DREW ALTMAN: The report that we’re releasing today – which I hope you have before you – provides a comprehensive source of information on what we know today about HIV and young people. And I’m going to highlight just a few of the findings – you can look through the chart pack or you can follow the Power Point, which I think is easier to see than the ads were. Let me move very quickly to just a couple of central numbers. But first of all – and the first main point I want to have in everybody’s head – is just that HIV is an epidemic driven, not entirely, but substantially, by young people. And that’s what you see in the first chart. Over half of all new infections in 2001 – 58 percent – were among children, teens, and young adults under 25 years of age. Four in ten, 15 to 24 years of age; 16 percent under 15. Basic point of message: A youth-driven epidemic. The consequences of this for young people are pretty startling, and they can be seen in the second chart. Almost four in ten people living with AIDS at the end of 2001 were under 25 years of age. Of course, in sub-Saharan African and other parts of the world where treatment is not available, we know what the outcome of that grim statistic will be.

Where are these young people, and who are they? You can see that in the third chart. Not surprisingly, most are in sub-Saharan Africa; the majority are young women and girls. So, a youth-driven epidemic; young women and girls. In some countries, the proportion of young girls living with HIV is – I don’t know what word to use, other than shocking, and you can see that in the fourth chart. In Botswana, 30 to 45 percent. In South Africa, 21 to 31 percent. In chart five, I highlight an important factor that I think does not get quite enough attention. It is that, in many hard-hit countries, the population is also disproportionately young, really disproportionately young. And so, it is this combination of high infection rates among young people and the more youthful populations in many hard-hit countries which really creates and explosive and problematic situation, and the kinds of projections I’m going to be showing you in a minute. And the populations in these countries, by and large, will get younger as the middle parts of the populations, unfortunately, are lost due to AIDS – what some people call the “HIV youth bulge.”

Third point: It is also the combination of these two factors – high infection rates among young people, more youthful populations in hard-hit countries – that leads to these two, I guess I would say unfortunate and troubling and new projections, that are part of the report, one of which we’re releasing today. You can see the first one in the sixth chart in your pack. Estimates are that there will be 13 and a half million people between the ages of 15 and 24 living with HIV at the end of this year. Projections now are – these are new projections contained in this report – that if we do not act, if we don’t find a way to change the trajectory of this epidemic among young people, there will be 21.5 million young people between the ages of 15 and 24 living with HIV just by the end of the decade, in 2010. And again, if nothing changes, this will lead to a staggering number of deaths among younger people. And you can see that in the seventh chart. More than 21 million 20 to 34 year olds will die in the 50 hardest hit countries between 2000 and 2010. So, more than 21 million just over the decade. And most, of course, as you know, were infected at younger ages. UNAIDS estimates eight to nine years between infection and death in sub-Saharan Africa. Again, my point earlier about youth-driven, young women and girls: 60 percent will be women.

And so, these numbers show why youth prevention needs to be a top priority in the fight against HIV, and they also show why we need to get much more serious about taking the existing prevention programs for youth to scale. There are many great programs, you see them highlighted in the reports, but most are small. There are very few large, comprehensive programs really with the ability to impact an entire epidemic. I believe we need to get about the business of developing a whole new generation of youth-oriented HIV prevention programs that are youth-friendly, that work with young people, that in fact are driven by young people themselves, and that is why we are highlighting the LoveLife Program today. It is the world’s largest and most comprehensive and, some would say, cutting-edge HIV prevention program for young people. That is why UNAIDS calls it in its report “youth prevention on a national scale,” which is precisely what it is. It is a powerful combination of a nationwide media campaign and services for youth, with an upbeat message about positive lifestyles and responsible decision-making. It is a program that builds on the hopes and aspirations of young people, not the fears of young people. And I think the other point I want to make about it is -- it is also living proof that large-scale, major league public-private partnerships really are possible. Every time I hear that word I kind-of recoil in horror because it’s a warm and fuzzy word – “public-private partnership” – that seldom means anything real. It is profoundly real in this sense, and unique, because LoveLife is a partnership between U.S. private foundations – Kaiser and Gates Foundation, which is a major funder – leading South African NGOs, including LoveLife itself, which is an NGO; the South African government, which is a full partner in the LoveLife program; and South Africa’s largest media corporations, which are central to LoveLife as well.

