THE DIANA, PRINCESS OF WALES LECTURE ON AIDS

Thank you very much for that compassionate introduction and thank you Dame Ruth and Derek and all the people that support the National AIDS Trust for the work you do. I'd also like to thank our good friend Cherie Blair for joining us today and for coming over with my daughter Chelsea and me and I would like to acknowledge in the audience Sandy Thurman; the woman who ran the AIDS programme for me in the White House and is now the Director of the International AIDS Trust. I thank them for joining me today.

I am honoured to be here to deliver this second lecture in honour and memory of your patron. My wife Hillary and I liked and admired Diana very much and we miss her still. More to the point, today the world misses her capacity to focus public attention on AIDS. As she did so dramatically in 1987 simply by sitting on the sick bed of a man and holding his hand. She showed the world that people living with AIDS deserve not isolation but compassion, and that simple gesture helped to change world opinion, helped to give people with AIDS hope, helped to save lives of people at risk. I thank all of you who carry on that mission; it is the greatest possible tribute to her.

Without her ability to focus public attention we must work harder every day to keep our own attention focused, as President I did what I could. We established the first AIDS office in the White House, more than doubled domestic spending and efforts to develop a vaccine. We tried to do more, we tripled our support for overseas programmes and now I am honoured to be involved with the International AIDS Trust along with former President Mandela of South Africa. In the ten weeks before September II, the world raised $1.5 billion for the Global Fund for AIDS and Health, the Secretary-General of the United Nations asked for last Spring at the African AIDS Summit. In the ten weeks after September 11, $2, 000 was raised. Do not misunderstand, winning the fight against Mr Bin Laden and the Al Qaida, replacing the Taliban and seeing the women take off their berkas and the men free to shave. This is very important to the future of our world. Lam profoundly grateful to Prime Minister Blair, to the British people, to our allies all across the world, but especially to Tony who has been the strongest voice of support for President Bush and for the American people in this very difficult time. So I don't want anything I say to be misunderstood. Winning this fight we are in is absolutely essential and so is the improvement of our domestic defences against terror. But these victories alone will not come close to building the world I think we all want for our children and our grandchildren. To do that we will have to create more partners and fewer terrorists by spreading the benefits and reducing the risks of the Modem World. Along with global poverty, global warming and global vulnerability to terror, the breakdown of public health systems, and the rise of epidemics especially AIDS, is one of those grave risks.

On World AIDS Day we learned, as has already been said, that there are now 40 million people living with AIDS, the number is projected to rise to 100 million by 2005. If that happens it will probably be enough to crumble fledgling democracies. It will probably be enough to spread wild fires of violence among young people; who fear that they only have a year or so to live and therefore cannot understand why they shouldn't be involved in whatever conflict is handy. If it is true that we will have 100 million AIDS cases in 2005, then the world is facing the biggest plague since Europe lost one quarter of its people in the l4th Century.

This is truly ironic that it could happen at the very time that we have sequenced the human genome. One of the happiest days I had in my last year as President was when Tony Blair joined me on an international television hook-up with representatives from other countries that had participated in our scientific consortium to sequence the genome. We have already identified the two major genetic variances for Breast Cancer. We are getting very close on Parkinsons and Altzheimers. Soon young women in countries with good health systems will be coming home from the hospital with their new born babies and a little gene card and it will say, here is your baby's strengths, here are your baby's problems, do these ten things and your kid will live to be ninety five. Now you're laughing, but I predict to you it will be quite soon that babies will be born with life expectancies in excess of ninety years because the sequencing of the human genome and all the things that will flow out of that. Because of the use of super micro technology, new technology and diagnostic tools, which will soon enable us to identify cancers when they are only a few cells in size, totally undetectable today, raising the prospects that all of them may be curable. Wouldn't it be bizarre to live in a world where your kid gets a gene card that is a ticket to live to be ninety five, and children are dying like flies because of AIDS? That is the challenge that we face and that is what I want to talk about today.

