25 Years of AIDS | Dr. Peter Piot | Talks at Google

I wanted to thank. I wanted to thank everybody for coming. I think, you know, I'm Eric Schmidt, local CEO here, and this one is so important, I could not think of a better venue and a set of players than the people in the room and our two esteemed guests. Google.org is trying hard to have an impact and because of Google and because of your work, I think we have a good shot at it. I think most everybody in the room knows Larry. Brilliant. This is a person who likes to eradicate things, bad things, I should add. And in talking to it, what I discovered is if you eradicate it, it really is gone. And there's no better compound activity than getting rid of something that's a scourge of mankind. One of the great heroes of the world, he very much led the eradication of smallpox in India. He's working on polio in his spare time, something which has killed millions of people worldwide. I can quite pronounce it correctly. Dr. Piot.

Piot Pyot. Piot. In Flemish it's Piot Pyot, not Pyot.

Is somebody I have admired for 15 years. And what's interesting about him is he's a very humble guy and in fact, he's probably one of the two or three most well known people working on global health. And he keeps being approached to do this and that. And he says, what I really want to do is I want to work on the disease that is bothering so many people today, which is aids. He's done many, many things in his career. The most interesting thing, of course, was the discovery of Ebola, which I'm sure you kept pretty far away as a younger researcher. But what I particularly like about him is, is that he's done this out of a passion to save lives. And I can think of no more principle than having two people who basically have spent their lives trying to prevent other people from losing their lives than these two gentlemen. Welcome to Google. What we're going to do is talk a little bit about first the sort of UNAIDS initiative and then maybe what we should just talk about AIDS today. And we have two people who understand it very well, two people who worked very hard on it. Can I get to start with where is the disease? How bad is it? I don't hear that much about it in the media and yet there are people being infected and it must be a terrible thing. How bad is it? Have we lost our interest in it?

Eric, the epidemic is far from over, far from over. Something that we never had heard of 25 years ago has become the leading cause of death in the world for men and women. For men and women between 15 and 59, just that happened in 25 years, 65 million people were cumulatively were infected. Over these 25 years, 25 million have died. It gives you also another notion of globalization and networks. Because every single of these 65 million people are connected with each other, either through sex, because their mother had it, or they shared blood and needles and so on. So that tells you a story of globalization of risks that is different from the globalization of markets and profits and so on. And we see actually I would say three trends in this epidemic. One, a continuing expansion, a globalization of the epidemic. Let's say the first reports were from the west coast. Remember the first report came out on the 5th of June 1981. Morbidity Mortality Weekly Report, publication of the Centers for Disease Control in Atlanta. Five gay men, white middle class, gay men with a mysterious pneumonia. And then the attention focused on Africa, where we do have countries in Southern Africa where 1 in 3 adults, 1 in 3 adults is HIV positive. In a small country like Botswana or Swaziland, it's even close to like 40%. 40 plus nearly one out of two. Just imagine you would have 100 million people in the US with HIV. You already have big problems with the healthcare system, just what that would mean, it would totally collapse. And we see now a globalization really the spread all over the world. The fastest growing HIV epidemic is in the former Soviet republics, Russia, Ukraine. In Russia There are over 1 million people living with HIV and it's moving fast with because of a heroin epidemic, heroin coming from Afghanistan and more and more sexual transmission. And in two years time there have been 50% more people with HIV in Eastern Europe, former Soviet Union than you know, than two years ago. And we see also an expansion of India. India today has the largest number of people living with HIV in the world. If it just bypassed South Africa last year, 5.6 million people. Of course India has a 1 billion population and South Africa is slightly over 40 million. So the denominator is different, but it's not. As an Indian minister of health told me about 10 years ago, we don't do these things. We don't have this problem. No, it's there, it's everywhere. So we see a spread all over the world and it's truly a disease of our globalized time. A second trend I see is feminization of the epidemic again. Remember what started as a problem of gay white middle class men. Today half of all people with HIV in the world are women. In Africa it's 60%. And in every single region in the world, the proportion of women is increasing. There are two reasons for that. This biology. It's simply more efficient to transmit HIV from men to women during intercourse and from women to men. But it's mostly to do with society, with culture, with the position of women. Let's not forget that in the Caribbean, in many parts of Africa, and this is where it's documented that in one of three cases of first sexual intercourse for a woman, it's rape, it's coa sex. So this is nothing to do with endocrinology or sex hormones. This is about sex in a certain context that has to do with the position of women or homophobia and so on. And a third trend that I see is that in so called hyper endemic countries, this is southern Africa, South Africa and the surrounding countries where As I mentioned, one in three, close to 50% of some cities are HIV positive. We're starting to see an enormous impact. 14 million orphans because of AIDS. In Africa, country like Swaziland, one in three households are headed by a child because the parents died from AIDS. You've got grandmothers taking care of 50 grandchildren because her husband died a long time ago. Women live longer and both and all of her children died from aids. So there is a whole generation that just wiped out. And if you're today a 12 year old boy in Botswana, the chance that you'll make it to 50 is about 40%, the 60%, mostly because most of the boys of that age will die from AIDS if there is no treatment. That's where we are.

