 My name is Lisa Cardi. I'm the Deputy Director of the Global Health Policy Center here at CSIS. I bring you all greetings from Steve Morrison, who leads our global health work. He is off at his daughter's grammar school graduation this morning, which, well, I know we all agree what we're doing is very important. I'm sure we'd agree what Steve is doing is even more important. But he's with us in spirit. I also bring you greetings from John Hemre, who's the President and CEO of CSIS, who's just really so happy that we've been able to host this event here this morning. Ambassador Gooseby, a special word of thanks to you for joining us. We know how really busy your schedule is, and we're just very grateful you've made the time, and also enormously grateful for your leadership on this set of issues. And then I just have to acknowledge Janet Fleischman, who's responsible for bringing us all together here this morning, and who's really been the guiding force and the inspiration behind so much of CSIS's work on gender and reproductive health and HIV. I, among many people, have learned an awful lot from her, and we're really grateful for her talents and her expertise. Before we formally get started, I just wanted to take a moment to say a brief word about the importance of the issues we're going to talk about today. CSIS was founded in the early 1960s, primarily as an organization that was going to focus on the big foreign policy and security challenges of that time, which were the challenges of the Cold War and the challenges of the nuclear threat. I think probably the founding members of the CSIS trustee board probably never imagined a day when we'd be convening meetings on global health and gender. But luckily, the world has changed a lot since that era of the 1960s, and we're now at a place where global health and development and gender have really taken their important priority among the big foreign policy and security issues of our time. This week alone, I think as many of you know, there have been two big international conferences here in D.C. on gender and global health. They've been addressed by the U.N. Secretary General and by two, a former and a current U.S. Secretary of State, both of whom happen to be women. So I think that's a great sign of how the world has changed. And here at CSIS, we're also trying to do our part to ensure that global health, and in particular issues related to women and girls, continue to get the sustained attention and energy they're going to need so that we can bring about real change. Last year, we convened here a group called the Commission on Smart Global Health Policy, which was charged with developing a set of long-term recommendations over a 15-year period for the future directions of U.S. global health investments. Actually, copies of that report are out and available to you today. The group was very interesting. It was comprised of global health leaders, but also senators, congressmen, corporate CEOs, people from the worlds of foreign policy and security and finance. Our co-chair was a retired Navy admiral. I can tell you they were a very diverse, smart and energetic group of people. And having to be someone who staffed them over about a year, they were a little intimidating to be around sometimes. But they were a very smart group of people. And when they released their final report about three months ago, the issues we're going to talk about today were really front and center on their mind. Specifically, the commission recommended that the U.S. continue to grow its commitment to HIV, that it expand programs targeted to the specific needs of women and girls, and that it better integrate those programs for women and girls with the broader U.S. development agenda. So our commission members are committed and hardworking and ready to pursue these priorities in the years ahead. They're very interested in hearing from groups like this about how they should focus their work. So this is all to say that I'm just very confident that with the kind of leadership we have today, leadership from the global community, leadership from many of you in this room, leadership from people like Ambassador Goosby, that the discussions we're going to have today are going to have an impact far beyond today and far beyond the confines of our conference center here at CSIS. So thanks again for joining us. Thanks in particular to our panelists, some of whom come quite a long way to be with us this morning. I'm going to give the floor to Janet. Thank you, Lisa. Thank you, Ambassador Goosby, for coming and thank all of you for being here. My name is Janet Fleischman. I'm a senior associate with the Global Health Policy Center. This is really an impressive gathering and we're thrilled to have such a knowledgeable and remarkable set of panelists who we'll be hearing from later, many of whom have traveled very far to be here and all of whom are real leaders in their field. As Lisa had said, this is a key moment. This is really an unprecedented opportunity both in the development of U.S. policy and globally and looking at new approaches to linkages between women's global health and development and addressing these cross-sectoral structural factors that shape the risk of HIV infection for women and girls and complicate their situation once they're infected. Specifically, this meeting is going to address how HIV and AIDS funding can better support and encourage more innovative programming and more innovative responses that place the AIDS crisis within the context of broader development and in so doing, hopefully, the U.S. can help influence others' efforts by other international donors, national governments and civil society organizations. I think we're all aware that there has never before been so much high-level attention on the issues of women and girls' health. There's a real recognition of the need to address these issues in an integrated, comprehensive and cross-sectoral fashion, whether that means integrating HIV-AIDS with family planning in the health sector or to make the critical linkages with the development areas such as education for girls and economic empowerment for women. I'm looking forward to hearing from our