – the business community or whatever it happens to be called?

That’s where we are right now is we have to worry all the time of what will the powerful say about our efforts to serve the poor? And that’s, you know, that’s where again, we need allies, I think, in the – my card says no country selected. And that was kind of an accident, but we need allies in the wealthy countries, to help us with this problem.

FEMALE SPEAKER: (MS?) HIV education prison projects. We’ve heard a lot about prevention and access to care for populations that are impoverished. And as you probably know, many of impoverished people are incarcerated in many of these different countries. And the HIV prevalence rate is very much higher in prisons.

I’ve heard very little at this conference about inmates and their concerns, access to treatment, access to prevention. And I’d like to know about those. 60 percent of recent releasees from South African prisons were found to be HIV infected. And 20 percent of HIV infected populations in the U.S. go through prisons every year.

So I’d like to hear from Brazil about what’s being done about inmates? Do they have access to care and perhaps Paolo could address, even though he doesn’t want to take this country affiliation, what the U.S. is doing about prevention in prisons?

PAOLO TEIXEIRA: Well, I hesitate – okay, I made a very brief statement on that, saying that this is one that we government, Brazilian government, will come to have with a group of (MS?) that are inmates.

We are trying for many years to introduce prevention measures and treatment. And officially, they have access to distribute condoms, to distribute materials, to distribute AIV. But they have to recognize they don’t receive the same quality of care or prevention access that – than the population in general. This is true.

And is the cause, the (MS?) is providing developing country a big problem, a big problem in all the sense. There is no condition of life, of food, of – no place to sleep. And generally, are involved with internal corruption with – is we did not get go on this.

And I think we will all (MS?) when the system in general is reviewed in our country. There are good – big example of a good preventions in prisons. And one of the most important for us (MS?) is that (MS?) in Spain because they succeed to take into prisons, even (MS?).

I need to maybe accent (MS?) effect. It’s necessary to have a co-agitator to make this. And we are trying to interpret this element. But I don’t know about the United States. I’m talking we know particularly about Switzerland and Spain that are in our point of view like (MS?) on the sense.

MALE SPEAKER: Paul?

MALE SPEAKER: Just one word, Andy. I actually came here from Haiti via Siberia. So – which is not a trajectory I’d recommend to any of you, but because of working in a prison there. And it’s very interesting, the United States finally got a run for its money in terms of high rates of incarceration.

We’ve always been the world leader, the world Olympic champions of imprisonment, the United States. I think now we hit 708 per 100,000. You’d know the figure, I think, better than I. Among African-American men, that figure is scandalously high, and many times higher, by the way. I’m not sure the result this year, but it promises to be spectacular.

Russia experienced between 1990 and – 1989 and 1991, the rates of incarceration doubled. So from Soviet Gulag times to now, they actually more than doubled. And they got close to the United States level – about 700 per 100,000.

So the difference is we have so much money in the United States that we could just keep throwing money at the problem, which you know, I think the – I may have gotten this from one of the journalists present today, the figure to make Reiker’s (MS?) Island – to respond to the outbreak of TB on Reiker’s Island, which is HIV associated, $114 million we spent on one prison.

So our response is then to sink more money into incarcerating, and into incarceration. And obviously, this is not the way to move forward the HIV or public health agenda.

We have to, in addition – this is the hard thing about this work, I think, is we have to work on so many levels at the same time. And I’m sure your experienced on Rhode Island has taught you the same thing.

We have to not only be interested in the clinical issues of the patients who are in and out of prison, right. They go back and forth. Brazil may be having trouble because of post release care. With all the good will in the world, if the prisoner is transferred to another prison, to another jail, or is released and lost, the care cannot be good.

So you have to worry about the clinical issues, the systems issues, and also penal reform. This is like right back to we have to worry about drug quality, too. So the clinicians, the doctors and nurses and social workers and (MS?), that’s what they often are in Russia, have to be concerned with penal reform. That is finding new ways to non prison related ways. Otherwise, these epidemics, especially in countries that do not have $114 million to throw at one prison, these epidemics are going to be prison seated and move out into the community rapidly.

And we learned the hard way in New York that New York had a billion dollars handy. And I don’t know other cities in the world, certainly Paris, you know, London. But you know, even in fairly affluent city, I can’t say that today, like Rio de Janeiro, identify to this.

They had a terrible time when they had these outbreaks. And I think every city in the world is destined to this if something isn’t done. So A, think about harm reduction. And B, think about penal reform in the light of infectious work.

And it’s very hard to link all these things together, but I don’t know any way around it.

MALE SPEAKER: Micro, please?

MALE SPEAKER: Dr. Farmer, you said in your speech that our leading medical journals are devoid of reports of treatment projects in Africa and so forth. Why is that so? Is it because academicians and clinicians in the field are not writing up their experience? They’re not conducting studies? Or is it because editors are rejecting them? Why is it the case?

