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Fighting AIDS: At the Tipping Point

Posted: 09/14/11 12:18 PM ET

Thirty years since the first case of AIDS was diagnosed in the United States, the world finds itself at a tipping point in the fight against this deadly disease. For the first time, grounded in scientific evidence, our efforts can put us within reach of an AIDS-free generation.

Our nation has been the preeminent leader in the global fight against AIDS. We have turned basic research into practical actions that have saved lives. The advances that have been made in this fight can be directly attributed to the commitment of the American people. The world is now poised to build upon the scientific advances that have been made and achieve our goal of ending the epidemic and making our world more secure in the process.

Starting in 2005, a series of randomized clinical trials demonstrated that medical male circumcision significantly reduces a man's risk of acquiring HIV. A recent follow-on study suggests the reduction in risk may be as much as 68% and the protective effect is increasing over time. The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is sponsoring large programs in countries where rates of HIV prevalence are high and levels of circumcision are low to bring this inexpensive and life-saving intervention to millions of men.

In May, a National Institutes of Health (NIH) randomized control trial documented for the first time that treatment also works as an extraordinarily successful tool for prevention. Initiation of antiretroviral treatment (ART) by HIV-positive individuals substantially protected their HIV-negative sexual partners from acquiring HIV. Treatment lowers the viral load of HIV in a person with the virus, greatly reducing the risk of sexual transmission to a partner. ART produced an astonishing 96 percent reduction in risk of HIV transmission, on par with a vaccine.

Earlier this summer, two other studies confirmed an initial proof-of-concept trial demonstrating the effectiveness of antiretroviral medication for pre-exposure prophylaxis (PrEP) among couples. Individuals taking a daily tenofovir or tenofovir/emtricitabine combination experienced infection rates as much as 73% lower than those on a placebo, advancing potential options for prevention among couples where one partner is infected with HIV and the other is not.

Finally, last summer, the CAPRISA study of tenofovir gel microbicide -- funded by PEPFAR through USAID -- found that those using the gel with the active ingredient had an average of 39% fewer HIV infections and 51% fewer genital herpes infections compared to women who used a placebo gel. These results provided the first evidence that an antiretroviral drug in a microbicide preparation can reduce the risk of HIV in women.

Nearly a decade after the creation of PEPFAR by President George W. Bush, with bipartisan support, these new scientific achievements are bringing a second wave of hope to communities impacted by AIDS, and are creating a real sense that this battle can be won. If these new tools are implemented in a strategic way, in concert with behavior change and condom programs, we can now look to the possibility of driving the epidemic into the ground.

It is important to remember the tragic situation that existed at the time President Bush launched PEPFAR. Many doubted that the fight against AIDS in resource-limited countries, where poverty and weak health systems were the reality, could ever succeed. Only 50,000 people in all of sub-Saharan Africa were receiving the lifesaving treatment they needed.

President Bush and Congress responded with an effort that reflected not only the compassion and generosity of the American people, but our insistence on impact. While increasing our financial commitment, the U.S. also created ambitious, quantitative goals for the program, creating a culture of accountability for results rather than mere good intentions.

The impact was extraordinary. With an urgency that reflected the magnitude of the challenge, PEPFAR rapidly built the health delivery capacities needed to deliver prevention, treatment and care, and provided the services people needed. In nations where widespread death from AIDS had reversed decades of improvements in life expectancy, people saw their neighbors begin to live with the virus, working again and supporting their families. And infection rates have been steadily, and in some places dramatically, decreasing. Simply put, PEPFAR has restored hope.

Since taking office, the Obama Administration has made building on the success of PEPFAR a priority. Recent scientific advances hold the promise that we will get to the finish line, and U.S. achievements under both the Bush and Obama Administrations have put us in the position to begin to make the final push.

Under the Obama Administration, there have been dramatic increases in the number of people who we are directly supporting. In 2010 alone, PEPFAR supported treatment for 3.2 million people; averted 114,475 mother-to-child infections; and provided 32.8 million people with counseling and testing and 11 million with care and support, including 3.8 million orphans and vulnerable children.

PEPFAR has also made great advances in strengthening health delivery. And these advances are permitting us to do even more work to save lives. Yesterday, President Bush and Secretary of State Hillary Rodham Clinton joined with the Susan B. Komen Foundation, UNAIDS and private sector partners in launching a partnership to enhance cervical cancer screening and treatment in developing nations. Women whose immune systems are compromised by HIV are much more likely to develop cervical cancer. Through the partnership being launched today, PEPFAR has committed an additional $10 million to screening and treatment of HIV-positive women, bringing its total investment to $30 million over the next five years -- and saving even more women.

During its first phase, PEPFAR rightfully focused on the emergency aspect of the response, while also creating sustainable, country-owned programs capable of managing and delivering the response to the epidemic. In the second phase, as many countries or regions of countries are moving past the emergency response, there is an expansion of efforts to further build sustainable and integrated country health programs. Through deeper strategic engagement and even greater shared responsibility with partner governments, we are building systems that provide more care at lower cost.

Our nation's successful investment in fighting global AIDS has also been a powerful tool of public diplomacy. Our commitment to support prevention, treatment and care for millions of people changes not only the lives of the people we touch, but the countries themselves. Giving people a chance at a healthy and productive life is among the most tangible contributions our nation can make to promote development and build stronger relationships with the U.S.

PEPFAR is a shining example of how people, working together across the political spectrum, can make tremendous accomplishments. When we come together in this way, quite simply, millions of lives can be saved and hope restored, making our world -- and our nation -- more secure.

Ambassador Eric Goosby, U.S. Global AIDS Coordinator (2009-present)

Ambassador Mark Dybul, U.S. Global AIDS Coordinator (2006-2009); inaugural global health fellow, the George W. Bush Institute