So, with that as an introduction, I will turn you over to Dr. David Harrison, who is the Chief Executive Officer of LoveLife, to tell you more about the program. Let me just say that it is certainly – and David will say this, too, but I want to say it clearly – it is certainly too early to claim victory or success for LoveLife. But the early evaluation results – and there is a serious commitment to evaluation of LoveLife – are incredibly encouraging and do validate that the program is certainly on the right track and has tremendous potential to achieve its goals. David.

DAVID HARRISON: Thanks very much. South Africa’s LoveLife program is one of the few programs in the world that really has few excuses for failure. We do have a high level of political support. Even today, the presence of Dr. Nono Simelela and people from the Ministry of Education. We also receive substantial funding from the Kaiser Family Foundation, the Gates Foundation, and the South African government, funding that has enable LoveLife to achieve a scope and a size that is really unprecedented in South Africa. Not enough, I might add, to sustain the program for the next five years, but certainly a significant starting point to lay the foundation. And I really want to make three points today: that LoveLife is a targeted prevention program for young South Africans; that projections point to high returns; but that it is early days. We seem to be on the right track for significant change, if indeed we can sustain that momentum.

As Drew has said, South Africa, like many other countries, shows that young people are the people who are most at risk, and that young people are (MS?) in this epidemic. The highest rates of new infections for girls is amongst the 15 to 20 year age group. Look at that large blue bar showing that about 25 percent of new infection occurs in 15 to 20 year old girls, with boys starting to peak in the 20 to 24 year age. This is what’s driving the epidemic upwards; this is what is sustaining it, even if incidence rates are beginning to flatten, even if prevalence is beginning to plateau. We still have this underlying fire that is sustaining the epidemic.

That’s the bad news. But if we can stop successive cohorts of young people from getting infected, we will starve this epidemic of its oxygen. We will put a stop to some of the major drivers of the epidemic. What I want to demonstrate here is that South African young people are still at considerably high risk. This is the risk profile at the very top, the percentage of young people who are most at risk, having multiple partners and partners never using a condom. This is sexually active young people. Those at the bottom are those that (MS?) are at least risk. And you can see that our curve is still highly skewed towards high-risk sexual behavior. On the one hand this is bad news, but it’s obvious from the HIV infection that the underlying causes are high-risk behavior. But also, if we can bring about a moderate shift in this graph, if we can bring about a moderate shift from high to medium risk amongst the significant proportion of our population, we also substantially change the course of the epidemic.

And so the question was, if young people are driving the epidemic, if we have to get across to young people, how do we do it? And when we had a look at the situation in South Africa, we saw that we had very high media penetration – 99 percent access to radio, 75 percent access to television; a relatively sophisticated advertising environment; and a high degree of brand loyalty, brand association. Put simply, we were competing for the attention of young people with Diesel, Gish (MS?), Nike, and that was the headspace that we needed to occupy. Coupled with the fact that many of the predictors of sexual behavior are lifestyle factors, those related to coercion, to peer pressure, to transactional sex, and to a sense of pessimism. So LoveLife was constructed as a new lifestyle brand for young South Africans, combining high-powered media, on the one hand, with a nationwide service delivery program. Media, using multiple-reinforcing media platforms, television, radio – (MS?) Television, one of our stars and one of our television programs, Mayam (MS?) is here with us today, she may speak – radio, we have partnerships with about eight different radio stations; advertising on billboards and taxis to position the brand and provide a contact number for our toll-free help line. And our print publications are the two largest publishing houses in South Africa.

But media, we know, is not enough, unless it is really integrated with services for young people so that there’s an active engagement with this positive lifestyle that we’re speaking about. On Sexual Helpline for Young People, we take about 20,000 calls a month from young people. The LoveLife youth centers around the country that provide regional hubs for many of our activities, really epitomizing the positive lifestyle that we’re trying to communicate. Working with NGOs through the LoveLife franchise, trying to mobilize grassroots-based organizations. Some of the young people you see here today are part of the national volunteer service called “Groundbreakers.” Trying to get young people be the (MS?) of LoveLife within their communities. At the heart of our service delivery, efforts of the international (MS?) clinic initiative, which is really aimed at making clinics more friendly to young people. All of this supported by outreach: the LoveLife Games, the biggest inter-school sports program in South Africa; the love tours, which are radio (MS?) broadcast units, and the love train, a big purple train. None of these on their own are enough to affect behavior change, but hopefully, in the context of this national brand, a growing national brand equity, and providing services that young people can really feel, we believe that we have the prospect of achieving behavioral change.