PAUL FARMER: Well, my own belief on that, I don’t think it’s because editors are rejecting it. I don’t think so. I think that their problem is multi level.

The first problem is that the projects don’t exist. They’re not donor supported treatment projects. They’re patient supported. And I mean, I have heard horror stories from African capitals that I will not name in which patients, in order to have access to antiretrovirals, were asked to show that they could pay for them, even a modicum.

And then what happens inside a family where mom is infected, dad is infected, and three kids are infected? And then they say, okay, now choose one person in the family to receive therapy? Who wants to write that up? And that is very much the – across – there is no African capital, there is no Latin American capital where these drugs are not available on the open market.

From Kampala to Ibijon (MS?) to Port Au Prince, which is considerably poorer, I might add, probably than any of the – certainly any Latin American – all the drugs are available. Probably 10 of them are available on the market.

So I think one of the reasons that we don’t have the ports is because well, I’ll just speak on a first person. We haven’t been able to get funding partnerships in (MS?). And on the grounds that I’ve already mentioned that it was considered not cost effective to implement a project like this in a place as poor as Haiti.

So I don’t think it’s because of editors rejecting good manuscripts. I do think, though, if I could seize the floor one more minute, that the burdens of proof that are placed, and I think with reason, in our academic journals, the burden of proof are very high. And they’re designed then, so that places like Bethesda or Paris or – can generate. And of course, English is problem, too. That is they are mostly in English.

They can generate the research, but places where you’re having to deal with stock lots of food and no electricity, it’s very difficult, I think, for them to develop the manuscripts and the methodologies.

But I don’t think it’s because the editors have some conspiracy against research in these areas.

MALE SPEAKER: My question is directed to Mr. Teixeira. I hope I’m pronouncing your name correctly. The sub Saharan Africa region is said to be – the magnitude of HIV and AIDS infection is quite pronounced. And I was just wondering out of the 10 countries that have been spot out in your speech, as well (MS?) to go into to help with HIV/AIDS treatment include countries in the sub Saharan African region? If not, is there anything in the long term or in the near future that you hope to have on the (MS?) for the region? Thank you.

PAOLO TEIXEIRA: First, yes, of course. And we have (MS?) sub Saharan Africa and some of the countries (MS?) to decide to start the same projects.

And secondly, you will have to recognize this is a very limited contribution, but the demonstration potential of this kind of initiative, we now understand, can be a good contribution.

And third, it’s very (MS?). We are trying out with this kind of project, to mobilize more international funds from other donors to associate with us and expand each one of these projects in the near future.

MALE SPEAKER: Last question, please?

MALE SPEAKER: Hello? I guess this is a question to Dr. Farmer. I think it was Dr. Casabone (MS?) that said at the beginning of this conference that this was going to be the grave of the debate between prevention and treatment.

And I was wondering, Dr. Farmer, if you would pronounce it dead? Or are we perhaps living in some kind of bubble here and that this perhaps the wishful thinking of the converted?

MALE SPEAKER: Just to clarify, I didn’t try to say that. Say that apart from the theoretical dilemma, I think the session today, if it was not clear enough, has put on the table that apart from prevention treatment within global development to be able to implement effectively, both of them. No?

So I think we should include the global development issues in the discussions (MS?) from prevention and treatment as well.

MALE SPEAKER: I think the debate is never going to die. And that’s okay, because there are real issues, in terms of setting priorities, in terms of – for example, if you have a weak healthcare infrastructure, there are some things that are easier to do than others.

We know this. And a group like ours has never contested this reality. Our group has always said, sure, we will – you know, let me give an example. We would never encourage the cash strapped Haitian ministry of health to start buying in great numbers antiretrovirals. We never did.

And we weren’t about to. They have other problems, which even outstrip this one. And so, setting priorities is a very, very poignant dilemma for every group working with us. Two problems, HIV and poverty.

So I don’t think that that debate will ever die. What I think needs to die is confident statements, usually almost exclusive in my experience, from the rich world about what can and should be done to, you know, to – with the fates of really now tens of millions and hundreds of millions of people.

I don’t think that we should do that. I think that we should leave a lot of margin inside our community. Again, a community of – that includes public health practitioners and academics. It’s a broad community, activists, people living with HIV who are activists, who are academics, the list goes on.

In our broad community, we need margin and space for these debates, but it’s what we’ve been struggling against in our own work in Haiti has been really dismissal from major and appropriate partners, funding partners.

They just – you can’t do this. It’s just – this is too poor a place to do this. There’s no healthcare. And I think that needs to be undone. And that I think this – the (MS?) on the conference for me, that’s what it means most to me is that there’s more space to say this is not an acceptable response to a growing problem.

MALE SPEAKER: Thank you very much. And we close this session.

(applause)