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									Mark Cloutier                                               Leadership Recognition Dinner
Chief Executive Officer                                     Fort Mason
San Francisco AIDS Foundation                               May 1, 2008




Thank you.

My name is Mark Cloutier. I am the Chief Executive Officer of the San Francisco AIDS
Foundation and President of the Pangaea Global AIDS Foundation and I am proud to
speak with you tonight and to share a few thoughts on this celebration of HIV/AIDS
leadership.

You heard about San Francisco over and over again tonight. Our honorees and
presenters spoke of visionaries in our midst. The film accurately cast this city as the
nation’s first responders to HIV and AIDS. As I watched it, my own memories of those
days many of us shared together washed over me. No metaphors are needed; we did
stand shoulder-to-shoulder against this virus. We supported one another through the
alternating tragedy and triumph that marked the last 27 years of our lives.

San Francisco’s role in the past has become the stuff of legend. But it’s time we
determined our role in the future. For decades, the world has shared the burden of
HIV with San Francisco. What will San Francisco do for the future of HIV and AIDS?

As you heard tonight, the coalition approach worked. Activists working with local
government together with generous donors working with organizations like the San
Francisco AIDS Foundation successfully reduced new infection rates. We defended
human rights and fought discrimination. We built institutions with the right tools,
some, like needle exchange, taken directly from the street; others, like advocacy for
the Ryan White CARE Act or increasing the availability testing in California, we sent to
Washington and Sacramento with a feverish new political voice that’s still heard
today. The work benefited people all over the country facing HIV and AIDS, most of
whom never set foot in San Francisco.

But as many of you have heard me say before, our work is still unfinished. In San
Francisco— and in many other parts of the US—  HIV infection rates have reached a
stubborn plateau. In this city, between 800 and 1,000 new infections have occurred
every year for the past eight years. Among African-American men who have sex with
men, new infections haven’t stabilized; they are still rising.

That is unacceptable.

It is unacceptable for a 41-year-old HIV-negative man on Noe Street not to reach for
protection when he does not know the status of his partner.




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It is unacceptable for a 24-year-old in a residential hotel on Sixth Street to barter sex
for drugs, with no connection to a network of friends to share the burdens of
adversity and no one with whom to talk about risk.

                                               or
It is unacceptable for anyone in San Francisco— the entire Bay Area—    who may have
been exposed to HIV, not to have easy access to testing, not to go for that test, and
not to access care and treatment.

As a leader, the San Francisco AIDS Foundation has a mandate to build on our
collective strengths, mobilizing prevention interventions that reflect challenges like
condom fatigue, substance use, and persistent poverty; interventions which can be
evaluated rigorously with proven results like our Speed Project or Black Brothers
Esteem; interventions grounded in the best available scientific evidence. The
Foundation is becoming a laboratory with the capacity to innovate, adapt and
disseminate strategies that reduce risky behavior and build healthy communities that
foster well being.

I know, I know, we’re dealing with areas of human condition, including sexuality and
drug use, that aren’t, frankly, rational. What’s more, acquiring HIV today is different
than in 1978 or 1988 or even 1998. HIV prevention predicated on the horizon of
fear, disfigurement and protracted illness, is ineffective in an environment of triple-
drug cocktails that have virtually eliminated the visible specter of disease.

But unless we are comfortable with the certainty that anyone seeking a future in San
Francisco will also find HIV here, we must act. If we don’t, new infections will always
be present. Today. Tomorrow. Years from now. A child born this morning will one
day come to San Francisco to make a home. Don’t we owe it to him to have done a
better job eliminating the risk that he will become HIV-positive on his 25th birthday?


HIV infection is not inevitable.


HIV infection is not inevitable when we embrace scientific evidence.

Scientific evidence stands at the center of every successful intervention. A growing
body of research now suggests that individuals who have been recently infected with
HIV—  what physicians call the acute infection stage— might account for as many as
half of new infections. The acute infection period is the time immediately following
infection trough seven weeks when an individual is at exceptionally high risk of
transmitting HIV to sex and needle-sharing partners.

We see an imperative to put new scientific information to use. I am pleased to
announce that we are creating a program to address acute infection. Staff, across
the Foundation, people rich with the intellectual capital of a 26-year-old agency, are
collaborating to attack this problem. They will use the expertise they’ve gained
throughout their careers, their interactions with our clients, and the emerging data on


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acute infection to put this science to work. I am eager to share details of this brand-
new initiative with you as it realized. It is the latest in a long series of interventions
based on evidence, one we will evaluate to see how well we have raised awareness
about acute infection and changed behavior to lower infections.


HIV infection is not inevitable when we demand a National AIDS Strategy.

