Rome, 12 May 2011.

Press conference presenting Project Malawi Corrado Passera: It is truly a pleasure for me to present a project that involved both Fondazione Cariplo and Intesa San Paolo in an important promotional role, which they continue to guarantee, not only through financing but also through coordination. However, concrete contributions were made by organisations which have already been partially mentioned: firstly the SantEgidio Community, Save the Children, the local Scouts and CISP, which is with us here today. We have also been joined, over time, by Italian paediatricians and neonatal doctors; this is a strong and committed team, which for a long time has been involved in important works. For this reason we are pleased to accept this invitation by the SantEgidio Community, which will host a convention over the next few days with the participation of many important African exponents who will examine the Project to date. We are pleased to do so in the presence of a representative of the Malawi Government, because these projects, if they are to be vital and sustainable over time, require strong integration with national structures. We cannot limit ourselves to taking skills and installing structures; we need to create internal strength, train people on-site, create structures capable of collaborating with central structures. Mary Shawa, who has worked with this project for more than six years, has acted as its sponsor in Malawi. The cover that will now appear on the screen is a sort of summary of all of this: strong contribution by the four non-governmental organisations, an equally strong contribution by the Malawi Government and the two sponsors and principal coordinators, Intesa Sanpaolo and Fondazione Cariplo of course. All of this leads to a project that we have simply called Project Malawi. It is a project that appeared to be somewhat impossible a few years ago, primarily for the reasons mentioned earlier by Marazziti: no-one believed that a country in such a bad situation could recover positive trends such as the ones we are witnessing today. Today, six years later, we are reporting to you and not because the project has concluded: it must continue and will continue with our firm support. However after six years and after real and proven results that have been achieved, it appeared to us to be a good occasion to benefit from the event organised over the next few days in Rome by the Sant'Egidio Community to share with you some of the work done. Two points must be underscored. Primarily, the issue of AIDS has not been resolved, although little is spoken about this in Italy, because we have learned to live with it and people are not dying in the way they did before. AIDS still represents - for the world in general and certainly for Africa - an enormous problem that has not been eliminated and must be dealt with. Project Malawi and the Dream programme in particular,

most specifically dedicated to treating AIDS, has proved to be effective so this is not just a promise, not just a commitment in dealing with AIDS using an integrated approach, which I would like to try and illustrate with regard to health and development. Clearly the maximum priority and emphasis have to date been given to health, the starting point to create hope for a future. However if we did not act on prevention, education, micro-financing, support for this endless population of orphans, there would be no hope of resolving problems with a merely medical approach. So lets look at some concrete data both on the first and second point. The first table shows that in certain countries, in the sub-Saharan part of Africa in particular, AIDS is still a problem of enormous scope: we are talking about more than 33 million infected persons with two thirds of them concentrated in this region. So it is absolutely and dramatically true that in some parts of the world it continues to represent the foremost problem. At page 4 you can see that AIDS is the main cause of death, far outweighing any other cause; we are therefore talking about an epidemic that is still important and this is the reason why we are not giving up, and in fact we are going to increase our action. At page 5 you will see the same type of message: AIDS is still the principal cause of death in Africa, and if we look at various parts of the world, where obviously there are many different causes of death, both in terms of mix and overall effect, you will see the difference between wealthy countries and the African continent. If we should investigate further and look specifically at the sub-Saharan area of Africa, the terrible string of illnesses and percentage of deaths from AIDS would be even higher, but even by this we know just how serious the problem is, and it is therefore essential to pay attention to this problem. This is not just a health issue, its a social issue, because AIDS destroys families, and when the fundamental structure of society is destroyed that same society is destroyed. AIDS has produced 16 million orphaned children and 90 per cent of them are concentrated in the countries we are talking about. We are talking about 16 million children. The extent of the problem is endless and triggers further exceptional problems: since orphans do not have access to education and are not cared for, desperate generations are created, generations without hope who are open to social and economic risks, which are far greater than the medical issue itself. According to the various countries involved, the cost of AIDS is enormous in terms of lost development and amounts to 1-2 per cent of GDP, a figure which makes a difference in many of these countries. Since the few doctors, nurses and teachers in these countries also die, society itself becomes weaker, destructured and incapable of coping with the extent of the problem. I have merely summarised some aspects, not to highlight the weaknesses of the country, but to justify the need for intervention and the commitment we have made

