I want to thank the Chairman for holding this important hearing today. 

I would also like to thank our distinguished witness, Dr. Mark Dybul, for coming to share his perspective on the progress made and challenges that lie ahead for the President’s Emergency Plan for AIDS Relief. 

It was just over four years ago that the President announced his bold new initiative to combat HIV and AIDS. 

Since that time, the United States has provided nearly $13.5 billion through PEPFAR, and we are well on course for exceeding the $15 billion originally pledged for this endeavor. 

Our commitment to eradicating this devastating pandemic, through PEPFAR, is a testament to the compassion and generosity of the American people.

The challenges are daunting. 

According to the Joint United Nations Program on HIV/AIDS (UNAIDS), over 39 million people worldwide are infected with HIV/AIDS, more than 60% of whom live in Sub-Saharan Africa. 

In Botswana, one of the hardest hit countries, life expectancy has dropped to an astonishing 34 years. 

By the year 2010, an estimated 25 million children will have lost one or both parents to HIV/AIDS.  According to the most recent annual report on PEPFAR, a child who loses a parent to HIV is three times more likely to die than other children. 

HIV/AIDS is not merely a public health concern – it is a development concern as well. 

This insidious disease is killing an entire generation of those who are typically the most productive in developing countries – people between 15 and 24 years of age. 

These are the workers, teachers, parents and caregivers – the people who keep economies moving. 

It is estimated that by 2020, HIV/AIDS will have caused GDP to drop by more than 20% in the hardest hit countries.

But the commitment of Congress and this Administration is firm. 

Through PEPFAR, the American people have helped provide care for 2.4 million people affected by HIV/AIDS, in addition to 2 million orphans and vulnerable children. 

We have supported the provision of antiretroviral (ANTI- RETRO-VIRAL) treatment for 822,000 people, with an estimated 50,000 new people gaining access to treatment each month. 

And though care and treatment are moral imperatives which we must continue to support, we will never win this battle if we can not prevent new infections from incurring. 

UNAIDS estimates that in 2006 alone, 4.3 million people became infected. 

An estimated 12% of those new infections occurred among children, 90% of which occurred as a result of mother-to-child transmission.

This is unfathomable to me.  These are not mere statistics, they are children . . . hundreds of thousands of the youngest children who have become infected simply through the act of being born. 

As a mother, I can not accept this as a foregone conclusion.     

Funding for PEPFAR for fiscal year 2007 is hundreds of millions of dollars higher than the Administration’s requested level. 

This extra funding should be directed in such a manner that it saves the most lives possible. 

I am eager to hear from our distinguished witness today how he will use those additional funds.  In particular, I am eager to hear how he will direct funding to bolster our mother-to-child transmission programs, where it is clear from UNAIDS data, much more can be done.

I am also very interested in discussing accountability and results.

As you know, the Institute of Medicine recently released its $4 million Congressionally-mandated report on PEPFAR.  They were specifically tasked with, “comparing the success rates of the various programs and methods used under the strategy … to reduce, prevent, and treat HIV/AIDS, tuberculosis, and malaria.” 

As medical experts rather than politicians, it was believed the IOM would be well-suited to provide the type of unbiased, scientifically verifiable data that Congress would need in order to make evidence-based decisions when and if it came time to reauthorize PEPFAR.  Unfortunately, IOM has asserted that it could not provide this data because the program is not mature enough to truly assess its impact. 

Dr. Dybul, your annual report to Congress includes a great deal of information on the perceived success of the PEPFAR strategy.  I am anxious to hear how you have measured this success, and whether you think the overall strategy, as shaped by Congress in the Leadership Act, needs to be updated or revised.  

The PEPFAR program is a positive example of the good we can accomplish when we work together to solve the most serious of problems.  I look forward to discussing how we in Congress can continue to work with you on this most important issue.