ALLEN ROSENFELD: Today, we’re announcing what we’re calling the MCTC-plus initiative – a program of care and treatment focused on women. This is funded initially at a level of $50 million by nine private U.S. foundations, who developed this in response to Kofi Annan’s call to action a year and a half ago. This program will work alongside of and in collaboration with a global fund and other initiatives. We are building on the pioneering work of the Elizabeth Glaser Pediatric AIDS Foundation, UNICEF, MSF and others who have been supporting a rapidly expanding network of PMCT sites throughout resource-poor settings, to help in the decrease in the transmission of the HIV virus to their infants during pregnancy.

The history of this initiative - some 15 years ago, I was asked to give a speech in which the title was “Where’s the MNMCH?” And it was looking at the focus of maternal and child health programs, which heavily focused on children and led to initiatives focused on maternal mortality. In Durbin two years ago, I was invited to give a speech in which they assigned me a title building on this earlier talk, “Where’s the MNMTCT?” The MTC, PMTC programs have been remarkable in what they’ve been accomplishing, but I think all agree – to lay the foundation, UNICEF, MSF, that in addition to preventing transmission to children, we need to begin to treat women themselves.

We’re hoping through this program to treat the women, their HIV-positive children, their HIV-positive partner. This is a family initiative, which we start by focusing on women. And I should add, because we’ve been questioned, we think it would not be ethical to ask HIV-positive health workers to embark on a treatment initiative without making treatment services available to HIV-positive health workers as well. This is indeed a family program which will provide prevention and treatment for opportunistic infections, and antiretroviral therapy where indicated. We hope we’ll have some lessons that will be instructive for the larger programs funded by the Global Program, the World Bank, bilateral agencies and many others, as we begin to initiate treatment programs responding to Kofi Annan’s call that we really can no longer ignore 40 million HIV-positive people who have not to this time had access to treatment.

I would like to introduce our panel one by one, who will make statements, and then we’ll be open for questions. Dr. Waffa Alsada is a physician, an internist, has been the Director of Infectious Disease and AIDS and tuberculosis programs at Harlem hospital in New York City in New York, and as a Professor of Medicine both at Columbia Medical School, and the Professor of Epidemiology at our School of Public Health. Dr. Alsada is the Director of the program.

WAFFA ALSADA: Good afternoon. I’m going to say a couple of words. I think we’re very excited to be here today, to announce the first pilot sites. The program will initially start at 40 sites in eight countries, seven of them in Sub-Saharan Africa.

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Establishing schools, nurturing hospitals, they include clinics and many, many other types of institutions. The goal is that this HIV care program will be able to provide some community care – not just antiretroviral therapy, but all the components of care that people with HIV need – the clinical care, the psychosocial support, the adherence support, the outreach, the community linkages – all the components of care that people with HIV need in order to survive with HIV and to stay healthy, and to remain productive families in these communities. I will stop here and take questions later on.

ALLEN ROSENFELD: I should add one component that I think is essential to all programs of this type. Once we initiate therapy, we are committed to continue therapy for as long as the individual needs therapy. This is not a time-constrained program. We hope working with a global fund that this will help us tire this out, but there is no ethical way one can offer treatment to an individual and not continue that treatment for as long as it’s indicated.

We are delighted and honored to have with us today the First Lady of Rwanda, a remarkable woman, Ms. Jeanette Khadami. Madame Khadami.

JEANETTE KHADAMI: Thank you. Thank you, Dr. Rosenfeld. Should I make my announcement now? I would like to take this opportunity to pay tribute to the personal commitment of Dr. Rosenfeld, as well as Columbia University, for (MS?) Africa and other developing countries to take care of the most disadvantaged health conditions in the world. But (MS?) approach in the fight against HIV/AIDS needs a concrete and practical long-term solutions of problems, of medical, economic and psychosocial problems which (MS?) Thank you very much for all of you. Your unwavering commitment to make the MTCT program available today and giving hope to the millions of other sisters, children and families around the world.

