Treatment brings AIDS-free age near: Clinton
WASHINGTON--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, U.S. 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 US$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 US$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 circumcised.
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 US$1,100 a year; today, it's US$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 were becoming infected every year than were starting treatment but that scaling up “combination prevention” strategies in hard-hit countries could drive the global new infection rate down by at least 40-60 percent.
PEPFAR director Eric Goosby said the combination of interventions could help the world turn the crucial corner where treatment outpaces new infection within the next several years.
“We are looking at models that identify 2013, 2015 and 2018 as critical timeframes depending on how hard you push any one of those variables,” Goosby told Reuters. “Our modeling shows it is in sight, it is reachable. We now need to apply ourselves.”
Clinton said the United States, which already has donated US$50 million to fund academic studies on how best to ramp up the new model, would spend another US$60 million to expand combination-prevention in four sub-Saharan African countries to provide more data on the efficacy of the approach.
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