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International AIDS Conference

What We Must Do to Turn the Tide on AIDS

We’ve made huge gains against AIDS, but there’s still work to do.


Yesterday, I wrote about the huge gains that the world has made against HIV in the past decade. I am confident that when the history of the 21st century is written, the global response to AIDS—marked by strong leadership from the United States and other donors, developing countries, and communities affected by HIV—will stand out as one of this century’s greatest achievements.

But while the theme of this year’s International AIDS Conference—“Turning the Tide”—reflects the incredible progress that we’ve made, it’s important to recognize that we still have a long way to go before we can credibly talk about the end of AIDS.

Today, I participated in a lively panel discussion at the conference about what we need to do, in tough economic times, to ensure that we’re getting the most impact—impact that can be measured in lives saved and infections prevented—for every dollar that we invest in HIV. 

The discussion included Ambassador Eric Goosby, the U.S. Global AIDS Coordinator; Mphu Ramatlapeng, Vice Chair of the Global Fund to Fight AIDS, Tuberculosis and Malaria and former Minister of Health of Lesotho; and Jim Kim, the World Bank’s new president. Our conversation was preceded by short remarks from two distinguished champions of the fight against AIDS, Senators Lindsey Graham of South Carolina and John Kerry of Massachusetts.

I focused my remarks on the importance of increasing the efficiency and effectiveness of every dimension of HIV investment—from the discovery and development of new treatment and prevention tools to the delivery of services that have real impact in preventing infections, improving lives, and keeping people alive. 

Things are getting better. But the challenge is that they aren’t getting better fast enough. For every person put on treatment like Florence Daka— the Zambian mother of four whom I mentioned in yesterday’s post—two more become infected. Only around half of those who need treatment actually receive it, and the number of those in need of treatment will continue to grow.

All of these challenges are set against a backdrop of a global economic crisis where the growth in HIV funding has significantly slowed. In addition to maintaining global funding for R&D, we still need to close gaps in access to treatment and prevention.  How can we achieve that?

First, we must recognize the creativity of the hundreds of thousands of people who are succeeding at doing more with limited resources.  A first step in learning how to close the access gap is to identify the programs and providers who are delivering high-impact services most efficiently, so that we can replicate how they are achieving this and expand access to services that work with existing funding. This requires fast progress toward understanding the costs and impacts of HIV programs.

Second, we need to focus not only on expanding access to services, but also on the quality and impact of those services. For example, programs can do a lot more to keep more people alive and well by improving retention in care and treatment programs. In some hyper-endemic countries, only 46 percent of people initiated on ART are retained in the program after two years.

This is a large part of the reason why we’re still seeing too many AIDS-related deaths even in countries that are successfully expanding treatment access. We need to focus on strategies to plug the many holes in the treatment cascade, in order to keep people alive, and also to realize the prevention benefits of expanding treatment.

Third, we must continue to innovate. While we can do better with the tools we currently have, we still don’t have all of the tools that we need to address the ongoing challenge of 2.2 million new infections each year.

We need to do more to provide people with a broader array of safe and effective treatment and prevention methods. We’ve seen many strong advances in the past two years, including the FDA’s recent approval of Truvada as a tool for HIV prevention, promising breakthroughs in HIV vaccine research, encouraging results with microbicide trials, and exciting findings from treatment as prevention studies. These efforts could be game-changers in turning the tide against AIDS.

During my trip to Zambia, I saw how, even with the long-established practice of male circumcision, which can reduce the risk of HIV infection by 60 percent, innovation has the potential to make a big difference. Field studies in several high-incidence countries are currently underway to explore the effectiveness of new male circumcision devices that could scale up access to voluntary medical male circumcision by simplifying the procedure and making surgery unnecessary.

We must keep up the momentum and build on all of the progress we’ve achieved. That’s why this year’s conference should be a moment to reflect not just on all that we’ve done, but all we have yet to do.

It’s important to give credit to the tremendous leadership of PEPFAR and the Global Fund over the past decade in expanding access to treatment and prevention. And we must also honor those who have led the way with R&D. The most important task now is to sustain our investments and stay committed to our goals.