Though San Francisco has been a leader in many best practices, the United States
has been less than a follower. We require countries funded under PEPFAR to have a
national strategy for addressing HIV, but our country doesn’t have one. That means
that efforts to improve prevention and treatment, to establish priorities to coordinate
interagency planning, and to focus on the prevention and treatment needs of the
most vulnerable populations move forward in a haphazard and aimless way.

As a response, the San Francisco AIDS Foundation is leading a coalition of national
organizations to require the federal government to adopt a National AIDS Strategy
and bring much-needed vision to the inequity that is increasingly typical of domestic
HIV. Earlier this week, I went to Washington with Foundation clients and met with
Congressional staff, determined to gain support for the National AIDS Strategy from
both sides of the aisle. We’ve worked to get all major Presidential candidates to
embrace a National AIDS Strategy…and we’ve been successful in two out of three
cases.


HIV infection is not inevitable among drug users or commercial sex workers, not on
Manhunt or Craig’s List, not in the Castro or on Sixth Street or Bayview / Hunter’s
Point or anywhere in our mosaic of a gay community.

I’ve asked the question many times, “what would a healthy gay community look like?”
When the Foundation acquired Magnet and the Stonewall Project last year, we knew
both were models of compassionate care that focused on gay men’s health, and we
wanted them to expand.

Did we need to? Yes. The zip code 94114 still accounts for more of San Francisco’s
HIV/AIDS cases than any other. Because HIV testing is one of the keys to reducing
transmission, we doubled Magnet’s testing capacity—    free, convenient, immediate.
Because need for culturally-appropriate testing for the City’s gay community is still
high, we’re looking for ways to expand these services further, offer healthcare and
substance abuse counseling to more people with an eye towards lowering HIV
infection rates among gay men all over San Francisco.


HIV infection is not inevitable anywhere that sees San Francisco as a model.

With the distinction of being HIV’s “first responders” comes the privilege of influence.
We have a proud history devising interventions that travel the world, reducing


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infections and improving quality of life for people living with HIV. Our global affiliate,
Pangaea Global AIDS Foundation, is providing life saving antiretrovirals to
subsistence farmers in Yunnan China and methadone treatment and antiretrovirals
to combat the epidemic among injections drug users in Ukraine.

This tradition of learning from our example continues in ways that reflect the best
work we’ve done, often with the seasoned expertise of the Pangaea Global AIDS
Foundation.
A few months ago, Pangaea was approached about creating comprehensive centers
for gay men’s sexual health—                          in
                               Magnet-like facilities— Lima, Peru and in 13 cities in
China.

At home, our needle exchange program, still the city’s largest, has brought new
infections among intravenous drug users to the current rate of less than one percent,
virtually eliminating HIV infections among women in San Francisco. Celebrating its
20th anniversary this year, our model of needle exchange is credited with driving
down infections all over the world.

More recently, the CDC paid a visit to Black Brothers Esteem where our innovative
work on health and community development may become a national model to be
duplicated in several US cities where HIV infection among African-American men who
have sex with men is as high as 46 percent.


HIV is not inevitable when we are serious about good health…and we take it on the
road.

This year more than 2,500 registered AIDS/LifeCycle riders will raise money to help
the Foundation continue to prevent new HIV infections. AIDS/LifeCycle and our other
signature events, the AIDS Marathon and AIDS Walk, are more than fundraisers.
They’re impromptu spaces for Foundation supporters to come together and celebrate
health – which is, by the way, a commodity you’re going to need if you’re planning to
ride 545 miles in a single week. The same formula fuels the Seismic Challenge, a
new event that will guide riders 200 miles down the San Andreas Fault on a single
weekend where HIV and AIDS will be the unifying factor motivating all of us— HIV-
positive or HIV-negative.

It’s obvious that we would never be able to produce events like AIDS/LifeCycle and
the Seismic Challenge without the friends we have, the people gathered here tonight.
And this allows me to return once again to you and to San Francisco.

The San Francisco AIDS Foundation takes seriously the trust of this community. We
see the city’s needs, and seek opportunities to solve the problems of HIV and AIDS
that resonate nationally.

If ever a city could stare HIV in the eye and say, “not here,” it is this one. If a town
ever existed that had the ideas, the resources, the support from its elected officials


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and its private citizens, to reduce…and reduce…and again reduce…the rate of new
infections, it is this one. If our work on acute HIV infection, on a National AIDS
Strategy, on improving the health of our communities, again puts San Francisco in
front, I am confident that others will learn that HIV infection is not inevitable. Not
anywhere.

Tonight I make a pledge to you that we will work tirelessly to lower…and lower…and
again lower…the rate of HIV infection in San Francisco, and make ourselves and our
strategies exemplars around the country and around the world. We will honor the
legacy of the past, thousands who made San Francisco the first city of AIDS, and we
will honor those who’ll comprise our future, to make San Francisco the first city
without it.




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