Well, that's a terrible report.

Sorry.

That's the reality, Larry. You've taught me that there is a correlation between global health and global poverty. And you've also taught me that.

The.

Poor and the sick can't wait. Is that why you're involved in this? How would you begin to attack this problem? You have a lot of experience with this.

You know, Smallpox was a terrible disease and I'm going to use it just as a foil. Many more people died of smallpox than of aids. Half a billion people died of smallpox in the last century, 500 million. But we were able to go from a situation where smallpox was everywhere and endemic to eradicate it because we had a vaccine, we had a tool which worked. The vaccine was almost 100%. Smallpox move so quickly because one person would infect five. AIDS is just the opposite. It goes so slowly that it's insidious. Remember those pictures of Katrina? We were all transfixed. We watched them on television. We could see a catastrophe coming towards us in slow motion. It came so slow, we didn't even know it was coming. And that's what's happening with HIV aids. We don't have a vaccine, we don't have as strong a way to prevent it. Yet it is the most preventable of diseases. As Peter said earlier, it's very hard to get aids. The joke is you have to work at it, but it is not like smallpox. So we have a really reasonable chance of getting to a point where we control HIV aids. It started off in a way different than any other std, the way in which sexually transmitted diseases have always been treated in the United States, around the world. You find them, you report them, you trace contacts, you protect the contacts. Because of political and weird way in which HIV AIDS was suppressed and hidden. All the things that public health wanted to do didn't get done. In fact, we institutionalized that hiding because if people were branded with HIV aids, they couldn't get insurance. In parts of Africa, if you're known to be HIV AIDS positive, that's a death sentence. People will kill you rather than let you in the bus with them.

Yeah, your kids are not allowed to.

School, so you've got a situation more like leprosy in the Middle Ages. So it's a very different kind of scenario. The most important thing that we can do with HIV AIDS is take this disease out of the closet and subject it to the sunshine of information. Because the more people know about it, the more they make the right personal choices. There are young people who make what they think of in the United States as lifestyle choices. They think, well, I'm gay, I'm going to get it one day or another. I might as well get it now, get it over with. That is a decision based on bad information. They genuinely believe these antiretroviral drugs will be a cure. They will not be a cure forever. Resistance will crop up. So the thing that I think Google can do, the thing that I think the world needs to do, and what I think Peter is here asking and talking to us about is, is that in a way, Google is the anti AIDS because of our ability to organize the world's information. If information were available and free, people would not be having as much HIV aids.

I'm still shocked by the report of how bad things are. And I'd like to understand a little bit more what the medical disease progression is. So let's assume for purposes of argument in the Western world you have Somebody who contracts AIDS in their early 20s, a man or a woman. And of course they have. Unlike these very poor countries, they do have access to modern medicine and they are able to get drugs through whatever mechanism. Take me through the course of the disease. As you said, it's not a cure.

Yeah. First of all, every single day 12,000 people are infected with HIV. 12,000 can say how many per minute while we're talking, while we're sitting here, what happened to 12,000 people? First of all, most people for many years will not know, will have no clue that they're activated, how long. And because they're totally healthy, asymptomatic, and that can be 10 years, 15 years, the average is like 8 to 10 years, depends where, where you are. And then if there's no treatment, no antiretroviral drugs, which I've only been around for 10 years, was announced in July 96 at the conference in Vancouver, then your life expectancy is another two or three years. But some people die without treatment after two years. And every single day 8,000 people die. That's how many jumbo jets that crash. Just imagine if that would be 20. Yeah, right, but then that would be headline news. But nobody, you don't see the headline news.