I’d also like to thank Columbia University for inviting me here today to participate in the launch of the MTCT-plus program, which is crucial. Not one previous program has been effective, neither to the mothers and their families. And particularly on that, that’s one that I identified among the 12 countries where the children have been left (MS?) And now I’d like to repeat the ever-shocking statistics of females and children affected, (MS?) because the statistics have been discussed in a session involving (MS?) and also because their knowledge of it (MS?)

I’d like to talk, to take this opportunity to share with you some important aspects and (MS?) which has come to know and (MS?) how essential it is to formulate and communicate that benefit from it. These aspects have been reinforced by my (MS?) project called “family package.” This package has the same goals as MCTC-plus. The program I’m working on (MS?) in two medical centers, with plans to cover the whole country.

Due to the realization and implementation of the family package, the International AIDS and organizations were at the forefront, and I take this opportunity to sincerely pay tribute to their (MS?)

It’s from this mission and experience that I would like to share with you some thoughts and ideas on the long-term benefits of an integrated family-based and community-based approach in the fight against HIV/AIDS.

In my opinion, the very aspect of this intervention program is that the children and preventative approach where prevention and (MS?) As the leader of this program, we ask these (MS?) that of mothers, includes the sisters and the little kids.

What chances of survival are we given when a newborn whose mother or both parents are infected and unable to care for the children? (MS?)

The Secretary General of the U.N., Kofi Annan, said, “we cannot and should not choose between prevention and treatment. We must do this.”

This is what the MTCT-plus program does. Another aspect of the MTCT-plus program is that it promotes the family and community approach, rather than an individual approach. Working to destroy the (MS?) of those affected in their communities. (MS?) the silence around it is huge, and the alienation of the infected (MS?) This (MS?) program has a (MS?) The (MS?) the MTCT-plus program (MS?) who are the most severely impacted by the AIDS pandemic due to their exceptional vulnerability. Ladies and gentlemen, I’d like to conclude my remarks, and I request each one of you to reflect for a moment the desperation and feeling of powerlessness of a (MS?) The MTCT-plus is the light at the end of the tunnel. Thank you.

ALLEN ROSENFELD: Thank you, (MS?)

(Applause)

We’re also honored to have another remarkable woman with us this afternoon. (MS?) from Uganda is the Executive Coordinator of the international community of women living with HIV/AIDS.

FEMALE SPEAKER: Okay. Good afternoon to you all. I’d like to speak as a woman living with HIV and from my experience of 11 years and as a mother. From my experience, I have lived with anxiety and worries, not knowing whether my first two children had HIV or not. And because of the fear and the thought that I would have no other step to take after knowing their face, after knowing their (MS?) I have chosen to live in denial of the fact that – fearing the fact that by knowing the truth, that they could’ve been with HIV, it would lessen my situation.

This (MS?) has been further complicated. For the past four years, when I started (MS?) while my husband was not (MS?) due to the complication of that (MS?) As a woman and as a mother, representing millions of women with HIV, in Africa, I live the reality of the complexity in our families and households. In 1999, when my partner eventually managed to get (MS?) there was hope in our family. The feelings of guilt and fear every time he became ill eased eventually. Over time, the situation became that of sealing another fate – (MS?) to have a child with my partner. Six months ago, I was blessed with a little baby girl, who, up to today, will know that she’s HIV-free, at least as by the last three tests.

Ladies and gentlemen, this is a wish from woman to women and men out there – (MS?) and I must say, because of my activism and because of the fact that I’m now basically okay, but I was able to have choices. Not many women have these choices. The MTCT-plus (MS?) is a hope for so many of us. It is hope for myself as a mother with HIV. As I sit in this chair, I can see myself coming out of this conference with another bold step to take – and that is to test my first two children. And I’ll do that because I can see light and I can see hope. And I would like to commend the (MS?) of this program, and I would like to commend those of us who are supporting it. And today, on behalf of women living with HIV, I want to say that we are very happy and proud, and we hope that this initiative will help us overcome the barriers and the fears that we have lived with for a very long time. Thank you.

