On Monday, December 1, 2014, the White House hosted our commemoration of World AIDS Day, welcoming key leaders in the global fight against HIV/AIDS to share highlights of our progress on both the domestic and international responses to the epidemic and discuss important priorities for our next steps.
President Obama opened the observance with videotaped remarks in which he observed that “we are closer than we’ve ever been to achieving the extraordinary: an AIDS-free generation.” Noting that both science and momentum are on our side, the President encouraged all of us to continue the fight, remain focused, and “recommit ourselves to achieving an AIDS-free generation in our lifetimes.” Watch the video [ 95.7 MB] of his full remarks.
Observing that the United States’ commitment to fight and end AIDS is unwavering, Ambassador Susan Rice, the President’s National Security Advisor, underscored that since President Obama came to office the U.S. has strengthened the Presidents’ Emergency Program for AIDS Relief (PEPFAR), building on its bipartisan legacy, and investing in interventions with the greatest impact. Thanks to these efforts, we are now reaching 7.7 million people living with HIV around the globe with HIV treatment. “But the truth of the matter,” Ambassador Rice observed, “is that as far as we’ve come, the finish line is still not in sight. There are still too many new infections, and our progress has been uneven, whole communities are being left behind.”
She pointed specifically to two key populations. In the U.S., the fastest rate of new HIV infections is among young gay and bisexual black men. We need to work harder to better address the needs of this population, she observed. In addition, we need additional global efforts to address HIV infections among adolescent girls. Globally, she noted, 380,000 adolescent girls are infected every year and in sub-Saharan Africa young girls are infected at about 4 times the rate of boys. “So we’ve got to do more to prevent adolescent girls from becoming infected and, if they are infected, we’ve got to make sure they’re getting treatment. Because everybody counts.”
Ambassador Rice then announced the launch of DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) — a public-private partnership involving PEPFAR, the Nike Foundation , and the Bill & Melinda Gates Foundation to significantly reduce new HIV infections in adolescent girls and young women.
Secretary of State John Kerry observed that the fact that we have an AIDS-free generation in sight is a remarkable accomplishment as well as “an incredible statement about America’s values, about our commitment, about our willingness to take on tough challenges.” Among the accomplishments he highlighted were substantial declines in both new infections and AIDS-related deaths since the launch of PEPFAR in 2003. Secretary Kerry also observed that through U.S. investments, “We’re providing HIV testing and counseling to more than 14 million pregnant women. We’re training more than 140,000 new health care workers to deliver HIV and other health-related services in AIDS-affected countries.”
Though he observed that we are at a real turning point, he emphasized that the battle is not yet won. “There are major challenges ahead and they will require major commitments if we’re going to control the HIV/AIDS pandemic and achieve this AIDS-free generation that is our dream.”
Dr. Anthony Fauci, Director of NIH’s National Institute of Allergy and Infectious Diseases, reviewed what the science tells us about how we can bend the curve toward zero new infections and emphasized the importance of three key actions: expanding HIV testing so that we can identify those unaware of their infections; linking those diagnosed with HIV to care and treatment since individuals who achieve viral suppression can live a nearly normal lifespan and are substantially less likely to transmit the virus; and focusing on what he called the “prevention continuum” for those who test negative for HIV.
Observing that the prevention toolkit is larger and more effective than ever with the addition of pre-exposure prophylaxis and post-exposure prophylaxis along with other tools, he recommended that those who test negative be assessed for their risk and counseled about what combination of HIV prevention tools might be most appropriate for them.
Finally, Dr. Fauci underscored that HIV risk is not uniformly distributed among countries, within countries, within states or cities. There are, as researchers have observed, “hot zones” or “micro-epidemics” among vulnerable populations that require our concerted attention and tailored combination prevention efforts if we are to successfully bend the curve.
HHS Secretary Sylvia Burwell lauded the progress made to date in combating HIV but observed that there is still important work to be done in the U.S. and around the globe. “The time is now to redouble our sense of urgency both at home and abroad – so that together we can achieve the goal that brings us all here today: an AIDS-free Generation,” she remarked. Among the near-term priority actions to improve outcomes along the HIV Care Continuum, she observed, is expanding access to quality, affordable health care to people living with HIV in the United States.
The Affordable Care Act, she observed, represents a major step forward in the domestic response to HIV. As such, she applauded those involved in helping people at risk for or living with HIV to sign up for coverage during the Health Insurance Marketplace’s first open enrollment period and underscored the need for continued assistance during the current open enrollment period.
Secretary Burwell then facilitated a conversation with some leading experts on the domestic and global response to HIV:
- Ambassador Dr. Deborah Birx, Ambassador-at-Large and Coordinator of U.S. Government Activities to Combat HIV/AIDS
- Dr. Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria
- Dr. Vignetta Charles, Senior Vice President, AIDS United and a member of the Presidential Advisory Council on HIV/AIDS
- Dr. Helene Gayle, President and CEO of CARE USA
- Mr. Greg Millett, Vice President and Director of Public Policy at amfAR, the Foundation for AIDS Research
They shared their perspectives on key developments in the response to the epidemic and priorities as we move toward an AIDS-free generation. Among the themes of their conversation were the importance of using actionable data to improve impact and results, the vital role of partnerships in the response, the imperative of focusing on vulnerable populations and hotspots and engaging communities in developing approaches and tools that they will find usable and useful.
While praising the progress and initiatives highlighted by the other presenters, Bishop Yvette Flunder, a founder of City of Refuge United Church of Christ in Oakland, California, reminded us that stigma is a real hindrance that we must more directly confront if we are to achieve the goal of an AIDS-free generation. Several forms of stigma and discrimination persist and hinder efforts to disseminate HIV prevention information, promote HIV testing among vulnerable populations, and support linkage to and retention in care for those diagnosed.
“The realities of homophobia, homohatred, and heterosexism are particularly harmful to people living with HIV,” she observed. “And homophobia still kills.” To confront this stigma, she encouraged us to think in terms of fostering sexual literacy, theological literacy, and justice literacy. She also called on young people and those that love young people to use social media, the arts, and all tools at our disposal to get the word out, reduce stigma and discrimination that surround HIV, so we can achieve our goals.
In observing World AIDS Day 2014, we committed to focus our attention on the programs and policies that impact those most vulnerable and explore opportunities to partner to achieve an AIDS-free generation. Through the event and other activities and announcements, we highlighted a few major accomplishments and new initiatives, globally and domestically, in an effort to better reach communities at risk, both at home and abroad, and demonstrate that everybody is in, and everybody counts.
You can read more about the Administration’s efforts to end the HIV/AIDS epidemic in this White House fact sheet: Focus, Partner, Achieve – the U.S. Commitment to Addressing HIV/AIDS.
Douglas Brooks is the Director of the Office of National AIDS Policy.