September 11 showed us a lot of things if we think about it and see clearly. It showed us that we couldn't claim the benefits of the Modem World, the benefits of the Global Economy, of information technology, of scientific advances, of open borders and diversity and democracy, and avoid the vulnerabilities of this age of interdependence.

Borders simply don't stop much good or bad anymore and whether we like it or not, we now live in a world without walls. This interdependence has brought people in the United Kingdom and America great benefits and increased vulnerability. Secretary General Kofi Annan who received the Nobel Peace Prize last week, richly deserved I might add, said here last year in the inaugural lecture, the spread of AIDS is partly a tragic bi-product of globalisation.

At least we now see in you the beginnings of a global response. Unless we deal aggressively with AIDS now, it will make us all poorer and less secure. Yes, 70% of the cases are in Africa, most people all across the world still see this as an African problem and, God knows, for the Africans it is a problem. But it is well for the Europeans to remember that the fastest growing rates of AIDS are in the former Soviet Union, on your back door. And it is well for the Americans to remember that the second fastest growing rates of AIDS are in the Caribbean, on our front door. My wife represents the state of New York in the United States Senate; she has a million constituents from the Dominican Republic alone. Can Europe really avoid the consequences if Russia and the former Soviet Union become consumed by AIDS? Can America escape the consequences when the Caribbean has the same rates of infection that Africa does? Do we really intend to let that happen? We all know the gory statistics, although they bear repeating over and over again. A child dies every minute, 8, 200 people a day, 13 million orphans already.

Interestingly enough, I think quite soon the nation with the greatest number of AIDS cases will be India, the world's largest democracy. A truck driver from North of Bombay recently told a journalist that he only had sex once a week on the road and he always takes a bath with limewater afterward. I say that to make this point, I love India and I worked there, I helped to organise a foundation to help Gujarat rebuild after the earthquake. The Prime Minister is a friend of mine and I think a very good man. The future of India is very important to the rest of the world but if you go there and talk to people, in the most astonishing places, you see the most unbelievable amount of denial. It is like going to Africa five years ago, maybe longer. What will happen to India if it has 30 million cases, what will happen to India if it had just one-third the infection rate of Botswana? This is a country of a billion people.

China recently had its first national conference on AIDS. The Chinese Health Minister estimated 600, 000 people were infected but the number of infections reported this year is 67% higher than last year. Experts say that only 4% of the adults in China have any idea how the disease is contracted and spread. This is a country that has worked for years to integrate itself into the Global Economy. To raise living standards of its people. I don't think the rest of us can afford to see China and India spend five more years fooling around the edges of this problem.

In Russia the infection rates are now triple what they were a few years ago, in the rate of increase. Dr Alex Gromyko, an HIV advisor to the WHO, says within two or three years several million Russians will be infected. It is a country of approximately 160 million people. When the death will be counted in the millions he says, then we will start to understand the tragedy. That is absurd. Is that really our position? Haven't enough Africans died to teach the rest of us, haven't enough Americans died, haven't enough of your friends died? How long ago did your friend die of AIDS? For me it was years and years ago, over a decade ago. When did your last friend die of ADS? For me it was a couple of weeks ago. Do we really have to sit here and wait for a few million Russians and a few million Indians and a few million Chinese to die, before we mobilise the global community to do what is manifestly in everyone's interest?

Most people who die of AIDS are between the ages of 20 and 50. In some nations teachers are dying faster than they can be trained, how will we educate the children. Doctors and nurses dying from the disease, how will we care for other people. Farmers and labourers dying, who will produce the food, Factory workers dying, how will the economy grow? Members of the police and the military are dying, in quite healthy numbers, who will provide order. Mothers and fathers are dying, what will be left for the children.