(Applause)

ALLEN ROSENFELD: Thank you. One of the foundations supporting this initiative is the Bill and Melinda Gates Foundation. The Director of their HIV/AIDS and Tuberculosis Program is a woman known to many of you, probably all of you. We welcome the woman in her right, Dr. Helene Gayle. Dr. Gayle.

HELENE GAYLE: Thank you. And I’m going to be very brief, because I know you probably have a lot of questions, but I just wanted to be here to express our enthusiasm for this initiative. The Bill and Melinda Gates Foundation’s very proud to be part of the consortium of foundations that will be funding this new initiative, and want to really recognize the leadership of Allen Rosenfeld and Waffa Alsadar for this initiative, but also of the Rockefeller Foundation, that was really in the forefront of initiating this and getting other foundations involved. We think this is a tremendously important initiative because it really makes practical one of the things that we’ve talked about a lot here at this conference, and that’s the integration of prevention with care initiatives. And I think that this is building on the wonderful foundation that we already have in the area of preventing mother-to-child transmission. And the Elizabeth Glaser Pediatric Aids Foundation call to action is one of the leaders in this area, and Kate Carr and Janice Bier are here from Elizabeth Glaser. So we think this is wonderful, that we are building on that foundation. And UNICEF, want to recognize Carol Bellamy and others who have done landmark work in this area of Centers for Disease Control. So there have been a lot of partners who have worked on mother-to-child transmission, prevention initiatives. But we’ve gotta do more and we’ve gotta go further. And this is a wonderful opportunity to build on that, integrate prevention and care, and make a reality some of the things that we have talked about for so many years.

And this is also a wonderful collaboration, and we look forward to not only our other foundation partners, but we hope that governments will also contribute to this initiative. And this will be a real base for us to look at ways of expanding access to care, using the base of mother-to-child activities. And really developing and growing as we look at the ways that we can build – decrease gaps in access to prevention, as well as decrease the gaps in access to care that I think that this initiative has addressed and filling. So thank you.

(Applause)

ALLEN ROSENFELD: Thank you, Eileen. A good friend and a major supporter of this initiative, Sandy (MS?) the President to the International AIDS Trust. Sandy?

FEMALE SPEAKER: Thank you, Allen. I’m delighted to join our partners here today for this important press conference. MTCT-plus is vitally important for a variety of reasons, and the first is that MTCT-plus moves us from saving babies to building families by providing treatment to HIV-positive parents and enabling them to stay alive and healthy to care for and nurture their children.

Secondly, MTCT-plus is a can-do approach to finally moving the treatment agenda forward, and not a moment too soon, I might add. You know, for too long we’ve all heard that providing care and treatment to people living with AIDS can’t be done, that it’s too expensive, that it’s too complicated. But this program demonstrates that not only can it be done, but that it must be done, and at last, we’re getting started. Very, very exciting.

I’m also pleased that the International AIDS Trust has been able to work with our partners here in a bipartisan coalition and the Senate of the United States to secure a $75 million match for the MTCT-plus program. And the full Senate will consider this legislation in the coming weeks, and we have every reason to believe that it will get the great bipartisan support that this program deserves.

Now, we’ve all talked a lot in the last years about the importance of public/private partnership in the fight against AIDS. The MTCT-plus initiative puts this talk finally into action. Foundations, universities, government, NGOs, doctors, nurses, people living with AIDS have finally found a way to save lives and better lives through this initiative. And I have no doubt that it will produce impressive and very important results.

When it comes to finally being able to expand that treatment to those in need, MTCT-plus will move us from rhetoric to real action, and it builds a strong foundation for more to come. The International AIDS Trust is very pleased to be a partner in this effort, and I congratulate all of you, Allen in particular for your good work. Thank you.

ALLEN ROSENFELD: Thank you, Sandy.

(Applause)

Finally, our leader, the major figure at this meeting this year and in Durbin two years ago and before, and a good friend, Dr. Peter Piot, the Executive Director of UNAIDS. Peter?

