AIDS 2014: Bill Clinton addresses International AIDS Conference delegates

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AIDS2014postScience Speaks is live-blogging from AIDS 2014 in Melbourne, Australia through the week, with updates on research, policy and insights from the 20th International AIDS Conference.

International AIDS Society/James Braund (C) 2014

International AIDS Society/James Braund (C) 2014

MELBOURNE, AUSTRALIA –   Former U.S. President Bill Clinton stirred the crowd here in Melbourne today with a talk that evoked memories and grief about the HIV leaders lost on Flight MH 17, outlined AIDS response successes including the work of his foundation, spotlighted country successes and expressed hope that the goal of an AIDS-free generation could be realized.

“For good or ill, we live in an interdependent world, and I invite us all to join the struggle to define the terms of our interdependence,” Clinton said.

“What happened to that airplane was a reflection of that struggle,” he said. “In 2003, Joep Lange helped us scale up HIV treatment and care in Tanzania and South Africa. He and the other colleagues we lost lived lives celebrating that interdependence.”

He said he was proud to be in Australia when the Australian foreign minister made his comments about the crash to the United Nations General Assembly, and that he was overwhelmed by the comments of the Dutch foreign minister as he imagined the last few moments on the flight before the plane was attacked. He also commented that he hoped government leaders will listen to the comments of the Dutch minister before they weaken their resolve to challenge this act of violence.

“We are here today because the world made the right decision in 2003 to fight AIDS and now to create a generation without AIDS,” he said. “This is more than a conference, it is a movement.”

He cited the nearly 13 million people who now get the treatment they need and deserve and called on all to embrace the ambitious targets recently announced by UNAIDS — 90 percent know their HIV status, 90 percent have access to antiretroviral therapy and 90 percent are virally suppressed. He called treatment “the most effective tool we have to fight AIDS” and noted that evidence continues to build that early treatment prevents transmission to others.

Clinton talked about the work of his Foundation to improve pediatric antiretroviral formulations and access for children while also acknowledging the need to eliminate the pediatric treatment gap and to go the “last mile” to eliminate vertical transmission, especially during the breastfeeding period when almost half of all transmissions occur.

Noting the tremendous progress made in improving HIV treatment regimens and making them affordable, he said that much more work needs to be done in the arena of diagnostic and laboratory services. He referenced the poor access of patients in low-income countries to viral load testing — less than 25 percent of patients. He said his Foundation has stepped up their work in this area and offered what he called his “favorite example”— the deployment of laboratory technicians in canoes equipped with point of care CD4 testing in rural Mozambique to reach people more quickly and expedite their access to care.

He also provided some success stories including an initiative in Ho Chi Minh City, Viet Nam, where expanded access to antiretroviral therapy and isoniazid preventive therapy resulted in a 90 percent reduction in TB among the HIV patients treated.

He worried aloud that countries and programs cannot currently afford to implement World Health Organization HIV treatment guidelines, “but we can’t afford not to.” He said the Foundation’s latest analysis of the global cost confirms that funding is not currently available, but suggested the goals are achievable if money is handled more effectively. He pointed to efforts by the Zambian government to scale up the use of paid community health workers in rural areas to reach more people with services. He also said that typically, U.S. non-governmental organizations take about 35 percent of the funds for overhead and as much as 12 percent for administrative costs, so that less than half the money actually reaches the recipient country. He applauded an initiative in Rwanda where 25 U.S. medical institutions were engaged in training the entire healthcare workforce without this kind of overhead.

He concluded his remarks by a call to redouble efforts to combat stigma and prejudice which he said is “actually on the rise in some countries.” Mentioning two advocates from Uganda who were honored at the Foundation’s annual meeting last year for their work on behalf of sexual minority communities he said, “They were profoundly aware that they were being honoured for work that should not be necessary.”

Finally, returning to the tragedy of the Malaysian Airlines flight, he said, “We have to remind people that those we lost devoted their lives to the proposition that our common humanity means much more than our individual differences.”

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