So if I were to take my retroviral drugs, do I then live a normal life?

Well, we only have 10 years. Look back and the answer is yes for most people. For most people, when you take your antiretroviral therapy, you can, you know, lead a normal life, go back to work in unaids. We have plenty of colleagues. We even have a calendar. I wanted to show this. We have a group called UN Plus. It's colleagues living with HIV across the UN system. And they make a calendar and the pin up of the month is, you know, it's a colleague with hiv. This has created a storm in with.

HIV who are taking with hiv, but.

Most of them are, all of them actually are on antiretroviral therapy. They're colleagues, they're productive, they work very hard. We have hardly any deadwood, I can tell you that. Not because we are a UN organization. So the problem is there are several problems. One is that this is a virus that mutates all the time. It's an incredibly smart virus. It's a Trojan horse strategy. In other words, it infects the cells immune system that are supposed to defend us against diseases. And it mutates all the time, so its code changes. And what it does is that in many people, after a while they become, they have a virus that is resistant to the treatment they're getting. So then that means that's not a catastrophe, just you need new drugs, but there's a limit to that. You have second generation, third generation, they're far more expensive. Very important consideration for the poor countries. Secondly, they often have far more side effects and people often die not from AIDS any longer, but from cardiovascular complications, but even from aids. Last week, a friend of mine in Paris died from aids. He had been struggling for the last two, three years with aids, terminal aids, because he was one of the first ones who got treatment. And he has already went through all the available drugs. So innovation, new drugs for the future, is going to be necessary.

So now let's ask the same question for people who are impoverished, who don't have access to the medical care of the Western world. Now, I read an article that the retroviral drugs were being made available at cost, but presumably most people still probably can't get them.

Yeah, there we've seen a sea change. This is a history of, let's say, when in 2000, I called for at a conference in Durban in South Africa, and I said, you know, we can't continue this absolutely incredible scandal where when you have aids in the rich world, rich countries, you know, you have access to treatment, you go back to normal. When you're living with HIV in a poor country, it's a death sentence. And that's because of the price of drugs. And that we've got to move from millions to billions of dollars to fight against aids. And we've been able, this is one of the big achievements of UNAIDS, to reduce the price of antiretrovirals from about 12 to $14,000 per person per year to, at the moment, 135. We got it down to about 250, and Clinton did the rest. It's half a dollar a day now. One billion people live on $1 a day. But we have now 2 million people on antiretroviral therapy in the developing countries, coming up from about 150,000 in 2001. And these were all Brazilians because Brazil had decided that they would offer treatment free, for free, to their citizens. But the truth is that 6 million people need it. And what are the problems? The price of drugs now is not the most important obstacle for the first line drugs. Once you need this second line, as I mentioned, then you go into five, six thousand dollars a year. And that is unaffordable for most. But there's a problem that most people don't know that they're HIV positive. There's continuing stigma. Women continue to breastfeed their baby even if they know they're HIV positive, because if you're in a village and you don't breastfeed your baby, she must have aids. She must have aids. And that is the most powerful obstacle to, you know, that she would not take the measures to prevent her baby from becoming infected. We have countries where there is a real, not a brain drain, but a brain hemorrhage of healthcare workers. There are more doctors from Malawi and from Zambia, in Manchester or in London than in the whole country of origin. And that, of course, has not so much to do with AIDS, although doctors also die from AIDS. A PhD or an MD, ladies and gentlemen, doesn't protect you from becoming infected with hiv. So we are up against many systemic issues that have to do with poverty and with culture, with the position of women. The drivers of this epidemic are not going to be fixed with technology, except information technology, but not with medical technology.

And Larry, you've actually talked to me a little bit about your concern about the next generation of leaders in this space. And I think one of the things that you want to do is make sure that the young doctors want to work in this.