The projections point to high returns, if we get it right. What we’ve done here is just try to model some of the incremental changes in behavior over the next five years. The blue line shows where we’re at today with respect to these behavioral mediators. The rate of the (MS?) showing where we hope to be over five years. And I’d just like to illustrate a couple of points. That, even if we track a single cohort of 15 year olds and we expose them to the intervention for the next five years, and then stop that intervention, and assuming that behavior patterns over time are not necessarily sustained all the way through, we can see – this is the impact on girls – we can see that even for the single cohort, there’s a significant proportion of infections that can be averted. Now, this modeling is done on behavior change that has been accomplished in other countries. Now this is not pie in the sky. This is based on the experience of Uganda and other countries. What is feasible over a relatively short period of time? Similarly with males – as you can see the curve for males peaks later – but also, about 20 percent of infections in that single cohort can be averted if we can achieve those changes in behavioral mediators.

But if we can do better than that, if we can, in fact, beat the deadline – in other words, instead of this incremental change over five years, achieve even faster gains in two or three or four years, the impact is compounded. The number of infections averted increases dramatically. Hence, the need for a comprehensive, national, high profile, sustained program that really gives the biggest bang for its buck in the shortest possible time. That’s our challenge. It’s early days, but we seem to be on the right track. This is at the end of two years of LoveLife’s existence, November 2001. Sixty-two percent of young people knew of LoveLife. And, of those who knew of LoveLife, about three-quarters said that it made them thing about sexual choices, that it was different, that they were interested. Seven out of ten said that it reflected young people’s aspirations and lifestyles. Almost half of all South African teenagers, or 75 percent of those who know of LoveLife, said that they have taken some direct action as a consequence of LoveLife. And that action that they’ve taken is mainly talking to friends, family, and others about LoveLife, about lifestyles, about sexuality, or looking for more information about sex and sexuality.

Parents, too, say that LoveLife has had an impact. This was a survey conducted before our major parent campaign earlier this year. Only 41 percent of parents knew of LoveLife, but four-fifths of them said that LoveLife had provided them with an opportunity to talk more frankly with their children about AIDS, and 71 percent to talk more openly about sex. Young people who are exposed to LoveLife – and these are self-reports, and I’ll come back to some of the qualifications of self-reporting – but young people are saying that LoveLife has caused them to be more aware of the risks of unprotected sex. Two-thirds said they talked to their friends more about sex, sexuality, and relationships. A full two-thirds say that it has caused them to delay or abstain from sex. And this effect is even more marked among sexually active young people. Four-fifths say that they’re now consistently using condoms when having sex. Seventy percent say that it has reduced their number of sexual partners.

We’ve tried to compare those young people exposed to LoveLife and those not exposed to LoveLife with respect to whether or not they reported having changed their behavior as a result of HIV/AIDS. Fourteen percent, a statistically significant difference, between young people exposed to LoveLife, reporting that they are more likely to have changed their sexual behavior.

This is tentative data. It’s early days. But we don’t have the luxury to wait for five or ten years to look back and decide whether we’re effective. We need to poll them (MS?) evidence of success. Our goal is to halt the rise of new infection of HIV within five years. That’s our goal. And tentative evidence suggests that, if we can sustain and build on this momentum, LoveLife has got a real prospect of achieving that goal. Thank you very much.

NONO SIMELELA: Thank you very much. I won’t be long, but just to make two or three points on the impact of HIV among the young people in our country. I think what has been extremely comforting to us is to recognize that over the last three years, the annual HIV (MS?) that we conduct has shown that the less than 20 year old in our country have had no increase in prevalence since 1998. That for us, we know, that internationally (MS?) this is the closest that you can get to defining incidence. So we are aware, even outside of the survey, that young people are heeding the message. An independent survey that we conducted with Commuter Net, which is one of our partners, where we surveyed young people in the trains, at the bus stops, taxi ranks, does show that over the last three years the behavior change has occurred and is being sustained. We, in the 1998 demographic health survey, recorded less than 20 percent condom use in the less than 24 year olds. But the latest survey, conducted in November 2001, shows that there was almost a 57 percent condom use, which is corroborated by the research that is conducted by LoveLife, among the less than 24 year olds.

