Yesterday, Secretary of State Hillary Rodham Clinton spoke at the National Institutes of Health about the remarkable progress that we have made in 30 years of fighting AIDS (You can watch or read her remarks here.) The Secretary also highlighted the extraordinary opportunity we now have to move toward an AIDS-free generation. For the first time in history, this prospect is not only imaginable but possible. For the President’s Emergency Plan for AIDS Relief (PEPFAR), her vision was an affirmation of the progress made over the past decade, and a mandate to redouble our efforts with global partners to bring the latest scientific advances to bear in order to save lives.
Over the past three decades, the fight against AIDS has been a global effort. Yet, as the Secretary noted, America’s leadership has played a vital role. From the earliest days of the pandemic to the present day, all sectors of American society have contributed, both at home and abroad. U.S. leadership, and our close partnerships with other governments, multilateral institutions, the private sector, and civil society groups (including faith-based groups), have set the stage for where we stand today.
In her remarks, the Secretary announced the bold vision of creating an AIDS-free generation, “[C]reating an AIDS-free generation has never been a policy priority for the United States Government until today, because this goal would have been unimaginable just a few years ago. Yet today, it is possible because of scientific advances largely funded by the United States and new practices put in place by this Administration and our many partners. Now while the finish line is not yet in sight, we know we can get there, because now we know the route we need to take.”
This goal requires us to utilize the many tools that we have acquired through scientific discovery and practical experience in innovative ways. It demands that we do business differently, by adapting our programs to embrace new evidence and opportunities. In 30 years, we have learned a great deal not only about what works, but also how to package those effective interventions in synergistic ways. Driven by this understanding, just as doctors talk of combination treatment — prescribing more than one drug at a time — we are now stepping up our use of “combination prevention.”
Secretary Clinton explained that PEPFAR’s combination prevention strategy comprises a core set of interventions that have been proven highly successful in the AIDS fight: prevention of mother-to-child transmission, voluntary medical male circumcision, and antiretroviral treatment for people living with HIV.
This combination prevention package is rigorously supported by scientific evidence. First, we have long possessed the tools and the knowledge required to virtually eliminate mother-to-child transmission around the globe — just as we have done in the United States — while also saving mothers’ lives. Second, research has proven that voluntary medical male circumcision reduces the risk of female-to-male HIV transmission by more than 60 percent — a one-time intervention that provides a life-long benefit.
Finally, new evidence proves that by treating a person living with HIV, you reduce the risk of transmission to a heterosexual partner by 96 percent. That is as powerful as any HIV vaccine for which we could hope. Simply put, treatment is prevention — and is extraordinarily effective.
When used in combination, these are smart investments that change lives. Mathematical models show that scaling up combination prevention to realistic levels using these three core interventions in high-prevalence countries would drive down the global rate of new infection by at least 40 to 60 percent. That is on top of the 25 percent drop we have already seen in the past decade. Moreover, by implementing this core package along with other effective interventions, such as condoms, HIV testing and counseling, legal reform, programs to reduce stigma and discrimination, and the behavioral supports needed for all successful efforts, we can maximize the total impact.
To realize Secretary Clinton’s vision of achieving an AIDS-free generation, the United States is working to support an optimal mix of HIV prevention interventions in each country. PEPFAR is prioritizing activities that will have the maximum impact on reducing incidence (new HIV infections) and on saving lives, and ensuring that all programs are well tailored to local and national circumstances. To this end, I am very pleased with the Secretary’s announcement that PEPFAR will commit an additional $60 million to scaling up combination prevention in parts of four countries in sub-Saharan Africa, on top of a previously announced $50 million for focused research in these countries. And we will closely measure the results of these efforts, and then use the findings to improve our programs in every other country where we work. By translating science into service delivery, and policy into programs, we are continually striving to do more, and to do it better.
Thanks to the leadership of the Obama Administration and strong bipartisan support from the U.S. Congress, the United States, through PEPFAR, will continue to play a pivotal role in the global AIDS fight. But we cannot do it alone. Much work remains, and we need all hands on deck to make it happen.
First, we need to strengthen country ownership of AIDS programs. All of our country partners — including governments, NGOs, and faith-based organizations — need to lead their national responses. And the PEPFAR team is committed to reinforce country ownership in concrete ways.
This means we need to share responsibility in the AIDS response, including by partner countries increasing their own funding. Some countries have made great strides, and others should follow. The American people respect the work being done on global AIDS and know it is important, but we need to show them — and the world — that it is truly a collective effort.
Second, we need other donors to step up their efforts, including by supporting and strengthening the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The Fund is an essential partner in the AIDS response, and the United States is the largest individual contributor to the Fund. At the same time, the Fund needs to meet its own responsibilities, including through continued reforms, to maximize the impact of its investments. As the Secretary stressed, it is our job as donors to make sure that the Fund continues to do its job, and I am committed to help ensure that it does.
Though the road ahead will not be easy, the opportunity before us is extraordinary.
The response to Secretary Clinton’s speech has been profoundly encouraging. I have already heard from many that they found her vision an inspiring one. In my role as U.S. Global AIDS Coordinator, I am committed to carrying forward this vision. I know that through the dedication of PEPFAR teams around the world, and of our many global partners from all sectors, we will do just that. I believe we all agree with the Secretary’s comment that “An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future.”
Editor’s Note: This entry also appears on the Huffington Post .