Well, I do want to say one other thing. As a corollary to what Peter said. The name AIDS is Acquired Immune Deficiency disease. It means you have a deficiency of your immune system. And if you are exposed, as we always are, to a whole host of bacteria and viruses, it means that you have become transmuted into being a perfect container of those viruses and bacteria. And in fact, you are a great petri dish for those viruses to mutate and then to broadcast out. So with climate change and the seas rising and the erosion of the green belt between humans and animals, There are now 35 new zoonotic diseases that have jumped species. You know, we talked about Ebola, West Nile, talk about Hantavirus, but we can also talk about SARS, Lassa fever, Marburg. All these diseases are now monkeypox, H5N1. We could really go on. Those diseases are now entering into human beings who have immune deficiency. They are now mutating. And when they come out, they come out as Mutant Ninja Turtles. They come out as strong as hell. And we're seeing it in tuberculosis, which is an old disease. And now you have X resistant tuberculosis. That X means it's resistant to everything. There's no way to treat it. So hiv, AIDS itself is terrible. It is a weight borne disproportionately on the poor. In addition, all these other diseases will form another additional burden on the poor. So we need to find a way to build a cohort of doctors and a consciousness in the public health community that HIV AIDS can be conquered. We need to use words that have strong emotive value. We're not going to sit back and take it. We want to conquer it, we want to defeat it. And in order to do that, we really need to build up global public health. We need to build up respect for the people who work in the villages. We need to build up the funding mechanisms. It's not easy. It's blocking and tackling. It's groups like google.org, it's groups like Pierre Omidier, it's the Gates Foundation. The whole panoply of the new foundations and the training that they do and the struggle that we are in, we're in it for a struggle. And I just have to say we're really lucky that we have Peter because he's a true hero. And what we didn't say is he's a baron.

He's actually a baron.

He's a baron. And you don't know this?

We've never had a baron before.

He was knighted by the King of Belgium, but they don't knight him, they call him a baron. So we're lucky that we have our baron as our leader.

But that's what I would say, Baron.

But he's obviously embarrassed. Where's your crown?

Don't you see it? It was taken off for YouTube. It'll be on the.

I did this because he said, he said his kids were going to watch this on Google video. So if you're watching, here's your chance at it.

But I, you, you know, I always say that journalists, people who spread information and education, can save more lives than doctors when it comes to aids. You need the doctors, the medical people when you're infected with hiv. But it's the fundamentally, if we have an epidemic, it's because of suppression of information. Of suppression of what? People's expression, creativity. And whether you're a priest or a doctor or a teacher or you're making sure people have access to information, that's going to make a big difference. That's why I'm so interested in being here.

Two unrelated, but I think responses to this. The first is, what is the status of an actual vaccine? And the second is what is the status of the idiots running the countries that blocked out access to all of this? And are they still in their jobs or have they been Overthrown or not elected?

Unfortunately not. But I'll start with the first one. And for the first one.

I can say that you can't say that you work for the United Nations.

I've said that before. Yeah, he's a baron.

Not to be a baron.

