The Path to an AIDS-Free Generation

On November 8, 2011, Secretary Clinton called on the world to join the United States in working to achieve the goal of an AIDS-free generation during an address at the National Institutes of Health in Bethesda, Maryland.

An AIDS-free generation means that virtually no children are born with the virus; that as these children become teenagers and adults, they are at a far lower risk of becoming infected than they would be today, thanks to a wide range of prevention tools; and finally that if they do acquire HIV, they have access to treatment that helps prevent them from developing AIDS and passing the virus to others.

Through the President's Emergency Plan for AIDS Relief ( PEPFAR ) and across the government, the United States is using science to guide policies, strengthen programs on the ground, and maximize the impact of U.S. efforts. Three key scientific interventions have been identified as pivotal: stopping mother-to-child transmission, expanding voluntary male circumcision, and scaling up treatment as prevention. When used in combination with each other, condoms and other prevention tools, these three interventions offer an historic opportunity to drive down the worldwide rate of new infection.

1 ) Prevention of mother-to-child transmission: Today, 1 in 7 new infections worldwide occur through mother-to-child transmission. In 2010, PEPFAR helped prevent 114,000 babies from being born with HIV. In June, PEPFAR and UNAIDS launched a global plan for eliminating new infections among children by 2015.

2 ) Voluntary medical male circumcision: This low-cost procedure reduces the risk of female-to-male transmission by more than 60 percent. It is a one-time intervention with a lifelong benefit. PEPFAR has financed three-fourths of the one million male circumcisions for HIV prevention around the world since 2007.

3 ) Treatment as prevention: Once people do become HIV-positive, recent science has shown that treatment with anti-retroviral drugs helps prevent the transmission of the virus to others. Effective treatment of a person living with HIV reduces the risk of transmission to a partner by 96%.

In her remarks, Secretary Clinton issued a specific call to action to the world to achieve the goal of an AIDS-free generation.

Science must guide these prevention efforts.

Partner countries must have ownership of their AIDS programs and share more responsibility for funding the fight against AIDS within their borders.

Finally, other donor nations must do more, including by supporting and strengthening the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Meanwhile, the Fund has its own responsibilities to meet to ensure its money is being effectively and efficiently spent.

To learn more about the U.S. commitment to the global HIV/AIDS response, visit www.pepfar.gov .

U.S. DEPARTMENT OF STATE, Nov. 8, 2011

Preview of Sec. Clinton's speech to National Institutes of Health

MR. VENTRELL: Hi, everyone. This is Patrick from the Press Office. I wanted to introduce [ Senior State Department Official ] . He's going to be speaking today on background as a senior State Department official. And I do want to highlight that in addition to the ground rules on background, that this entire call and the transcript are embargoed for use until the Secretary begins speaking tomorrow up at NIH.

So having said that, I'm going to turn it over to [ Senior State Department Official ] .

SENIOR STATE DEPARTEMNT OFFICIAL: Well, thank you. I appreciate you taking time to listen to this. We're excited about the speech tomorrow and we wanted to give you a heads-up on what we think is the beginning of a series of speeches and messages from the Administration that will lead up through the World AIDS Day leading to the international AIDS meeting that will be based in Washington next summer.

Secretary Clinton will speak at 11:00 tomorrow morning at the National Institute of Health. She'll deliver a major address that focuses on HIV/AIDS. I've had the privilege of being — and watching Secretary Clinton over many years in her role as first lady and as senator and, with her husband in the White House, really focusing on issues of American leadership globally and introducing specific legislative — legislation that expanded the ability for us to focus on low-income individuals who were HIV-infected in the '90s, fought to stave off AIDS treatment program cuts that impacted the availability of drugs in many states and people whose eligibility to access those services was threatened, and sought to increase the ability to coordinate around global AIDS issues, giving a strong emphasis on the importance of increasing our prevention behavioral messages that come to young people in a variety of different settings, and consistently supporting our federal efforts to allow states and local municipalities domestically and globally to find and access the resources they need to create and mount an effective response for the epidemics they were confronted with.

I think that the Secretary really wanted to deliver the speech at NIH because it was the NIH scientists who really have been at the forefront for the last 30 years in conducting what retrospectively now is groundbreaking research that really dates back to the early '80s when the discovery of the virus, the ability to develop an antibody test that reflects infection in 1984, our ability to identify the targets for the first antiretroviral drugs in the late '80s, give instruction and guidance on how to recognize and treat the opportunistic infections that HIV-positive patients in later stage disease are susceptible to, as well as the malignancies, and vaccine research, doing — looking at immunopotentiators, understanding how the immune system's ability to identify and prevent replication of the virus is impaired as the immune system is destroyed, all of which presented to the pharmaceutical companies a rich array of targets that they could develop molecules for or against that would block viral replication at multiple different sites. And our ability to effectively stop viral replication now came out of that NIH-based research, and I think that it has — it is this continuum of science and the application of science to inform policy as well as program that she is trying to highlight here.

