The United States set a new direction for its global AIDS campaign on Tuesday, emphasizing HIV-fighting drugs that can prevent new infections to bring the goal of "an AIDS-free generation" within reach, Secretary of State Hillary Clinton said.
Clinton, outlining new priorities for the U.S. global AIDS program started in 2003, said drug treatments, combined with new efforts to stop mother-to-child transmission of HIV and the preventive effect of expanded voluntary male circumcision, had changed the AIDS battle plan.
"Creating an AIDS-free generation has never been a policy priority for the United States government—until today," Clinton said in a speech at the U.S. National Institutes of Health outside Washington.
"This goal would have been unimaginable just a few years ago," she said. "While the finish line is not yet in sight, we know we can get there because now we know the route we need to take."
The United States, through its President's Emergency Plan for AIDS Relief (PEPFAR) program, has channeled billions of dollars into the fight against HIV/AIDS, which has infected more than 60 million people and killed nearly 30 million since it was first reported in 1981.
The PEPFAR program has been a major factor in the global response to HIV. In 2010, nearly $16 billion was spent on HIV response in low- and middle-income countries, according to the U.N. Program on HIV/AIDS (UNAIDS) and it estimates that at least $22 billion will be needed to combat the disease by 2015, helping avert 12 million new infections and 7.4 million more deaths in the next decade.
Strides have been made in preventing mother-to-child transmission of HIV, integrating prevention and treatment efforts with broader health programs to prevent HIV infections, keep children healthy and help mothers give birth safely.
Voluntary male circumcision also has been shown to cut the risk of female-to-male transmission by more than 60 percent, and since 2007 more than 1 million men have been voluntarily circumcized.
But drug treatment appears the most promising. A series of studies in the past year have shown that drugs used to treat HIV also can dramatically reduce the risk of new infection among heterosexual couples—fueling discussion on whether AIDS money is best spent on drugs or traditional prevention programs, such as condoms, counseling, testing and education.
Clinton said the answer was clear.
"If we take a comprehensive view of our approach to the pandemic, treatment doesn't take away from prevention. It adds to it," she said. "So let's end the old debate over treatment versus prevention and embrace treatment as prevention."
Rising benefits, falling costs
With some 34 million people living with HIV around the world today, the new U.S. emphasis on treatment could prove costly—although Clinton noted that the per-patient cost had fallen dramatically as AIDS drugs become available as generics in many poor countries.
"In 2004, the cost to PEPFAR for providing ARVs and services to one patient averaged nearly $1,100 a year; today, it's $335 and falling," Clinton said, referring to anti-retroviral drugs. "Continuing to drive down these costs is a challenge for all of us."
Clinton said more people still were becoming infected every year than were starting treatment but that scaling up "combination prevention" strategies in hard-hit countries could drive the worldwide rate of new infections down by at least 40 percent to 60 percent.
She said the United States, which already has donated $50 million to fund academic studies on how best to ramp up the new model, would spend another $60 million to expand combination-prevention in four sub-Saharan African countries to provide more data on the efficacy of the approach.
Clinton, who has been fighting hard to preserve U.S. spending on overseas aid and development as the U.S. Congress grapples with huge U.S. budget deficits, said it was important the United States maintain its leadership in the AIDS battle.
"At a time when people are raising questions about America's role in the world, our leadership in global health reminds them who we are and what we do," she said.