Hard to say. I'm called the. I'm the infant terrible in the United nations sometimes. But in 1984, Margaret Heckler, who was then the Secretary of Health and Human Services of this country, announced that Bob Gallo had discovered the AIDS virus. I mean, it was together with Luc Montag from Paris, but also that within five years there would be a vaccine against HIV. So this was 84. That's 23 years ago. And we still don't have a vaccine. And when somebody gives a talk about the future of vaccines, in five years we will have a vaccine. And the good news is that there are far more investments, including by big companies like Merck. There is the International AIDS Vaccine Initiative. Gates is funding heavily the enterprise, HIV vaccine enterprise. Today, this morning, the Prime Minister of Canada announced a big investment by the Canadian government, together with Gates, to boost vaccine research. But the truth is that we don't really know where we're going to. And there are biological reasons for that in the first place, because we don't know yet what are the correlates of protection. We don't know why somebody is going to live for 10 years with HIV, or somebody without treatment or somebody will die after two years. And why somebody? I mean, I worked in Nairobi in Kenya for many years, and we worked with a group of sex workers who had had thousands and thousands of unproductive sex clients. And some of them, a tiny fraction, never became infected. Why? We don't know. These are probably the most heavily studied women in the world. Because we want to know what is it? We don't know. Is it genetics? Then there's not much we can do. Is it something else that's different? It's certainly not the virus, and we certainly shouldn't count on it. Now, if we have an AIDS epidemic today that's so bad, it's a collective failure of leadership that is the reason for it. And we've seen that in every country. We've seen it. In this country, it took President Reagan many, many years to pronounce the word AIDS in public, just to pronounce it. And according to Freud and to psychoanalysis, what you cannot say, you can't work on, and it's not true. So that's the first step. And we've seen that country and country after country. And on the other hand, we saw denial in the gay community, but also the big successes. First success in overcoming AIDS was in the gay communities, not counting on the government or whatever. There was no technology. There was no treatment. The only technology, if I can say so, was the condom. And it worked. But the problem is, today it's going up again. And several years ago, I said, the time has come that when those in power don't deliver for their people in terms of fighting aids, they should be kicked out of power, they should lose office. That has not happened yet, but I think the days are closer, particularly when you take countries where one in three citizens are infected, where access to treatment is a rare commodity. There's going to be enormous fights. It is already disrupting social life. It is disrupting business. But we see that in the former Soviet Union. Still enormous denial. But what I see and what's encouraging and why I've become a bit more of an optimist in my job, is that we've seen a sea change, particularly since 2001. For once, I would say a huge meeting in the UN General assembly, which three days of talk, talk, talk, but 40 heads of state and government went home and said, I'm going to take charge. I'm not my minister of health. This is a matter of national security, survival of the nation. Huge difference. Funding went up from about $200 million 10 years ago when UNAIDS was created, to $9 billion last year. It's unprecedented in the international development. And we see first results in East Africa, Kenya, coming down from about 20% to 6% of the population is infected. 6% is still a lot, but huge difference. And we see that in some southern Indian states, in Cambodia, in the Caribbean. So we're starting to see a return on the investment. And I think it's the political leadership that made a difference, but we shouldn't take it for granted. It's really AIDS activism that has made a huge difference. And when I got into this job, I had three objectives, and my first objective was to politicize aids. And my colleagues in the public health arena hated me for that, because they said, oh, it's a technical problem, and we must be public health, but it's about politics. And so putting AIDS on the political agenda in every single country, that it's the president, the prime minister, the CEO, the bishop, the imam, whatever, are feeling that this is my job to make sure that my people are not becoming infected. And in order to do that, we had to expand the people, the coalition. But now We've come to a stage where we are still dealing with the crisis. 8,000 people dying every day. There's nothing less than a crisis. But we're starting to see results. And we now have to look into the Future. The next 25 years must be different from the.

So the question that comes to mind is that the most vulnerable are also the people who are the least represented.

Yes.

Especially with your statistics of the feminization of the disease and the terrible things that happen with the social status of women in many countries. In the collaborations that you all are putting together, the simple answer is more information is good, but you must have more that you want to accomplish than just spreading information. There must be a way that you and your experience can really affect change. Because again, it seems like the AIDS crisis is not on the front page in the Western world anymore, but it's on the front page of an awful lot of people's lives. And that's a terrible thing.

There are many people, there's about five people in the room here who attended a meeting called Pan Defense. We had this meeting a year and a half ago, and it was before H5N1 or bird flu was on the front pages. And the goal of that meeting was to look at what was going on with bird flu and to try to make some concrete changes. And Pan Defense was a phenomenal meeting. There was only 40 people, but it was a meeting that led to Kleiner Perkins establishing a $200 million venture fund to, for the first time, I think, in history, invest in global public health, in vaccines and early diagnostic. It led to a billion dollar supplementary appropriation bill in Congress that we forced through, literally nurturing it day by day so that pandemic preparedness could be taken at every state and local level. It led to a special issue of the Harvard Business Review. It led to a whole new generation of people going out and talking about H5N1. That's what we hope will happen from this meeting that Peter is calling here. Not any one thing, not just raising money, but bringing the best minds of the venture community, of Googlers from all over the world, of the people who write for blogs and write for all the new media, trying to carry the message of what can and must be done to conquer hivaids. And you can talk more about what you want to have come out of that, but that's generally what we've been talking about.

Yeah. The way I look at AIDS today is that it's in the same league as climate change, as massive poverty. It's not One of many infectious diseases. And what we need is nothing less than the brightest minds of our time to stop this epidemic. Because it's simple. When you look at Africa, if AIDS is not brought under control, we can forget about all the rest. Because when a disease that kills people in their most productive and reproductive years of their life means that there are no teachers to educate, no engineers, no farmers, no nothing. And so you can't develop a society. And as Michael, our friend from Thailand, said, he said that customers don't buy either. I mean, it's really just however you look at it, it is undermining the very fabric of society. And what we need is that the brightest minds, we need the creativity and the imagination of the Googlers and of others in the world. We need new leadership. And what I hope we can achieve here is let's call it a strategic conversation of how to reshape the response to aids. Challenging conventional wisdom. Bring in a new generation of leaders of people who are doing it on the ground, but not people in their 50s. Because the whole AIDS era, be it research or programs or the politics of it, is dominated by my cohort, by my generation, the 50s, because we were the rebels and the young Turks when AIDS came up in the 80s. But it's still the same people who are now. We're controlling the thing and we need new ideas and new people enlisted.