thanks to this information, which we evaluate periodically with Mary Shawa and the people who manage the project in Africa. AIDS remains the number 1 cause of death and this is easy to state: more than 12 per cent of the population is infected and 17 per cent of mothers are HIV positive. If project Dream did not exist, many of them would have to give birth to sick children, and when you are born sick this means that there is no hope. The aim of Project Malawi, if we want to summarise it, is to raise a barrier against the disease in order for healthy generations to be born, who can hope for a better future. It is extremely difficult to construct a life from an economic, social and democratic viewpoint, but if we dont protect the right to be born healthy there is no chance of achieving something positive in life. We are talking about transmission through deliveries of tens of thousands of possible newly infected persons each year; we are talking about an illness which, as stated in the remarkable film, is not only critical and leads to death, but marginalises, hides, ghettoises people and facilitates or worsens economic and social degradation, making it even more terrible. I mentioned the fact that the first victims are those who can contribute to the solution, such as doctors, teachers, nurses and persons who generously treat this illness. When you think of Malawi, a country with little more than 10 million inhabitants, and more than 1 million orphans, imagine what that would mean proportionally in Italy, adding levels of poverty that we have certainly not experienced for many decades: these are problems that appear to be irresolvable. Since hope was almost lost, we wanted to concentrate our efforts together with Fondazione Cariplo in an area where it appeared that everyone had given up but where the possibility to take action still existed. The numbers, above all six years ago, showed that Malawi was reacting to these characteristics. Lets now look at some of the results. I will quickly recall some of the characteristics of Project Malawi: the first objective is to improve the living conditions, health and overall development for the population. A second specific objective is to create a barrier against AIDS which we spoke of earlier, through preventing the transmission of AIDS from mother to child, i.e. contributing to creating healthy generations. We must then contain the economic and social impact of the AIDS epidemic. The approach adopted is fundamental: we are talking about an integrated project including cooperation with the locals, because woe betide if each person deals with their own little piece autonomously and the interventions made from the outside are not linked to local structures so that they can be developed over the long term. A second aspect: the fight against AIDS is the main objective, but health education, prevention, aid to orphans, local development and micro-finance must also be developed. It is a fairly unusual model, there are not many cooperation projects of this kind and this is one of the reasons why the UN recognised us and awarded us for our work. We were talking

about financing, because these works cannot be carried out in the absence of important resources which in our case are guaranteed by Fondazione Cariplo and by Intesa Sanpaolo. We have already earmarked 18 million over the last six years, and then we found other contributors: for example, employees of Intesa Sanpaolo made part of their resources available. We reached a total of 20 million, a figure which makes this one of the biggest private projects in this field globally. We belong to the Business Coalition Association, which involves all those private persons committed to the fight against AIDS throughout the world. We have received confirmation that there are really very few projects of this scale, duration and scope. The quality of therapy is another important feature, as our experts will explain later. This was not the case in the past: Africa was given leftovers, whatever we had; today the results that we have achieved originate from the application of the best global standards. The care that you receive in Italy or in the US is the same that we guarantee there. The quality of the laboratories, the type of analyses and prevention that we now guarantee to parts of the population and hopefully to an ever increasing number in the future, are just as good as the care that has allowed us to start to isolate AIDS in our countries. The most important thing is that we collaborate with the Government, because the project must be implemented within the structures and life-style of the country, it must involve local communities, which are of utmost importance, villages, local provinces, which are in part responsible for applying some of the changes that we introduce. Investment in training: we are talking about hundreds of trained locals, who then continue on their own, with better organisation and coordination in various parts of the country. We involve non-governmental organisations with territorial offices and whose members are predominantly Malawi. What does that mean? Take the scouts for example, the girl-guides, one of the most vital organisations in Malawi: they spread the message of training, education and hope throughout the country. They do this through theatre, establishing small pre-schools, or pre-schools for local children. Only with large local structures can we achieve results that will make a difference. One last word on the role of the sponsors, Fondazione and Intesa Sanpaolo. They do not just write a cheque, they are directly involved, they feel part of this, they feel responsible, they travel to Malawi, they ensure coordination, which does not occur naturally. This is truly a long-term commitment, because often as many governments tell us, also in other parts of the world - these projects start, they have an initial boom, they make spot announcements, but then they fade away, whilst the commitment that we have made is to go through to the end. A great deal of rigour is required on monitoring and controlling costs and investments; in this regard, I believe this is one of those cases that can lead by example. Clearly this is also due to Fondazione Cariplos extensive experience in managing humanitarian and social projects, with its tried and