The spread of AIDS is literally a tragedy in the Shakespearean sense. If you read of Shakespeare's tragedies, it's the thing that is moving about all of them is, how all of life's greatest wounds are self-inflicted because they don't have to happen. I once read when I was running for President a statement that someone said that insanity is doing the same thing over and over again and expecting a different result. Now the world has tried ignoring this long enough, we are not going to get a different result. We have a Secretary-General who has given us a vehicle through which every country can contribute. More importantly, I think, we actually know this whole deal can be turned around. Almost on a dime in historical terms. We have the knowledge and the means to turn the tide. The only question is whether we have the wisdom and the will. Of course every nation has some customs that make it difficult to talk about AIDS, but around the world people are doing it, because they prefer their children's lives to their own sensibilities. It seems such a simple choice.

We know the difference strong leadership can make. In Cambodia focus prevention programmes have resulted in a 30% reduction in HIV among pregnant women in just three years. Senegal has kept HIV prevalence at 2%, with intense prevention. One in which Muslim clerics have played a strong role. Uganda pioneered a broad-based national effort of prevention, counselling and testing and treatment of sexually transmitted diseases. That has dropped the overall adult infection rate nearly in half in five years, from 14% to 8%. 1 always thought one reason was the President's wife is a nurse, who gave a very compelling speech about why grown-ups should not let their feelings cause the deaths of children.

Now, this is going a lot of places, the Prime Minister of Mozambique has spoken bluntly about practices that accelerate and spread AIDS and the need to save the lives of his children. Everybody in this room knows prevention works. Everybody in this room has personal experience with programmes that are effective. All we need to do is take what works where it has been implemented and implement it everywhere AIDS is. What else can we do? Well, so far Brazil is the only country in the world that has combined vigorous prevention with the provision of triple combination therapy free of charge to people living with AIDS. Sounds rather grisly but I think it is impressive that actually did a study in Brazil and found that in their culture, it was cheaper to give people the drugs than to bury them when they died and pay for the last few weeks in hospital. So when the President was pressured to drop the programme, as Brazil got into difficulties economically, he said no and the evidence that it was both morally wrong and economically stupid. What's happened, they have got drugs out to the most remote villages and proved that people with no education could be trained and monitored to take the drugs at almost the same frequency they are taken by HIV positive people in USA and other Western countries. About 70% of the people in Brazil are taking their drugs in the prescribed way. As a consequence, the hospitalisation rate dropped by 80% and the death rate by 50% in three years. This is not rocket science. It is hard work and doing what has to be done.

So what are we going to do? We have to support the people first of all that are doing the right things. I will never forget when I went to Nigeria last year. President Obasanjo attended an event on AIDS, and a young man spoke about how he fell in love with a woman who is HIV positive. Her parents were against the marriage, his parents were against the marriage, they went to their local priest and he blessed the marriage. The parents gave in, they got married, he became HIV positive. He lost his job and he was desperate to find the money that would enable his then pregnant wife to get the medication that would prevent mother to child transmission. Finally, he got the money, his wife took the medicine, the baby was born without the virus and he got up and told the story to all of us who were crying by the end of the story. He then brought his wife up, resplendent in beautiful Nigerian dress, and the President of Nigeria got up and hugged his wife and hugged him on national television in Nigeria. It was a big deal for them and it sent out a big message.

So we know what to do. We know what prevention programmes work, we know what treatment programmes work. Moreover, the settlement of the South African drug case means that, though negotiations will still have to take to place, more and more countries will have access to more and more drugs at more affordable prices or in some cases for free. The question is how quickly can we get this done, how quickly can we change the attitudes of the people in the countries that aren't doing what they need to do and will there be people on the ground to do this work. Meanwhile, back in the rich countries, will we fund the Secretary-General's programme and keep funding the search for a vaccine and a cure? This is not complicated and we cannot let it get complicated, we cannot prevent, for example, this tired old debate whether we should be funding treatment or prevention rear its ugly head. We have to fund prevention and treatment; they are two sides of the same coin. Of course there are not enough doctors and clinics, we have got to get them out there. We have to accelerate the negotiations with the drug companies and if we want them to participate in finding a vaccine, we are going to have to give them financial incentives to do so and the settlement of the South African drug case makes it even more imperative that those of us in wealthy countries that are hosts to drug companies, actually give them financial incentives to keep working in this area.