Thank goodness you were here.

And that's why I'm here. That's why I wanted to come here.

Why don't we extend the conversation with some of the folks in the room. People have comments or questions of what you've heard. And if you don't mind, if you could address the mic so we can get you on the broadcast as well. Who would like to start? Yes, it's okay to line up? It's fine.

Go ahead.

Thank you.

Can you tell us a little bit about the funding?

Can you give us some figures as to how much is being received and spent and how. And how would you think that money should best be allocated?

Are you talking the whole global. The whole thing. Globally.

Globally.

The fight against AIDS Globally.

Yeah. For the developing countries. Last year, $9 billion was spent on AIDS, and of that about 2/3, $6 billion is coming from rich countries or foundations, Gates being the biggest one.

It doesn't seem like a large number.

It's not a lot compared to the. The need is close to $20 billion. So that's the gap, let's say.

The good news is, my argument is that just the professionals that you're Losing in the economic infrastructure of those countries would generate far more revenue.

Absolutely.

Than the cost.

No, we know exactly for many countries what the cost is of inaction. And the cost of inaction is much, much larger than what it costs to bring this epidemic under control. And so two thirds is coming from donors and one third from the budgets of poor countries. About 2/3 of that money is going to treatment and one third to prevention. But the need is about double. And the challenge is that that need is going to go up over time. Why? Because as we discussed before, when time goes by, more and more people need treatment. So what we need to do is to make sure that while we keep people alive who are with HIV today, again, 8,000 people dying every day, we need to invest far more in HIV prevention. If nobody would become infected with hiv, the ultimate cost to society and for individuals is going to go down after a while. And unfortunately there is no, not that force for HIV prevention because you've got to deal with sex, you've got to deal with drugs. And there is no, not a group of activists to say, I need the drugs because I'm going to die tomorrow. Which is a very important reason that there is so much money for raids.

I guess this is a follow up question to that one. You mentioned that in Kenya the rate had fallen from 20% down to 6%. What specific programs actually caused this dramatic fall in the infectious infection rate?

Well, we have a deja vu from many countries in East Africa first that happened. Such a decline in Uganda and in Thailand and the other side of the world, if you want. And the key has been leadership from the top and community mobilization. Not hardly any technology. In Uganda, it started before there were any drugs, any medicines. And so we need to work on two feet, I always say two legs when it comes to fighting aids. One is social change, positive social change, changing the social norms and in terms of behavior and from condom use and all that. And on the other hand, using science and technology, hopefully one day a vaccine. We're not there yet.

I was interested. Larry was talking to me about the number of people involved in the smallpox. The, the actual number of humans were many, many, many people worldwide, especially to get to remote villages. What did you learn from that?

Well, in the Smallpox program, we had to find every single case of smallpox in the world. At the same time, in a metaphysical moment, we had to find every virus. So we had to go to every single house and search for every single case. So in India we had 150, 50,000 people going door to door and we made 2 billion house calls. These are big programs. The polio program has 4 million people working in India alone right now. So when you start talking about global eradication, if you added up all the HIV AIDS workers, including all those who were frontline, you'd get to a number similar to that. But it really is leadership more even than the numbers.

So do you see a program where you have volunteers who go out and educate each and every village about proper sex practices, turning AIDS from a shunning thing to actual disease management, all of that. Is that part of the solution here?

Absolutely. But start at school, in primary school, sex education, and there. Developing countries are far more advanced than many Western countries, including the United States, you know, and it's not by waiting until people become sexually active that then it's too late. You've got to win, and you bring it on. So it's partly volunteers, it's partly professionals, it's partly integrating it in the workplace. Each company should have an HIV prevention workplace program in some way or another. And that is happening more and more, particularly in the worst affected countries. You can talk about it in churches, in mosques, where women's groups. We work a lot with youth organizations, so we try to use what I call we play judo as UNAIDS. We are a small organization, 850 people worldwide. There's no way we can stop the epidemic. It just depends on us. What we try to do is make sure that we use the strength and the weight not of the opponent, but of groups we work with to do more on AIDS and to do it more effectively.

