POZ Exclusives : Creating an AIDS-Free Generation

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November 8, 2011

Creating an AIDS-Free Generation

Now let me be clear:  None of the interventions I’ve described can create an AIDS-free generation by itself.  But used in combination with each other and with other powerful prevention methods, they do present an extraordinary opportunity.  Right now, more people are becoming infected every year than are starting treatment.  We can reverse this trend.  Mathematical models show that scaling up combination prevention to realistic levels in high-prevalence countries would drive down the worldwide rate of new infections by at least 40 to 60 percent.  That’s on top of the 25 percent drop we’ve already seen in the past decade.

As the world scales up the most effective prevention methods, the number of new infections will go down, and it will be possible to treat more people than are becoming infected each year.  And so, instead of falling behind year after year, we will, for the first time, get ahead of the pandemic.  We will be on the path to an AIDS-free generation.  That is the real power of combination prevention.

But success is not inevitable, nor will it be easy.  Coverage levels for many of these interventions are unacceptably low.  And we know from experience that to scale them up, we have to be able to deliver them not just in hospitals, but in clinics located in communities of every size and shape.  If we’re going to make the most of this moment, there are steps we must take together.

First, we need to let science guide our efforts.  Success depends on deploying our tools based on the best available evidence.  Now, I know that occasionally it feels in and around Washington that there are some who wish us to live in an evidence-free zone.  (Laughter.)  But it’s imperative – (applause) – that we stand up for evidence and for science.  Facts are stubborn things, and we need to keep putting them out there, even though they might, in the short term, be dismissed.  Eventually, we will prevail. 

Through PEPFAR and across the government, the United States is using scientifically proven results to inform our policy, which leads to real change for programs on the ground and maximizes the impact of our investments.  For example, we need more research to identify the most effective ways to combine these interventions in different contexts.  We know HIV is a complex pandemic that varies from country to country, district to district, from urban areas to rural.  It’s the same in our own country.  Combination prevention needs to reflect this complexity.  Which combinations are most effective in areas where the virus is concentrated in especially vulnerable populations?  What about places where it is more widespread in the general population?  

We're already working to answer these questions.  We recently granted more than $50 million to three of the world’s leading academic institutions to develop rigorous studies that test what works in various settings.  Today, I’m pleased to announce that we’re stepping up our efforts.  The United States, through PEPFAR, will commit an additional $60 million to rapidly scale up combination prevention in parts of four countries in Sub-Saharan Africa and to rigorously measure the impact.  

The results will have implications for every country where we work and for our partners as well.  They will help ensure that we are translating the science into services that deliver the most impact and will allow us to take bigger steps together in our march toward an AIDS-free generation.  I want to challenge other donors to join us in this effort.  Go out and find partner countries that will work with you to test the most effective combinations of tools.  Scale up support for treating as many people as possible.  Measure the impact and share the results, so we can all learn from each other.  

The second step is to put more emphasis on country ownership of HIV/AIDS programs.  This is a priority for the United States.  We know we can’t create an AIDS-free generation by dictating solutions from Washington.  Our in-country partners – including governments, NGOs, and faith-based organizations – need to own and lead their nation’s response.   So we are working with ministries of health and local organizations to strengthen their health systems so they can take on an even broader range of health problems.

Country ownership also means that more partner countries need to share more responsibility for funding the fight against HIV/AIDS within their borders.  Some countries have allowed money from outside donors to displace their own investments in health programs; well, if PEPFAR or the Global Fund or another donor is going to be giving us money for health, we can just take that money out of health and build some more roads.  That has to change and we have to demand that it change.  More countries need to follow the lead of South Africa, Nigeria, Senegal, Rwanda, Zambia, and others that are committing larger shares of their own budgets to HIV/AIDS.

Finally, we’re calling on other donor nations to do their part, including by supporting and strengthening the Global Fund.  Consider just one example of what the Global Fund has already done.  In 2004, virtually none of the people in Malawi who were eligible to receive treatment actually received it.  As of last year, with significant help from the Global Fund, nearly half did.  

This kind of progress deserves our support.  The United States is the largest individual contributor to the Fund, and the Obama Administration has made our country’s first multiyear pledge to it.  Some donors are, unfortunately, considering reducing their contributions.  Some emerging powers and nations that are rich in natural resources can afford to give, but choose not to.  To sit on the sidelines now would be devastating.   It would cost lives, and we would miss out on this unprecedented opportunity.  When so many people are suffering, and we have the means to help them, we have an obligation to do what we can.

And for its part, the Global Fund has its own responsibilities to meet.  The United States has supported reforms at the Fund to ensure that its resources are reaching those in need and that they are focused on cost-effective, evidence-based solutions.  The Fund is conducting a number of audits and investigations that have surfaced reports of fraud and corruption.  It is the Fund’s responsibility to root out these abuses and end them as quickly as possible. 

But let’s remember, uncovering problems is exactly what transparency is supposed to do.  It means the process is working.  So let’s not put the Global Fund into some kind of catch-22.  Go be transparent, go be accountable, and when you find problems, we’re going to take money away from you.  Now, from day one, the United States Congress has insisted that our contributions to the Global Fund support accountable programs that produce measurable outcomes.  And it’s been my experience that the American people are happy to support lifesaving programs if they know they really work.  And this is how we show them. 

The goal of an AIDS-free generation may be ambitious, but it is possible with the knowledge and interventions we have right now.  And that is something we’ve never been able to say without qualification before.  Imagine what the world will look like when we succeed.  Imagine AIDS wards that once were stretched far beyond their capacity becoming outpatient clinics caring for people with a manageable condition, children who might have been orphaned and then trafficked or recruited as child soldiers instead growing up with the hope of a better future, communities where despair once reigned filled instead with optimism, countries that can make the most of every single person’s God-given potential.  That is the world that has always been at the core of American belief, and we have worked toward it in our own history.  It’s the world I think we all would like to live in.  An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future. 

Much of what we do will depend upon the people in this room and the hundreds and thousands like you – the researchers and scientists, the public health docs and nurses and other personnel, the community health workers, the funders and donors, the government officials, the business leaders, philanthropies, and faith communities that have all joined together in this quite remarkable way to combat this disease. 

So I end where I started.  We’ve made a lot of progress together in the last 30 years.  It hasn’t been easy.  It hasn’t been without controversy.  But it has been steady, and we have stayed the course as a nation.  In these difficult budget times, we have to remember that investing in our future is the smartest investment we can make.  And generations of American policymakers and taxpayers have supported the NIH, medical research, scientific work, not because we thought everything was going to produce an immediate result but because we believe that through these investments, human progress would steadily, steadily continue. 

Let’s not stop now.  Let’s keep focused on the future.  And one of those futures that I hope we can be part of achieving is an AIDS-free generation.  Thank you all very much. (Applause.)

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