tested mechanism for reporting back on the results of the projects. I repeat, the four big areas are health and the treatment of AIDS, which is obviously the biggest in scale and is managed by the SantEgidio Community, followed by the integrated activities of education and prevention, carried out by Malawi scouts and by the project Dream. Save the Children is mainly involved in the care of orphans, while the International Committee for the development of people (or CISP) carries out economic policies on micro-credit and micro-entrepreneurship. Let us take a look at the main results for each sector. Since scientific matters must be explained in a comprehensible manner, Dr. Palombi will be much better than me at this, but some things make a difference and I would like to concentrate on them. Africa before and after Dream Project are two different realities, because Africa has now been given protocols of global excellence. As Marazziti mentioned at the beginning, initially at the very most we provided some prevention with the excuse that there was no money nor viable solutions to carry out therapies. No, Dream has shown that by combining prevention and therapeutic treatment we can achieve results. Initially the therapies adopted were extremely simple, mono-therapies, bi-therapies and therefore they had scarce results in the prevention of mother-to-child transmission. However it is clear that only through the application of tri-therapies to all pregnant women the results are extremely important. Third point, when do we start? At birth? No, we need to start much earlier: when the conditions are this bad that is too late and so it is necessary to start earlier, monitor and invest in terms of preventive care. According to the Dream model, only if mother and child are accompanied throughout breast-feeding is it possible to eliminate and lower the probability of an early death for young babies. This has become the Procedure. Last but not least, we have progressed from purely clinical diagnosis in the field to thorough and rigorous diagnosis based on laboratories and techniques which represent the frontier of knowledge in this field, as you would confirm if you could see them in person. Results: this blue line represents the percentage of mother-to-child transmission of AIDS for mothers under care as part of project Dream: the other lines show the results in the absence of care, or obtained following different and much more simpler care plans. So these are numbers that speak loudly in terms of effectiveness. This is the maternal death rate. Many mothers died after giving birth; now, as you can see, with the application of the Dream protocol as part of the project Malawi death rate is reduced by three quarters: this is a different life expectation and result expectation. Dr. Palombi will provide more details on this, however these numbers demonstrate that the viral load, i.e. the strength of the illness in communities in which the Dream protocols have been adopted, drops significantly: we are talking about numbers that drop from 91 to 5. These are concrete demonstrated results: thanks to them the WHO and the Malawi Government have