What the government seeks to do, though, is to locate this program within the context of the broader strategies that are currently going on in the country, the moral regeneration, which is critical for the older generation to support the interventions among youth. The behavior change we’re talking about is not just behavior change for young people. It’s behavior change across the board. We want, as adults, to stop seeing young children as an HIV infection about to happen. When I see this young boy here I must see a potential leader, a potential president, a potential astronaut, not a potential HIV infection. And that’s a mindset we need to change in the adults of the population to support our children. The behavior change we are seeking is in parents, to start talking to their children. The behavior change we want to see is in couples, older parents, talking to each other about safer sex. The behavior change we want to see is in the political leadership. The behavior change we want to see is in the priests and the pastors embracing issues of sexuality. And we’re seeing all of that happening in small bits and big bits, but we’re happy to see young people in our country starting to drive the responses. And defining to us what they want to see happening for themselves. And we’re happy to see this change and this declining prevalence.

And, in the context of partnership with LoveLife, with other players in the country, we’re excited, but we want to do what David is saying – sustain this wave of optimism, of hope in the young people in our country. That way, we will be able to stop this epidemic. That way, we will be able to create a future for our children in our country, which we hope will not stop only in South Africa but will spread through the region and the world as a whole. So, we’re happy, and I want to salute the young people from South Africa and say to them, we’re here, behind you, supporting you, we’re proud of you, and we will be there all the way. It is our responsibility as parents, our responsibility as leaders, to ensure that the democracy you won in that country, through the blood of young people, is (MS?) into your future, so that you drive South Africa beyond what it is today to something else. That’s (MS?), to see you people, coming to forums like this and driving the discussions, not just sitting and witnessing while other people are trying to define it for you.

DREW ALTMAN: Thank you, that was absolutely wonderful.

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DREW ALTMAN: A major funder of LoveLife, from day one. It is a cutting-edge program, and they deserve credit for doing that. They are leading, and Helene is leading, in so many ways in the global fight against HIV. And, also, there was this big event that Dr. Gayle happened to be involved in this morning, and I think we should all congratulate her on her plenary address this morning, which was just wonderful.

HELENE GAYLE: Thank you very much, Drew. It is my pleasure to be here today, and it’s also our pleasure from the standpoint of the Foundation to be a partner in LoveLife. Let me just start by once again thanking the young people who are here. I’ve had the opportunity to come out to South Africa and visit the LoveLife program, and it’s really a unique experience. It is a wonderful program, and having young people at the center of finding solutions to this problem is critical, because, as I think the previous three speakers have said, it is – what happens in young people is going to determine the shape of this epidemic. So, I applaud you, I salute you, I hope maybe one day I can be an honorary groundbreaker myself. It’s a wonderful, wonderful effort.

I’m just going to say a couple of things. As Drew mentioned, I talked this morning at the plenary, and I talked about several things. One of the things I talked about was where prevention is going to go in the future. But I also tried to make the point – and we’ve made it in the global prevention working group report that was released last week that the Gates Foundation and Kaiser Family Foundation convened – that there is so much that we can do about prevention today, now, with what we already know. I think that the LoveLife program is a wonderful example of taking what we know works, and taking it to scale, so that you can have the impact in the short run, but ultimately in the long run, of reducing the number of new infections. We estimate 45 million new infections will occur in the next decade, by the year 2010 if we continue doing what we’re doing, that may mean more than 20 million new infections in young people. But I think the corollary to that – and this is from the Lancet paper – is that if we scale up what we’re doing and really massively increase our efforts, we could reduce the number of new HIV infections by over 60 percent. And that particularly has an impact on young people. I think the data that David Harrison showed, where the epidemic in young people highlights the importance of focusing on youth in all of our efforts, in everything that we do.

I think another example that LoveLife demonstrates, besides taking what we know and making it work, another point that we tried to highlight in the working group report is that there is no one intervention that is going to make a difference. This is a result of having an integrated approach to prevention; the combination prevention approach, where you hit risk behavior in multiple different ways that we’re going to have an impact. LoveLife is an outstanding example of taking what we know and putting it in combination. It has a media approach. It has a services approach. It has youth empowerment approach. So it really takes all the things that we know make a difference and puts that together and integrates that in one program. So these are the kinds of efforts – the combination prevention approach – that we know will make a difference.

Another aspect that we talked about in the working group is looking beyond individual level behavioral interventions, changing individual behavior alone, and looking at societal issues. We know that one of the things that drives people’s willingness to change behavior is a sense of hope and hopefulness, and a sense of the future. And the LoveLife program takes that concept and gives young people a sense of meaning to their lives, a sense of hope and a sense of future. So, again, it’s one of the ways in which LoveLife brings very concretely the sense of increasing social capital, increasing the sense of hope and for the future. It really has made a difference, and, as Drew has said, I think one of the most cutting-edge programs worldwide, not only for youth but for prevention in general. So thank you.