* HIV drugs make "AIDS-free generation" possible-Clinton
* U.S. seeks to ramp up treatment in hard-hit countries
* Circumcision, mother-to-child transmission also targeted
By Andrew Quinn
WASHINGTON, Nov 8 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
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
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.
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
"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
Clinton 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.
Michel Sidibe, the executive director of the U.N.'s UNAIDS
program, said the funding constraints around the world would
force AIDS programs to become more cost-effective as the new
goal appears on the horizon.
"I personally feel that the developed world and
particularly the United States is not turning their back on
AIDS," he said. "Today was a clear demonstration of that. But
they are turning their back on business-as-usual."