Sec. Clinton: “Creating an AIDS-free generation has never been a priority of the U.S. government until today…”

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The community responds to Clinton’s momentous speech

The U.S. Secretary of State Hillary Clinton made a bold announcement Tuesday – that an AIDS free generation is possible and the U.S. will be working toward that goal. Aiming to reinvigorate the fight against global AIDS, she emphasized the leadership role the U.S. must play but, as administration folks have reiterated for several months, the U.S. cannot do it alone.

Secretary of State Hilary Clinton speaks to a packed audience Tuesday at the National Institutes of Health.

Achieving an AIDS free generation, she said, requires ensuring that no children are born with the virus; that as these children mature they are at a far lower risk of becoming infected; and if they do acquire HIV, that they have access to treatment that keeps them from developing AIDS and passing the virus on to others.

“Creating an AIDS free generation has never been a priority of the U.S. government until today – because this goal would have been unimaginable just a few years ago,” she said, referring to new groundbreaking evidence that utilizing a combination of prevention interventions can make a significant impact on the devastating toll of this disease. The key interventions needed, she said, are prevention of mother-to-child transmission (PMTCT), voluntary medical male circumcision and antiretroviral therapy (ART) to prevent transmission among discordant couples — where one partner is HIV infected and the other is not.

“She spoke emphatically about the importance of using scientifically proven tools to prevent the spread of HIV infection,” said Dan Kuritzkes, MD, director of AIDS Research at Brigham and Women’s Hospital in Boston, noting that the three tools she highlighted have each proven effective through prospective, randomized clinical trials funded by the National Institute of Allergy and Infectious Diseases with other donors and funders. “Her call to change the course of the AIDS epidemic by applying these science-based approaches, including condom use and counseling and testing, emphasizes the need to use combination-based prevention strategies.”

Citing a recently published scientific paper, Clinton said, “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.” Clinton also noted that the President’s Emergency Plan for AIDS Relief (PEPFAR) program costs for treating patients – including medication and services – have dropped by 24 percent in just the last year.

To further assess the benefits of combination prevention, Clinton announced a new $60 million investment by PEPFAR in four countries in sub-Saharan Africa, to rapidly scale up these interventions and “rigorously” measure their impact. The U.S. recently gave grants totaling $50 million to three institutions to develop rigorous studies to test what combinations of interventions work in various settings.

The Secretary also took a moment to speak in defense of the Global Fund to Fight AIDS, Tuberculosis and Malaria – a multilateral donor organization that has taken heat recently as internal investigations have turned up the mismanagement and misspending of some grant money. “…Let’s remember, uncovering problems is exactly what transparency is supposed to do. It means the process is working,” she said. Giving an example of one of the many achievements of the Fund, Clinton said, “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.” She then urged donor nations to step up and continue to fund the organization and not penalize them for taking steps to uncover internal fraud.

Community Response

Her speech to a packed audience of policymakers, global AIDS advocates and scientists at the National Institutes of Health in Bethesda, Maryland, drew varied yet positive reactions from the community, as well as some unanswered questions. Like, what next? And what about funding?

“Sec. Clinton laid out a vision for beginning to end this epidemic,” said Chris Collins from the Foundation for AIDS Research (amfAR). “Her leadership, and the startling scientific results of the last year, raise our hopes, and also our expectations for what comes next in terms of policy implementation from the White House.”

“What I hope would come from this speech is a continued, long-term commitment by the U.S. to the fight against HIV – A concerted effort to focus on what we know works and to take that to action and scale,” said Wafaa el-Sadr, MD, MPH, founding director of ICAP at the Columbia Mailman School of Public Health and a professor of epidemiology and medicine at Columbia University “Now is the time to move from aspiration to action.”

“She made it clear that the United States is not walking away from treating and caring for those living with HIV and helping to prevent the spread of new infections,” said Smita Baruah of the Global Health Council. “Collectively we all must help the U.S. keep up its commitments.  Congress must also not back away from efforts to fight against HIV/AID and other global health issues.  Funding is a critical component to ensuring an AIDS-free generation.”

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