panelists who are really in the front lines of this effort. They are pioneering the design and implementation of programs linking gender with AIDS and development and leading the efforts to ensure that the national and global policy environment will be conducive to such innovation. We have much to learn from them and we thank them again for being here. Today we're going to focus on three main areas of linkages between HIV-AIDS programs and education for girls, economic empowerment for women and family planning, reproductive health. The panels are going to try to address three key areas. First, building the argument for linkages. What are the advantages and challenges of linking HIV-AIDS with development? How do we define the goals? The second area is monitoring and evaluation. What are we measuring? And how do we measure progress? How do we capture impact? And are there intermediate steps to mark meaningful milestones toward structural change? And finally, how do we overcome the obstacles for greater innovation and build sustainability? What are the obstacles to linkages on different levels in the field, in M&E, in funding? And how do we encourage innovation in key countries learning from the kinds of models that we'll be hearing from today? And then how can we take that to impact national level policies and U.S. government policy? The answer to these questions can help inform the structure and scale of programs linking gender, AIDS, and development going forward. Clearly it is time to put together solutions that make a difference in the lives of women and girls and to address head-on the complexities that program linkages and cross-sectoral programming present. These issues will be key to the success and sustainability of U.S. global AIDS policy and the new Global Health Initiative. And this clearly is the moment to move forward and to build on the opportunities we hear about today. Let me take a moment to thank the David and Lucille Packard Foundation for their generous support, which has made this conference possible today. And I'd also like to thank the leadership at the Global Health Policy Center at CSIS, Lisa Cardi, and Steve Morrison in particular. And a special thanks to Carolyn Schrode, who really helped pull this together with all kinds of logistics. So a little bit of housekeeping. We will have three panels. The first panel will address the structural drivers of HIV risk, with a focus on innovative programs linking economic empowerment for women and girls with HIV AIDS. The second panel will look at what we call wrap-around programs with lessons from programs on education for girls and family planning reproductive health. And the final panel will look at new directions in U.S. policy and where linkages fit with PEPFAR II and the new Global Health Initiative. Our very able moderators will introduce all the panelists, so I won't do that now. And they will also work to keep them to their time so that we'll have plenty of opportunity for questions and answers. We look forward to a very lively and informed exchange. It is now my pleasure and my privilege to introduce Ambassador Eric Goosby, the United States Global AIDS Coordinator. Many of us who know him know what a deep commitment he has to the issues faced by women and girls in the AIDS epidemic. Ambassador Goosby exemplifies the opportunities that we have now for U.S. leadership in the area of linkages between AIDS and development. And we should recognize that a lot of movement is already underway. The issues faced by women and girls have gained new prominence in the Obama Administration, with both PEPFAR and the Global Health Initiative adopting a women and girls-centered approach. Ambassador Goosby has overseen this new emphasis in this new phase of PEPFAR, including a newly launched initiative on gender-based violence, and has expressed a clear willingness to work with other sectors to pursue innovative programs that address the realities that women and girls face. As Global AIDS Coordinator, Ambassador Goosby oversees the implementation of all PEPFAR programs, as well as the U.S. government's engagement with the Global Fund to fight AIDS, TB and malaria. Prior to this position, Ambassador Goosby served as the CEO and Chief Medical Officer of Panjia Global AIDS Foundation and was a professor of clinical medicine at the University of California, San Francisco. Ambassador Goosby played a key role in the development and implementation of HIV treatment scale-up plans in South Africa, Rwanda, China and Ukraine. He has over 25 years of experience with HIV-AIDS, ranging from his early years treating patients at San Francisco General Hospital to the engagement at the highest levels of U.S. policy leadership. He was the first director of the Ryan White Care Act at the U.S. Department of Health and Human Services and helped develop HIV-AIDS delivery systems in the United States. During the Clinton administration, he served as Deputy Director of the White House National AIDS Policy Office and was Director of the Office of HIV-AIDS Policy at the U.S. Department of Health and Human Services. So please join me in welcoming Ambassador Goosby. Well, I'd like to thank CSIS and the Global Health Policy Center for giving me an opportunity to speak to you today. It's really an honor and a pleasure to do so. I want to thank Lisa Carthy as well for her kind words, and I think Steve is doing the right thing with his child's graduation from grammar school. We are going to go through about 12, 13 slides today that attempt to really emphasize the continued acknowledgement and role that PEPFAR specifically has seen gender-based violence, gender issues, women's issues, continue to present to our medical delivery system and our ability to effectively identify, test, and retain women, their children, their partners, and care systems over the duration of their illness. It is clear to us that a woman-focused approach is the most effective at identification and retention issues over time, and that if we feature and target her for that entry and retention strategy, we are more likely to be successful in retaining children and family. That theme is also moved into the Global Health Initiative, which along