Diary Prequel Package — page 257

ple Oct. 25, 2011 - Raj Shah (Administrator of USAID) called me at 1:30 PM to get a better feel of my position on treatment as prevention. I thought that he would have a problem with it, but he was really asking if it was better to target people with very early infection since they are most likely to spread infection. I explained to him that although this was the case, they represent a relatively small fraction of infected people and they are very difficult to identify at this early stage. I found out later in the day from Cheryl Mills (Chief-of -Staff to Hillary Clinton) that Bill Gates had told Hillary that treatment as prevention was a waste of money and would not work. Hillery (HRC) heard from Eric that Bill Gates is probably the only person in the world who felt this way and that is exactly what I told Cheryl (see my breakfast with Bill Gates above). It seems that HRC is to meet with Raj today to get his opinion and so that is why Raj called me. Also, HRC will come to NIH on my suggestion to give speech on this subject on Nov. 8. I helped drafting her speech. Oct. 26, 2011 - Conference call with Eric, Ariel, me, Charles Holman and various people from USAID, PEPFAR, and CDC (Tom Frieden) trying to hash out the difference between Eric/me/Tom and USAID. It appears (maybe) that we have convinced Ariel that our model is valid. More to come. Oct. 31, 2011 - Another WH (EEOB 430A) meeting regarding above topic. Chaired by Gayle Smith. Also there was Amy Batson (USAID), Lois Quam, and Tom Frieden by phone. Cold crisp day in DC. Fall is here! Again the tension between USAID goals and PEPFAR goals become clear. USAID is trying to enhance their own agenda, which in my opinion has failed with their spending millions on prevention messages that do not work. They are trying to derail the PEPFAR "scale up by efficiencies" initiative. Ariel is turning out to either be naïve or nefarious. I always heard that he was a good guy, but he and USAID team keep insisting that the efficiency money should go either to a broader GHI or to enhancing the non-treatment prevention agenda (PMTCT, AMMC, condoms, etc.). The PEPFAR/Fauci/CDC agenda is to use the efficiencies to scale up Tx from 4.2 million by 2013 to 6+ million by 2013. This should reach 8 million by 2015 without any additional funds. If you go to "blue Sky" of +$2.5 billion from 2013 to 2015, you will go from 8 million in 2013 to 10 million in 2015. The PEPFAR model also assumes and enacts a maxing out of the non-treatment prevention modalities. USAID disagrees and want to use efficiency money to favor non-treatment as Prevention. This is what Ariel is saying. After meeting with Eric Goosby, Ariel seems more convinced that the PEPFAR model may be OK. However, what does Raj Shah think???? Nov. 1, 2011 - Dinner with Rick Klausner at Matisse Restaurant on Wisconsin Avenue and Fessenden. Discuss the Qatar initiative, see above and below. But, conversation turned to Raj Shah and the PEPFAR/USAID story. Bottom line is that Raj has been talking with Rick and it appears from Rick and my prior conversation with Raj that Raj is not against treatment as prevention (TAP); however, he does not like the model and want to do it differently. (More on Qatar later - stick with USAID/PEPFAR for now)