Washington — Delegates to the XIX International AIDS Conference greeted Secretary of State Hillary Rodham Clinton with cheers and applause July 23 as she outlined the U.S. goal to achieve an AIDS-free generation in the near future, and she pledged an ongoing U.S. commitment to sustain funding for global programs to prevent the spread of HIV, to treat infected persons and to assist their families.
“We will not back off, we will not back down,” Clinton declared to a chorus of whistles and hoots. “We will fight for the resources necessary to achieve this historic milestone.”
Clinton first raised the call for achieving an AIDS-free generation in November 2011 in a speech at the National Institutes of Health (NIH), one of the world’s foremost research organizations, which is developing the scientific understanding to make an AIDS-free goal possible.
Since that time, Clinton said, all U.S. government health agencies have been working at an increased pace to reach the goal domestically and internationally. HIV — human immunodeficiency virus — will not be completely absent in an AIDS-free generation, but, Clinton said, it will be so controlled by medications and so contained by prevention methods that no one will develop the debilitating disease that steals vitality and productivity from its victims.
“Our strategy includes condoms, counseling and testing, and places special emphasis on three other interventions: treatment as prevention, voluntary medical male circumcision, and stopping the transmission of HIV from mothers to children,” Clinton said.
“Treatment as prevention” has been a breakthrough scientific finding of the last couple of years. If persons with HIV infection receive life-sustaining antiretroviral treatment (ART), the level of the virus in the bloodstream drops to a point where the chance of transmitting the virus to a partner is greatly reduced.
In the last nine months alone, Clinton said, U.S. investments have put 600,000 more people on ART, which increases the total number of people receiving therapy with U.S. support to 4.5 million. The U.S. goal is to provide ART to 6 million people by the end of 2013.
The United States is also earmarking more funding for another prevention method proven to significantly reduce female-to-male transmission: voluntary, medical male circumcision.
“The impact can be phenomenal” in the level of prevention achieved, Clinton said, as she explained U.S. investments to support close to 1 million more circumcision procedures in various countries.
Treatment-as-prevention can also protect another population vulnerable to HIV infection: infants born to HIV-infected mothers. Reducing the viral load in the mother’s bloodstream is a proven practice for preventing infection of the fetus so that the mother gives birth to a healthy infant.
Clinton announced in her AIDS conference speech that the United States will invest $80 million to ensure that infected pregnant mothers are able to gain access to treatment.
U.S. programs have supported the Zambian government’s effort to expand treatment for pregnant mothers, Clinton said.
“Between 2009 and 2011 the number of new infections went down by more than half,” Clinton said, “and we are just getting started.” The United States will provide more assistance to other treatment-as-prevention programs in Zambia, a country that has an estimated infection rate among young adults of 13.5 percent, among the world’s highest.
“We will for the first time get ahead of the pandemic there,” Clinton said.
The U.S. secretary of state announced several other initiatives to address the global AIDS issue: research to identify the most effective means of reaching certain infected populations; a “challenge fund” to motivate country-led service expansion; and investment to support civil society groups who target vulnerable populations.
Clinton shared the stage at the opening session of the AIDS conference with a U.S. scientist who deserves a share of the credit for expanding understanding of the disease to the point where an AIDS-free generation is conceivable. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has been a leader of the U.S. research effort and has achieved global prominence in medical circles.
Fauci has attended all 19 International AIDS Society conferences, dating back to the 1980s. Those early years — when science had just identified the virus causing a previously unknown, rapidly debilitating and fatal disease — are the years Fauci describes as “the dark years” of his career. At that time, he would diagnose a person infected with HIV and know the patient had only six to eight months to live. Thirty years of research has made a monumental difference in what Fauci can say to a 25-year-old patient recently diagnosed as HIV-infected.
“You put them on combination therapy, and you can look them in the eye and tell them it is likely, if they adhere to that [treatment] regimen, that they will live an additional 50 years,” Fauci said, as a wave of applause surged through the audience of AIDS conference delegates.
Fauci also sketched out the “scary” side of this scenario: the person who doesn’t know he’s infected, or doesn’t seek treatment, or doesn’t follow the drug treatment regimen faithfully. Significant numbers of people fit that profile, and they must receive a new level of attention if an AIDS-free generation is to be achieved.
Fauci called on the AIDS community to create a “care continuum” that finds, tests, treats and monitors HIV persons to ensure the virus is contained and not transmitted to other people.