PETER PIOT: Thank you, Allen. I’ll never forget the day, it was about ten years ago and I was visiting Uganda and TASO, the AIDS Support Organization. And one of the things I did was I met with a group of positive women. And I asked them, “What is your dream? What would you dream of?” And after some discussion, which I didn’t understand, which was not in my language, the language I understood, they come and said, “We would like to have healthy children, free from HIV.” And that was ten years ago. There was nothing we could do then. And perhaps also because I’m a man, I didn’t fully understand why that was a top priority. I’d expected treatment for themselves.

Anyway, this for me is really one of the defining moments in my own life and how I look at AIDS. I could say safely that this MTCT-plus initiative is one of the most complete results of the Secretary-General’s call to action, and of the special session of the U.N. General Assembly on AIDS. It is typically something that foundations should do and do well. It’s opening new areas, it is taking some risks, and it’s hopefully – and I couldn’t agree more with what Helene said – it’s paving the way for governments to support this fully.

Actually, the person who should sit here on behalf of UNAID should be Carol Bellamy, who stands there, because UNICEF has really been the pioneer in UNAID’s introducing mother-to-child transmission prevention programs. And so we’re very proud that we’re associated with this initiative, we will support it as much as we can. I would say that – to repeat what I said this morning when the report on “Children on the Brink.” 40 million orphans because of HIV. That report was launched this morning.

For those who are still not convinced that treatment is cost-effective, think of the orphans that will be less when you treat the mothers. And so this is really a pioneering initiative, and perhaps also a first in history, because for once, one could say that it will be women who benefit the first from a new technology, from a new initiative, HIV treatment. That in itself I think is worth mentioning. Thank you.

(Applause)

ALLEN ROSENFELD: Thank you, Peter. Let me just – before we open for questions, reiterate thanks to those that have already been mentioned – Carol and UNICEF, Kay Carr and the Elizabeth Glaser Pediatric Foundation, CDQ, USAID, the Global Health Council, one of the originators of the idea. (MS?) is here. MSF, a pioneer in the beginning of treatment as well. And to all the others who have been supportive of this initiative, thank you. And particularly, as Helene said, not only the Gates and all the other foundations, but a particular thanks to the Rockefeller foundation, who started this initiative and brought in their fellow foundations. Now, let us open for questions to any of us on the panel. Go ahead, I guess speak up.

Let me repeat as you’re going on, because I don’t know if people hear – how many women and families who’d be – will be benefited from this program – and the criteria by which they’re being chosen. Waffid, you want to take this?

WAFFID ALSADA: We estimate now that will be funding available that we will be able to treat probably about 10,000. Provide care, HIV care to about 10,000 individuals. That includes women and the families.

The second question was about what are the criteria. I mean, clearly there’s a need for much more, and there are many more women and families that do need HIV care, that we’re hoping that this is a first step, and with more resources, we’ll be able to reach more. What are the criteria? The criteria are for the women – the HIV-infected women would be identified during their pregnancy and participate in a PMTCT program. And then will be involved in MTCT-plus program. And into the HIV care activities. There are certain criteria for initiation of antiretroviral therapy and so on and so forth, but essentially, a woman who has been through a PMTCT program, and her children and her partner will be eligible to be enrolled in MTCT-plus.

ALLEN ROSENFELD: Let me just add that as (MS?) mentioned, we have been in discussions not only in our (MS?)

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In USAID, and it is our hope that there will indeed be this public/private partnership, in which the funds provided by the foundations will indeed be added to by our government and perhaps others so that the numbers of women that we will be able to provide women and families, that we’ll be able to provide care and treatment to, will be expanding as this program moves forward. Yes? Yes.

Why don’t – let me – Let me answer that, because we have made that decision. We are one – we are using protocols approved by the world health organization. I’m sorry, the question is will we be using generic drugs as well as pharmaceutical company drugs. Those generics that have been approved through the process at W.H.O. and are part of the W.H.O. protocol will be provided. And with the approval and help of UNICEF, UNICEF will be the procurer of these drugs for us and will distribute them to the sites from their warehouse in Copenhagen. And it is agreed that whatever has been approved through the W.H.O. process, we will make use of. And W.H.O. is another partner who I should’ve mentioned up front that we’re working very closely with. Yes, sir?

