Hillary Clinton: An Aids-free generation is in reach


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The Independent Online

In 2003, only 50,000 people with HIV in sub-Saharan Africa were receiving the drugs that would keep them alive. Now, eight years after the launch of the US President's Emergency Plan for Aids Relief (PEPFAR) more than 5 million do, along with more than a million in other regions of the world, and the vast majority receive drugs financed by either the emergency plan or the Global Fund to Fight Aids, Tuberculosis, and Malaria.

Our efforts have helped set the stage for a historic opportunity: to change the course of this pandemic and usher in an Aids-free generation. By that I mean one where, first, virtually no children are born with the virus; second, as these children become teenagers and adults, they are at far lower risk of becoming infected than they would be today, thanks to a wide range of prevention tools; and third, if they do acquire HIV, they have access to treatment that helps prevent them from developing Aids and passing the virus on to others.

I want to focus on the three key interventions that can make it possible to achieve an Aids-free generation. First, preventing mother-to-child transmission. Today, one in seven new infections occurs when a mother passes the virus to her child. We can get that number to zero.

Last year alone, PEPFAR helped prevent 114,000 babies from being born with HIV. Now, we have a way forward too. PEPFAR and UNAIDS have brought together key partners to launch a global plan for eliminating new infections among children by 2015. In addition to preventing mother-to-child transmission, an effective combination prevention strategy has to include voluntary medical male circumcision.

In the past few years, research has proven that this low-cost procedure reduces the risk of female-to-male transmission by more than 60 per cent, and that the benefit is life-long.

In the fight against Aids, the ideal intervention is one that prevents people from being infected in the first place. But even once people do become HIV-positive, we can still make it far less likely that they will transmit the virus to others by treating them with the antiretroviral drugs. This is the third element of combination prevention We now know that if you treat a person living with HIV effectively, you reduce the risk of transmission to a partner by 96 per cent.

There's no question that scaling up treatment is expensive. But thanks to lower costs of drugs, bulk purchasing, and simple changes like shipping medication by ground instead of air, we and our partners are reducing the cost of treatment. In 2004, the cost of providing antiretroviral drugs and services to one patient averaged nearly $1,100 (£800) a year. Today, it's $335 and falling. Continuing to drive down these costs is a challenge for all of us.

None of the interventions I've described can create an Aids-free generation by itself, but used in combination with each other and with other powerful prevention methods, they do present an extraordinary opportunity. 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 per cent. That's on top of the 25 per cent drop we've already seen in the past decade.

As the world scales up the most effective prevention methods, the number of new infections will go down, and it will be possible to treat more people than are becoming infected each year. And so, instead of falling behind year after year, we will, for the first time, get ahead of the pandemic. We will be on the path to an Aids-free generation. That is the real power of combination prevention.

Success depends on deploying our tools based on the best available evidence. Through PEPFAR and across the government, the United States is using scientifically proven results to inform our policy, which leads to real change for programmes on the ground and maximises the impact of our investments.

We recently granted more than $50m to three of the world's leading academic institutions to develop rigorous studies that test what works in various settings. The US will commit an additional $60m to rapidly scale up combination prevention in parts of four countries in sub-Saharan Africa and to rigorously measure the impact.

The second step is to put more emphasis on country ownership of HIV/Aids programmes. Some countries have allowed money from outside donors to displace their own investments in health programmes. That has to change and we have to demand that it change. More countries need to follow the lead of South Africa, Nigeria, Senegal, Rwanda, Zambia, and others that are committing larger shares of their own budgets to HIV/Aids.

Finally, we're calling on other donor nations to do their part, including by supporting and strengthening the Global Fund. 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.

The US is the largest individual contributor to the Fund, and the Obama Administration has made our country's first multi-year pledge to it. Some donors are, unfortunately, considering reducing their contributions. Some emerging powers and nations that are rich in natural resources can afford to give, but choose not to. To sit on the sidelines now would be devastating. It would cost lives, and we would miss out on this unprecedented opportunity.

The goal of an Aids-free generation may be ambitious, but it is possible with the knowledge and interventions we have right now. Imagine what the world will look like when we succeed.

Imagine Aids wards that once were stretched far beyond their capacity becoming outpatient clinics caring for people with a manageable condition, children who might have been orphaned and then trafficked or recruited as child soldiers instead growing up with the hope of a better future, communities where despair once reigned filled instead with optimism, countries that can make the most of every single person's God-given potential.

That is the world that has always been at the core of American belief, and we have worked toward it in our own history. It's the world I think we all would like to live in.



Hillary Rodham Clinton is the US Secretary of State. A longer version of this article can be read at independent.co.uk