taken some important steps. Let us look at the strength of the virus in communities where mothers have been treated during pregnancy: in addition to higher rates of recovery, the entire community produces persons who are less vulnerable and less open to infection. So, these are world championship numbers, which led to important changes both with regard to WHO (in the first chapter the results of the Dream programmes are cited as being of significance in relation to the WHO decision to introduce this type of protocol in place of earlier ones) and at a local Government level, which set up the early use of these protocols for a large part of the population. Since these results are not based on good intentions alone, investments are only possible if local structures are built. We have financed and sponsored the construction of nine hospitals that provide this type of assistance, which in a small country makes a difference; seven maternity structures the majority of which are connected to local structures, and four laboratories built from scratch, progressing from nothing to the possibility of thoroughly following the trend in the viral load and increase the effectiveness of care timing. Seven hundred trained operators, including educators and extremely specialised health operators. We are talking about numbers that start to be noticed within the entire country thanks to great communication activities and connections between the country, the continent and the rest of the world. This is the small country where our health centres and laboratories have been recognised together with communities in which Project Malawis activities have concentrated. These are just a few numbers, because the numbers provide proof of whether we have achieved success in our project or not, both in relation to our initial choices and in our operations. Clearly, these numbers will now grow much more quickly, because the structures have only been created over the past few years; we are however talking about three thousand children born healthy, we are talking about ten thousand people in care: these are significant quotas in the communities in which we are working, which lead to people who can hope for an acceptable life, rather than certain death. We are talking about significant activities by laboratories, but in this case too there has been an additional spurt, since all four of them are now operating perfectly; finally, consider the number of medical check-ups and samples: we are talking about large numbers which, in a country of this size, certainly make a difference. Aside from the fundamental activities carried out by Project Malawi, i.e. Project Dream, local scouts are doing their work wonderfully. I mentioned the enormity of this matter: we are talking about thousands of young people who made themselves available to help thanks to permanent initiatives in 158 schools, and tens of thousands of kids who have been trained. You have no idea of the scale of cultural retardation the film shows this to some extent because some things which make your skin crawl are not known. We not only have to fight against ignorance but also against convictions that appear to be

insane, such as if you rape a healthy girl you can recover from AIDS, so think what can happen within families. So informing families and kids that these are absurd things or about the right things to do can really make a difference. Now I dont want to give you all the details, but as you can see we are talking about tens of thousands of boys and girls. Everyone knows what Save the Children is: 104 centres have been created in the country, almost 600 educators have been trained, a Childrens Club has been created in many countries together with places where the hardship is dealt with and resolved. This is no mean feat: hundreds or thousands of works are ongoing and will not stop. Micro-finance and micro-credit, together with education regarding microentrepreneurship are difficult to put into practice and take a long time, the foundations are to be laid to transform a henhouse into a small economic venture, a business for the repair of buckets into something that can represent a source of income for the village. This is what the CISP deals with. A large working structure with local rural bodies, 300 business-men assisted on setting up their business plans and 77 revenue producing activities which proved to be successful with an impact that cannot be forever monitored, because when you understand that you can escape from absolute poverty by doing something relatively simple, the avalanche effect starts. We are also incredibly grateful to the Italian society of neonatology and paediatrics who, taking turns, are always present in a certain number of paediatric and neonatology departments of the area, providing a direct service and training local personnel. The next moves stem naturally from what I have been telling you. We must carry on: the original project has proved to be right, a second three-year period is concluding and a third one will commence soon. We must obviously continue to rethink protocols used to date. How to adapt them, how to develop them, whether or not to concentrate them in certain areas only, or to ensure that they are more widespread; in all probability we will concentrate them in order to defeat all sources of AIDS in a particular area, which is what we are evaluating at present. However we will speak of this another time, when we will specifically deal with activities planned for the next three years. Certainly, these commitments only make sense if they are long-term commitments. 3,300 children born healthy and their mothers still alive is a result that appeared to be impossible to achieve: we think that this is living proof that our efforts were worth it and that, as Marazziti said, this was a small contribution to real hope that is being created in Africa. So once again I would like to thank the organisations, firstly the Sant'Egidio Community; thanks to the support of the Malawi Government. Thanks to so many of you for following us, we hope you will continue to. I think I must now pass the floor to Mrs. Enoch, then to Palombi, a technical expert who will talk to you and provide more detail than I have. We must be convinced, because often all we do is write a cheque and we are not part of the decision and of the risk of starting a

new journey because Dream was revolutionary compared to other projects so, if we dont try and understand things a little, we wont have the same enthusiasm. And then Mary Shawa will speak to you and give you an idea of Malawis viewpoint.