The question is how many family members do we estimate? To give a simple answer, a minimum of probably two, because the chances that the husband or partner is HIV-positive are very great. In many cases, the partner has brought the disease to the woman. In terms of how many children (MS?)

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As many as 35% or 40% of the HIV-positive. With the treatment now in place, that has decreased by approximately 50%. How many children may have been HIV-positive before PMTC programs were put in place, we don’t know. So let’s say on average it could be three or four, but we don’t really have the data until we’re in the field and see how that progresses.

The question is, are we gonna treat all family members? Yes. There is no way ethically we could go in and say, “Look, the mother has this child, but we’re gonna ignore the other HIV-positive children or partners in the household.” So we will treat all the members of the family. Yes.

How do we select whom we assist? We have a process we call a request for proposals. And we set out the guidelines of who would be eligible. And the basic guideline was those sites that already have prevention of maternal-to-child transmission programs in place, and that had a prevalence of at least 5% and where it was estimated that there would be, I believe, 250 women minimum per year eligible to be introduced into the program. So those were the basic criteria upon which it was built.

I should also mention, because I see him in the back, another major figure who’s been most helpful as the special advisor to Kofi Annan. That’s Stephen Lewis in the back, who has been a real supporter of this initiative, and we thank him for all he’s done.

Are there other questions? Yes? I’m sorry – first – go ahead.

I’m sorry, the what?

No, the $50 million that we currently have on hand is for the entire treatment program, the whole program that we have discussed today. It will build again on the prevention of maternal-to-child transmission programs in place. And everything that we describe will be included in the funding we have available. Yes?

There will be three sites in South Africa. Can’t predict exactly how much each site will get over the five-year period, but there will be three sites that have been selected in South Africa. One in (MS?), one at Whits University and one in Capetown.

I can’t give you an actual figure per site at this point in time. Yes, sir?

The treatment time of delivery is already under way in the sites that we’re – I’m sorry, repeat the question. How are we going to have the funds available to not only treat at the time of delivery, but to continue treatment of the whole family. First, the treatment at the time of delivery – the program’s already under way in the PMTCT programs that we’ve discussed, run by the various agencies and supported by them. We are predicting (MS?)

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would allow us to do what we’ve prescribed. It is our anticipation that we will work with the global fund, with the World Bank, with W.H.O., with the U.S. government, with a variety of other organizations over the next five years expanding these funds. And as the global fund particularly gets more and more into treatment, we assume that some of the programs in which we’ve started, they will continue in the longer term. That’s why we’re looking very closely and having discussions with the global fund all the way along, because we need to be running parallel to that. Yes?

The criteria is that one person must take place in the program that’s presently designed, and then they must be a participant in the testing to see whether or not antiretroviral therapy is indicated. In other words, CD4 counts. But let me – Waffa wants to add to that. We don’t anticipate every member of a family will be HIV-positive.

WAFFA ALSADA: Clearly, we do not want to force people to test, and clearly this is for people who are either willing to be tested or agree to be tested. We hope the availability of (MS?) which is treatment in HIV care, that there actually will be more – people will be more likely to want to know their statues, they’ll be more likely to want to know if they have Aids, because now they have the option of getting treatment for the disease. So that’s one of the real (MS?) of this program, is that in addition to the benefits that – for the people who are being treated, that this will draw in more people into counseling and testing, as well as also to other prevention programs.

ALLEN ROSENFELD: Are there other questions? Yes.

WAFFA ALSADA: Diagnostic – the question is about diagnostic status. I think, clearly for the women who are identified as being willing to be tested, to go through whatever test is provided for HIV testing at the PMTCT sites. We’ll be providing testing kits for children to identify the infants, infected infants and children. We will also be providing funding to – for some of the laboratory tests that are necessary for monitoring, from tests for immunologic monitoring (MS?) some other simple tests also. I’m going to be on treatments.

ALLEN ROSENFELD: Are there other questions (MS?) I would like to make an announcement that tomorrow at 1:00 (MS?) which is where our organization will have a press conference here. Again, thank you all for coming. We’re excited by this very important initiative. And we’re available for additional questions.