We're especially happy because over the last few months we have been able to identify a number of new prevention interventions and, I guess more specifically, prevention interventions in different combinations that, when appropriately implemented, drop your number of new infections precipitously, a combination prevention/therapy, the most notable of which has been male circumcision in conjunction with prevention to mother-to-child transmission, the use of condoms in partners who are discordant, the use of antiretroviral drugs, finally, in dropping the infectivity of an individual to the point where they cannot infect their partners, their sexual partners. These all together give us the tools that we need to prevent new seroconversions in a population and drop the number of new infections to the point where we are able to keep up with the treatment needs of the community and continue further to drop numbers of new infections, so we are actually looking at creating a new goal of an AIDS-free generation.

I think tomorrow's speech will call upon the world, not just the United States, to continue the work that they're doing but, more importantly, to now look for new ways to combine that work and the resources needed to concentrate these prevention interventions in and with the populations that most need them.

Over the past few weeks, the Secretary has talked about different aspects of American leadership. I think that it's fair to say that tomorrow the Secretary will state that our global health is an investment and another pillar that reflects American leadership globally, advancing our national interests and making other countries more stable and the United States more secure. It's also a clear expression of American values.

When I travel with PEPFAR — to PEPFAR programs all over the world, I see that I am most humbled by the impact that these programs have had in restoring an essential ingredient that keeps individuals going and allows them to move through adversity, and that's the idea of hope. The hope is restored not just in the patients who are infected with this virus and struggling in the response but also in the healthcare providers and in the communities in which these epidemics have ravaged so many — 5, 10, 20, 35 percent of the population infected in a given community or greater, seeing whole villages disappear from the planet because of the death that's been caused by HIV/AIDS, the number of orphans that are created turning around, and what was predominantly a inpatient response, where you would go to these settings and see two to four people in each bed, people in the hallways, people stuck in a — waiting outside of the hospital to get access now empty and full of individuals who are no longer HIV infected but there with other diseases. We truly have moved HIV in most every country we're in from an inpatient response to an outpatient response.

I think that you'll hear the Secretary talk about this hope and the importance it plays in allowing the expression of the — both the will and generosity of the American people, but also it'll take a challenge that she will put out for individuals to really stand up both within the country itself, the country leadership to engage in a stronger response that builds on what President Bush started with the PEPFAR program, and to really challenge the Administration to continue its support in what is a bipartisan effort to continue to bring these resources to the millions of people that we serve.

I think Secretary Clinton has also really challenged the world to look at partnerships differently, looking at our ability to find efficiencies, not just within our program but also in planning and implementing with programs such as the Global Fund, where we are in 88 countries together. Both of these resources, matched with the countries' resources, create three pots of opportunity for us to increase both planning and implementation to find efficiencies as opposed to parallel systems, and we know that there are great efficiencies to be found.

In PEPFAR, I think that we have been able to drop the number of individuals who are seroconverting or becoming HIV-positive. There's been an 84 percent increase in individuals on antiretroviral treatment. That's a total of 3.2 million in 2010, a 57 percent increase in mother-to-child infections averted. Last year alone, 114,400 infections prevented in 2010 from transmission from an HIV-positive mother to the newborn. We've had 8.3 — to do that, we had to find and test 8.3 million pregnant women. Fifty-two percent of the increase in the number of individuals receiving counseling and testing for HIV. That's a 36 percent increase in care and support, including orphans and vulnerable children. We now care for almost 4 million orphans and vulnerable children from birth until they're 18.

And after 30 years of fighting this epidemic, I think that the Secretary is at a point where she is saying we need to focus our resources and our knowledge to be smart, to create an AIDS-free generation. It's in our sights if we focus our ability to converge these resources. We now know how to do it. We can map out and, with modeling, show that we can drop our incidents or number of new infections precipitously and give ourselves a real opportunity to prevent children from being born who — HIV-positive. We will also identify people who are HIV-negative and have strategies that prevent them from becoming positive. And the third is that for those who are HIV-positive, that we will find them and initiate antiretroviral drugs that restores their immune function, but also gives them a drop in infectivity that is precipitous.

So after 30 years, I think, of the world responding to this epidemic, we will hear from the Secretary that we are at a tipping point where we now can be preventing new infections, so when we start people on treatment, we are not seeing two or three new infections pop up for every person on treatment. But we are now at a point where there's one person going on treatment, and one or less than one people getting newly infected.

So that's what we will hear from the Secretary tomorrow, and I'm happy to take questions.

OPERATOR: Thank you. At this time, if you'd like to ask a question, please press *1. You will be prompted to record your name. Again, to ask a question, please press *1. One moment, please. ( Pause. ) Once again, if you'd like to ask a question, please press *1.

At this time, I show no questions.

SENIOR STATE DEPARTMENT OFFICIAL: Well, I guess what I would do is just reiterate one point: An AIDS-free generation, virtually no children will be born with the virus. The second point is that as these children become teenagers and adults, they'll be at a far lower risk of becoming infected than they would be today because of our prevention interventions being effective and targeting them. And for those who do acquire HIV, as the third point, they'll get treatment that helps prevent them from developing AIDS and passing the virus onto others. So that's the AIDS-free generation.

PARTICIPANT: Okay. Well, thank you very much, everyone.