Could I just say one thing before you ask your question? In Thailand, Peter was talking about the successful program in Thailand. The leader of that program christened himself Mr. Condom, and he was a minister, and he went around telling everybody, I'm Mr. Condom. And he made. He made it into a big deal to talk in public about things that nobody would have talked about before. We do not have a Mr. Or a Ms. Condom in the Democratic Party right now in the legislature. And we're having a problem, which is a very funny problem, because Bush did do something with a program called pepfar, and that program. I mean, I did say that, didn't I? I said Bush did do something positive. For the record, I did say so. So we need now to make sure that the Democrats don't throw the baby out with the bath water, so to speak. Speak. And that we continue to support programs that bring money to support hivaids. And I'm worried, and I think, Peter, you're Worried about the Democrats not living up to some of the commitments. So those of you who have good contacts with important Democrats, this is a good, this is a good fight.

It's interesting. When I was in Cape Town, by the way, there was a skyscraper that had a picture of a condom that was the height of a skyscraper. And I think this would never happen in America. Go ahead.

Hi.

You mentioned, we talked about education and prevention and treatment, but there's also detection. And I'm wondering sort of what the cost structure is of detection.

We all know, I mean you talked.

About $135 a year for first line drugs and we all know what condoms are, but I have no idea like what the cost of detection is.

A test you mean?

Yeah, right, a test.

And also how quickly can you find out before spreading it and so on?

Yeah, that's an important question actually. For a dollar you can have a test and you can have the result in 10 minutes. The big problem though is like in healthcare in this country, one to get a test, it can take months to get the appointment and then it takes weeks before you get the result. So good services, and that's one of the things we work on with unaids is making sure that people have access to testing on the spot, that you don't have to come back. I mean it's a matter of management more than anything else and not a matter of money. So it's cheap. Basically, it's cheap. I mean that's the price that we get and we use in developing countries. Yeah.

Yes, ma'.

Am.

I have two points I want to make. The first one I attended like last Google. Org event. So in that event it was mentioned that Google is helping like United nations on the terms of technology, let's say mapping out what new disease coming out in some area in the remote world of the country. The world. So have we done anything to like using Google technology like Google Earth or Google, some sort of statistic data to mapping out where the fast growing part of the world that AIDS is growing?

Yes. We have four or five different initiatives with unicef, with undp, with who, with the United Nations Disaster Response Community, each of them a little bit different. We're doing a lot with helping to identify any new disasters and build a community of disaster response organizations using Google tools. In fact, you'd be surprised at how valuable Google Earth is. You already know that. But Google apps for your domain turns out to be one of the most popular things that these disaster community workers want to have so they can share information. We're going to help Peter by providing Google Earth type tools so the HIV AIDS epidemic can be visualized and seen in a way a little bit more realistically than it has been in the past. We're doing the same thing with UNICEF and we're doing a lot with who's polio program. So yes, absolutely. Google has created some of the most wonderful global public health tools imaginable.

My second point is you mentioned earlier that most people infected are the least represented. So I'm looking at Google also grow globally like in Russia, East Europe. So are we kind of thinking of any program like using the Google web page, sort of like campaign sort of program to bring awareness to the users or basically people. The fundamental issue we have with these underrepresented groups is they're not online. And so if they're online, I think it makes a of lot, lot of sense to do your proposal and variance of that. We already have a number of programs that we're strengthening around personal health, targeted education, various free advertising programs for health initiatives and so forth. My personal view is that health is going to become one of the great new areas for Google's involvement because there's so much information, it's so hard for the average person to, to understand this. Of course we have two fine doctors here. Somebody is given some diagnosis or something and they're very confused and afraid and we could really help there. My concern is that the people we're talking about are not online yet and we're going to have to find some other ways of reaching them with this message. That's my personal view.

Go ahead.

You've talked quite a bit about politics and political leaders. What about religion and religious leaders or if there are any fingers to point, say to the Pope or someone.