with Raj Shah and Tom Frieden are coordinating the specifics of, after now, what is pretty much a year since its announcement. So sex refers to the biological differences while gender describes the characteristics that a society or culture delineates as the masculine or feminine. The norms that affect access to services, the gender norms, the risk-taking and protective behaviors, the gender-based violence and access to prevention messages all coming out of this. It's important to us that we remind ourselves that gender refers to both women and men, given that the impact of gender norms is on both, and tackling the structural drivers of the epidemic that lead to the gender inequities really have become clear to us to be the key to responding to the HIV epidemic. These are a few examples of how gender and HIV converge. These are some of the statistics that show the disproportionate vulnerability of women to this epidemic. In sub-Saharan Africa, 60% of those living with HIV are women. In the nine countries in southern Africa most affected by HIV, the prevalence among young women 15 to 24 was on average about three times that than men. A review of the studies of child sexual abuse across the world reports a prevalence range from 2 to 62%. In our experience in country it is an overwhelming issue that is largely not part of the clinical awareness of the providers in the settings that we support because of educational issues and educating the provider, the nursing staff, the medical staff, lab staff, the healthcare worker staff. All of which for years now PEPFAR has attempted to target, but the real problem has been not having a system to respond to problems identified. So the impetus or pressure on a provider to identify a problem that they can't really respond to is low. But now we are trying to increase our ability to create services and a meaningful response that will allow us to expect and monitor and document our providers in their awareness, number one, but just as importantly in their ability to respond and demonstrate that they indeed have responded. The global health initiative really is something that we have all thought about and after the announcement last May really had to put on what was a very general kind of 60,000 foot description. 63 billion over six years expanding in services integrating doing the right thing into some very specific descriptions of how the vertical programs that are in the United States government to date, how these programs can actually increase and enhance our ability to respond to the needs of the patients, people in front of us who we are already with in any given vertical program. One of the larger platforms is the HIV AIDS medical platform that has been put in place through the PEPFAR effort and before. And then maternal and child health family planning platforms are probably your second largest platforms. And what I mean by medical platform is the bricks and mortar, but the human resources, the doctors, the nurses, the health workers, the lab techs, the healthcare worker aspects for outreach, how they relate to the community or don't, how they are linked to other services within the community, TB, family planning, maternal and child health. The Global Health Initiative from our PEPFAR perspective is an expansion of the service constellations that the patients were already caring for in an HIV AIDS context now need to access. So from our perspective it's somewhat of a no brainer to say that we will increase the services available to the patients that we are currently interfaced with by a Global Health Initiative approach. What it will basically be is an ability to take funding resources, services that are now in a vertical funding line for maternal and child health family planning HIV AIDS, let's say. Have those resources aggregate above the level of the HIV AIDS platform site, a PEPFAR site or a maternal and child health site so the HIV AIDS can either create or link to or refer, but preferably create the capability to do maternal and child health, kid immunizations and family planning services from an HIV AIDS platform for the maternal and child health platform to do testing for HIV, diagnose, stage, and perhaps even initiate treatment in some of the maternal child health family planning combined platforms to move toward creating a one stop shop idea where possible but everywhere an ability to link refer in a meaningful way with transportation and childcare issues as part of that package of referral. It is going to increase the number of populations that we from an HIV perspective now will newly interface with that we currently do not. So the number of individuals who will have access to testing, the number of HIV positives that we find, the number of high risk individuals who are negative but are participating in high risk that we now identify for continued and repetitive prevention messaging is going to go up. And I think that it is only going to be a good thing. In terms of looking at resource movement, the fact that we are building off of already existing program platforms puts most of the resources in the 63 billion over six years going toward continuing those vertical programs but now having resources to make the linkages real is really what the GHI is about. It is the next logical step for a more comprehensive service portfolio to be able to respond to it. Instead of listening to complaints of diabetes, coronary artery disease, screening for high blood pressure, having a woman who gets pregnant and has a baby, we can now access family planning services to from a different vantage point from their HIV AIDS platform. All of these expansion of service capability is really something that we believe is the first step toward putting a basement of health care capability out there for the planet. A move toward the first discussions of really making health care available more broadly in settings that really do not have a chance at establishing that capability from their country's resource portfolio and perspective will now move into that. The other central theme of being women-centered will continue in GHI and be a central piece of it, but the country ownership is, I believe, as in PEPFAR, the new