At a speech delivered in early November at the National Institutes of Health, Secretary of State Hillary Rodham Clinton called on the United States and the rest of the global community to create an “AIDS-free generation” using measures based on scientific research completed in the past two years.[1] Clinton called for a decrease in the number of new HIV/AIDS cases to occur through increased use of anti-retroviral drugs, male circumcision, and prevention of mother-to-child transmission.[2]

 

Clinton’s suggested strategies build on the global health policies of the administrations of presidents George W. Bush and Barak Obama. The Bush administration developed the President’s Emergency Plan for AIDS Relief (PEPFAR); President Obama both expanded on PEPFAR and developed the Global Health Initiative, which is not specific to HIV/AIDS but focuses on the prevention of a number of diseases.[3] While PEPFAR provides billions of dollars to the global HIV/AIDS fight, Clinton’s suggested measures would expand on the program and “take a comprehensive view of our approach to the pandemic.”[4]

 

Male circumcision, a prevention strategy whose use has increased in the past few years, is a low-cost procedure that reduces female-to-male transmission of the virus. The aim to prevent mother-to-child transmission would include broader health programs that keep both the mother and the child healthy and directly affect the goal of an AIDS-free generation. Finally, the increased use of anti-retroviral drugs would treat HIV-positive patients before they become ill, creating indirect economic benefits.[5] Clinton emphasized that these three main strategies are most effective when used in tandem with condoms, counseling, testing, and other prevention interventions that have been used in the past.[6]

 

Clinton specifically defined an AIDS-free generation as “one where, first, virtually no children are born with the virus; second, as these children become teenagers and adults, they are at far lower risk of becoming infected than they would be today thanks to a wide range of prevention tools; and third, if they do acquire HIV, they have access to treatment that helps prevent them from developing AIDS and passing the virus on to others.”[7] The first goal she set was for no more mothers to infect their babies with HIV through birth or breast-feeding by 2015.[8]

 

Clinton’s suggestions received praise from the public health community. “It’s very encouraging to see the U.S. government wanting to turn the latest HIV/AIDS science into policies that will save lives while beginning to reverse the epidemic. Now is the time for bold action in order to get ahead of the wave of new HIV infections” commented Dr. Unni Karunakara, president of Doctors Without Borders.[9]

 

Even with such support, concerns still exist about the high costs often associated with HIV prevention. Since PEPFAR’s inception in 2003, it has spent tens of billions of dollars to treat seven million of the 34 million individuals infected with the virus.[10] With the U.S. budget facing the possibility of severe cuts, it is still unclear if the United States will be able to fund the necessary increases in programming.[11] While no overall costs were given, Clinton emphasized that the suggested measures are also the most cost-effective measures. The cost of anti-retroviral drugs has dropped from $1,100 a year per patient in 2004 to $335 today.[12] Clinton also outlined three chief ways this program would gain strength and support, both financially and otherwise, by basing prevention and treatment efforts on scientific conclusions; expanding the role of partner countries, particularly through work with governments, non-governmental organizations, and faith-based organizations; and calling on donor nations.[13] The Obama administration’s global AIDS coordinator, Dr. Eric Goosby, notes that there will be several more speeches in the next few months that will address the specific costs.[14]

 

Through implementation of this comprehensive approach, Clinton’s hope is that the debate around treatment versus prevention will cease. As this speech marks the 30th year in the fight against AIDS, she says the United States must continue to be a leader in the fight against AIDS, with the focus on “treatment as prevention.”[15]

 

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