29 November 2012

Africa: U.S. Issues Road Map to an Aids-Free Generation

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Washington — U.S. officials battling HIV/AIDS have a goal to bring an AIDS-free generation into the world. When that may happen remains unknown, but on November 29 Secretary of State Hillary Rodham Clinton laid out a five-point plan on how to get there.

"HIV may well be with us into the future," said Clinton, to an audience gathered at State Department headquarters, "but the disease it causes need not be."

A widening distribution of antiretroviral drugs (ARVs) that protect HIV-infected persons from developing full-blown AIDS makes an AIDS-free generation an achievable goal. An international campaign to increase accessibility to ARVs has been building for the last decade, and the lifesaving medicines now reach 8 million people, according to a survey released by the Joint United Nations Programme on HIV/AIDS (UNAIDS) November 20.

While 34 million people are still infected with the virus worldwide, an encouraging sign that the coordinated campaign has slowed the disease comes in UNAIDS statistics on new infections. They have plunged by dramatic percentages in many nations: down 58 percent in Malawi, 68 percent in Botswana and a remarkable 73 percent decline in new infections in Namibia.

"As we drive down the number of new infections," Clinton explained, "and drive up the number of people on treatment, eventually we will be able to treat more people than become infected every year. That will be the tipping point, and AIDS-free generation will be in our sight."

In a Washington speech a year ago, Clinton introduced the aspiration for an AIDS-free generation. In an 2012 announcement timed in recognition of World AIDS Day December 1, the secretary of state outlined a strategy to lead international efforts toward that goal.

UNAIDS Executive Director Michel Sidibé, who participated in the event, said the blueprint shows the world how the United States will support other countries "to start the endgame" of the epidemic.

First, treatment programs will continue to expand, according to the blueprint. Shortly after Clinton explained the plan November 29, President Obama released new figures indicating that U.S. investments now support treatment for 5 million people with AIDS, a gain of 3.3 million since 2008.

"As I pledged last year, we are on track to treat 6 million people by the end of 2013," Obama said in a statement issued by the White House.

The second step on a road to an AIDS-free generation, Clinton said, is, "We have to go where the virus is." Efforts to contain the pandemic must be extended to marginalized populations, which in many cases worldwide have been ignored by government officials or health care providers. These include intravenous drug users, sex workers and men who have sex with men.

"When discrimination, stigma and other factors drive these groups into the shadows, the epidemic becomes that much harder to fight," Clinton said.

Efforts going forward must also focus more deliberately on women and girls, Clinton said, because their reduced social status in many countries makes them more vulnerable to infection and less able to protect themselves.

Cost-effectiveness is another important milestone toward achievement of an AIDS-free generation, and Clinton said the United States will press to extract full value from its investments in containing the pandemic.

Sidibé said, "Getting more out of every dollar spent will save more lives."

Promotion and commitment are also important, and the United States will rely on partner nations to exercise leadership in identifying their greatest problems in attempting to combat the disease. At the same time, Clinton said, donor nations must fulfill commitments they make to provide assistance in the international campaign.

Finally, the scientific pursuit of medications and techniques to ease suffering for patients and advance treatments that providers can offer must continue full force, Clinton said.

"It is science that has brought us to this point," Clinton said. "It is science that will allow us to finish this job."

Dr. Nkosazana Dlamini-Zuma represented the African Union (AU) Commission at the State Department event. A medical doctor and a former South African minister of health, Dlamini-Zuma said the AU will work with member nations to ensure they stay focused on delivering prevention and treatment services to their populations without discrimination or stigma.

The focus of the event was on a proscribed and focused plan to overcome the epidemic, but between the lines Dlamini-Zuma also read a larger message. The United States, other donor nations and the new blueprint demonstrate that humanity is "Indivisible," she said.

"What bothers a child and a woman in one corner of the world is felt by the women and children and men of this country," said Dlamini-Zuma. She also cited the strength and will of persons living with HIV who have shown their will to survive and to help other people.

The blueprint has been months in the making, and Clinton thanked the professionals of the AIDS community for their contributions to the plan and dedication to the cause.

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