Kofi Annan says it takes $7 to $10 billion a year to deal with AIDS and other infectious diseases. Our share would be a little over $2 billion, if you take the $10 billion figure. UK share would be a little under half a billion dollars. These are serious numbers, calculated by the UN based on what it would actually take to do an adequate job to stop there being 100 million AIDS cases in four years. But how serious are they. For the US $2.2 billion is about one tenth of one percent of the Federal budget. Or about two months of the Afghan war. It has cost about $1 billion a month. This is far cheaper than picking up the pieces of the shattered lands and shattered lives that we will live with if there are 100 million AIDS cases in 2005. Of course, there are other things we could do to help as well, including doing more to improve economic empowerment in poor countries. That gives people incentives to take care of their own problems and to do more to avoid AIDS. There are a lot of proven strategies, micro enterprise loans, debt relief that has to be put into healthcare, education or development. Education programmes that get children into school by giving them a good meal, we did that for 6 million kids this year. Or pay the parents to send their kids to school as Brazil does. All that helps to change the climate and to change attitudes. But we cannot avoid the fact that the governments have to do direct and specific things and so do people who are in government.

Beyond the governments of the world contributing to the Secretary-General's Fund, contributing the effort to find vaccines, business can do a lot as well. Contribute drugs, test kids, computers, offer work place progranm~es, get their workers tested, and expand from their own workers to their communities. They can offer expertise in distribution centres and they can help to promote marketing campaigns to change behaviour. NGOs, unions, churches, synagogues, mosques, foundations, students, citizens, people living with AIDS and their family members and friends, and all the rest of us are critical to this effort. One of the things I know from walking in little African villages and seeing plays young people put on against AIDS, seeing clinics actually treat patients. The prevention efforts and the treatment programmes have to be done by real people on the ground. The provision of funds and permission by distant entities is not enough. So there is something for all of us to do.

I would like to pay special tribute to the role that has been played in this struggle by the people who have been infected and the people who have been affected by AIDS the families, the communities, the friends. Who have sounded the alarm and joined together to care for their own in the UK, the US and other nations. With such limited resources for such a long time. Many of you have developed solutions that laid the groundwork for the global response to AIDS. But I will say again, you have shown us what works, what remains is to take it to scale and implement it wherever AIDS exists. That is why I am honoured to chair the board of the International AIDS Trust with former President Mandela, to work with Sandy. We will be working with partners here and throughout the world to tap the genius people have for fighting AIDS at the grass roots level, wherever we find it and then to spread it. It is maddening to go into a place where you have seen AIDS basically banished and ask yourself if it happened here, why hasn't it been done somewhere else. Why hasn't it been done everywhere else? Why is anybody dying if all these people are alive? This is not rocket science, it is a matter of money. organisation and will. Yes, it won't be over until we develop a vaccine or some cure but we can certainly prevent 100 million AIDS cases. We can certainly prevent 40 million orphans. The tragedy of 2005 does not have to become a reality.

In the US most people are still mourning what happened on September 11. Believe it or not, we have just finished the memorial services a couple of days ago. About 300 of those people were from the UK, and Cherie and Tony Blair came to the US for a very moving memorial service which Chelsea and I attended with them. But about two and half times as many people die every day from ADS as died on September 11 from the terrorist attacks. In a world without walls, these people are our neighbours too. Of course the nations with high infection rates have to do more to help themselves, but we can help them do that. Of course it will cost money to do this. But if we don't spend it now, we will spend more, much much more later on.

Just as the world's poor cannot be lead by people like Mr Bin Laden who believe they can find their salvation in our destruction. The world's wealthy nations cannot be lead by people who play to our shortsighted selfishness and our indifference to the suffering of people beyond our borders. AIDS is a great test case for the age of interdependence. If we really want a future for our children, we will have to make the world without walls a home for all its children.

Thank you very much.