Yeah. When I talk about leadership, it's not only politicians. I mentioned a bishop or a CEO, I mean, or a chief in a village. I mean they're all, or you know, somebody who has a youth club and religion so often can be responsible for the death of people or it can save many lives. Depends on how it's used. And 10 years ago when I started with UNAIDS, I said we've got to get the religious leaders, the churches and so on board because in many cases they were preaching against condoms. The former Pope would go, and I remember to Rwanda and say that, you know, condoms are absolutely against God's will or whatever it was phrased. But in the meantime a lot has changed. Many churches now have joined the battle. When you take South Africa, we had an unlikely coalition to Fight for the rights of people with HIV in treatment, Treatment Action campaign. So people infected with hiv, that's the least you could say. The Chamber of Mines, if you want. Big capital in that sense. The cosatu, the trade unions, the Anglican Church and the Communist Party just try to put that kind of coalition together. How could it become together? Only AIDS can do that. So. And Desmond Tutu, we had for a while on our website in unaids, we had Desmond Tutu with his very specific smile, don't smile, and said, sex is a beautiful gift of God. That's one aspect of religion. And then you have people who say aids, it's, you know, is the punishment for your sins. The whole homophobia comes in that the fact that in many religions, I mean in Islam, Judaism and Christianism that women are considered as second rate. I mean, look, go back to the origins of men. I mean it's, it's very fundamental. So we're in a constant dialogue. But take Iran. Iran has actually is a pretty serious AIDS problem, particularly driven by heroin, again from the neighboring Afghanistan. But they're providing needles, condoms and methadone in prisons for, you know, for people with hiv. Quite enlightened. But when it comes to issues around women, that's for both. So my view has become a far more pragmatic one. But we should speak up when religious leaders are condemning people with hiv, stigmatizing them, or saying that condoms are spreading hiv, because that's killing people and the highest moral imperative is saving lives. And that's what should be our common ground. And I think we can find that.

We'Re going to have the honor of the last question.

Wonderful. I'm just wondering where you, in your day to day work, where you find your source of hope and optimism and what keeps you going on a day to day basis. I think that a lot of people in the United States don't sort of have the convenience of not like having it in their face every day. Sort of the convenience of blissful ignorance. And I'm just wondering for people who don't necessarily respond well to a message of you should feel guilty about this, like what is your hopeful message to get people excited about the change? Well, I feel very privileged that I'm in this job and I think it's working on one of the most important issues of our time. And I don't know, my inspiration comes a lot from people living with HIV who are working with us. When I travel to a country, you know, I sit down with them, they tell me what all their problems are. But Also their true heroes. Just having fought the bureaucracies, the political denial, the bigotry, the churches or whatever, the innovation that comes out, it brings out the worst and the best in people. The worst is like exclusion, stigmatization, blaming. And the best is in solidarity, thinking through how can we overcome all these problems? How can we dream and make our dreams come true? How to use new technology, new science. So I feel very privileged and I'm not somebody who easily gives up. I don't need the quarterly results in terms of. Otherwise I would have been fired a long time ago. Eric. Sorry. So the long term view is very important and never give up. But I think it's important to realize that wherever you are, it's highly likely that in a room like this there are people living with HIV in the room. It just is hidden in most cases. And never forget that. And also never forget it could have been you. And it's just an exercise.

Might be you.

Except it might be you, of course. Present company accepted. If you, as we always say. But just it's. It gives you a sense of, I don't know, humility. And so what we are as a human being, but wherever we are, we can contribute. And I think you definitely can contribute in a big, big way. Don't underestimate what you can do.

I'd like to just answer the question about what gives me hope. I saw the worst disease of its time, pre aids, smallpox. And I had thousands of little babies die in my arm. My wife Girge, and I saw smallpox in little villages. We saw rivers that wouldn't run because of dead bodies. And that disease has been eradicated. So I saw the horror of it and then I saw the realization of it being conquered. Now, if that doesn't give you hope, what will? I want to extend that to hiv, aids. That's really what my aspiration is.

It's a problem with the solution.

I think you all can see why I don't admire both these two men so much. Both are medical doctors who have given up other things in order to serve the world. Both are academics, both are executives, both lead teams. And they lead it with a passion that I admire. When you think about the compounding that's going forward, if you do the straightforward math, if we don't act as a global society on this, we are really screwed. And I'm not just talking about the suffering, I'm talking about the innovation, all of the bad things that can happen from the loss of smart people and the return to tribalism, the loss of control dictators, wars, poverty and so forth. AIDS strikes me as being could go either way now. And I think it's to both of your leadership that we should thank and obviously support as much as we possibly can. So thank you very much.

Thank you so much.

Thank you.