Today is a remarkable day. Today, we come together, as a global community, across continents, faiths and cultures, to renew our commitment to ending the AIDS pandemic - once and for all.
--President Obama, December 1, 2011
Combating a Global Pandemic
Since AIDS was identified 30 years ago, the United States has played a leading role in achieving scientific progress, and in translating science into programs. The President’s Emergency Plan for AIDS Relief (PEPFAR), established by President George W. Bush and a bipartisan Congress and expanded by President Obama, has put that science into action to save the lives of millions in the developing world. Today, President Obama announced new prevention goals for PEPFAR.
Under the Obama Administration, PEPFAR has continued to achieve extraordinary results. In Fiscal Year 2011 alone, the United States supported:
· Lifesaving antiretroviral treatment for more than 3.9 million people.
· For prevention of mother-to-child transmission (PMTCT):
o HIV testing and counseling for more than 9.8 million pregnant women.
o Antiretroviral prophylaxis for more than 660,000 HIV-positive pregnant women.
o 200,000 infant HIV infections averted.
· Care and support for nearly 13 million people, including more than 4.1 million orphans and vulnerable children.
These results, along with encouraging scientific advances, create an exciting moment on global AIDS, with an opportunity to use existing tools to push the rate of new infections downward dramatically. To do so, the United States is working to support an optimal mix of combination prevention tools in each country in which PEPFAR works. This means prioritizing combinations of activities based on sound scientific evidence that will have the maximum impact on reducing new HIV infections and saving lives.
Expanded efforts in the areas described below will dramatically reduce new HIV infections and save lives. This expansion will occur in concert with other proven interventions, such as HIV testing and counseling, programs focused on people living with HIV and populations at higher risk for infection, and behavioral supports.
Prevention of Mother-to-Child Transmission (PMTCT): Pediatric HIV can be eliminated worldwide. No scientific or technical barriers stand in the way. PEPFAR has been the global leader in the effort to prevent mother to child transmission, and the prevention of 200,000 infant infections in FY 2011 by PEPFAR programs represents accelerating progress toward this goal. In June, PEPFAR and UNAIDS led an effort that outlined a path for achieving virtual global elimination of new pediatric HIV infections by 2015, assuming a continuing and shared commitment among donor and partner countries. To capitalize on this opportunity, over the next two years the United States will reach more than 1.5 million HIV-positive pregnant women with antiretroviral drugs to prevent them from passing the virus to their children.
Voluntary Medical Male Circumcision (VMMC): PEPFAR is leading the world in support for a rapid expansion of voluntary medical male circumcision. In the past few years, research has proven that this low-cost procedure reduces the risk of female-to-male transmission by more than 60 percent—and the benefit is life-long. Approximately one million male circumcisions for HIV prevention have been done in recent years, with the United States providing the support for three-quarters of them. Building on this, over the next two years, PEPFAR will support more than 4.7 million voluntary medical male circumcisions in Eastern and Southern Africa.
Treatment as Prevention: The effect of antiretroviral treatment in saving lives has long been known. Recent science has shown that treatment is also highly effective in preventing transmission to others. A study published in May 2011 showed that effective treatment of a person living with HIV reduced the risk of transmission to partners by 96%, on par with a vaccine. In FY 2011, PEPFAR reached 3.9 million with treatment, laying a foundation for heightened efforts. By the end of 2013, PEPFAR will directly support more than 6 million people on antiretroviral treatment – two million more than our previous goal.
Condoms: When used consistently and correctly, male and female condoms are highly effective in preventing sexual transmission of HIV. In heterosexual relationships where one partner is HIV-positive and the other is HIV-negative, when condoms were consistently used, HIV- negative partners were 80% less likely to become infected than persons in similar relationships in which condoms were not used. For this reason, the United States has long been a leading provider of condoms for HIV prevention in the developing world, and over the next two years will distribute more than 1 billion condoms.
The President believes that we must make smart investments with each dollar available. Using our wealth of scientific evidence and programmatic experience, we must support the interventions that have the largest impact and deliver them effectively and efficiently. With this focus, U.S. investments through PEPFAR have delivered exceptional and increasing results. In the area of treatment, PEPFAR has driven down its cost per year per patient on treatment from over $1100 to $335 in FY 2011. This translates into more lives being saved, and this continued focus on lowering costs and finding efficiencies will allow us to achieve these ambitious targets with existing resources. Some of the ways we’ve lowered costs include:
· Instituting more efficient procurement via a new pooled supply chain management system.
· Expanded use of generic antiretroviral drugs (ARVs) – over 98% of the ARV packs purchased by PEPFAR are generic, up from 15% in 2005, due in large part to the expedited Food and Drug Administration drug approval process that has approved 137 generics to date.
· Switching from air to land and sea freight – delivering live-saving drugs on-time and for less money.
· Maximizing investments through better coordination with the Global Fund and the elimination of parallel systems.
PEPFAR is one of the key platforms upon which the Obama Administration is building the Global Health Initiative, which supports one-stop clinics offering an array of health services while driving down costs, driving up impact, and saving more lives. Through PEPFAR investments, we have put systems of care in place that countries are leveraging to improve their citizens’ overall health.
Investments in global health are a pillar of American leadership – advancing our national interests, making other countries more stable and the U.S. more secure. They are also an expression of our values. The global AIDS response is a shared responsibility that cannot be met by one nation alone and today President Obama called on the global community to join the United States in this undertaking. The President has written to leaders of other nations that have demonstrated notable leadership on HIV/AIDS, expressing his desire to work together to meet the shared global responsibility.
PEPFAR is working with partner countries to build their capacity to lead their national responses and increase their own AIDS funding. Progress toward country ownership is essential for AIDS programs to be sustainable for the long term. In addition to governments, country ownership means embracing the efforts of civil society, including faith-based groups and groups of people affected by our programs. The U.S. is calling on other donors (including governments, foundations, and the private sector) to join us in increasing their investments. This includes supporting and strengthening the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The U.S. is the largest donor to the Fund, providing more than $5.8 billion through 2011. In 2010, the U.S. made its first-ever multi-year pledge to the Fund, and the U.S. stands by this historic pledge. The U.S. is also a strong supporter of the Fund’s efforts to transform its operations at both the country and headquarters levels, in order to become more efficient and effective and save as many lives as possible.
The International AIDS Conference, returning to U.S. soil for the first time in over 20 years in July 2012, will provide an important platform at which the United States will communicate this shared responsibility message.
Fighting the Domestic HIV/AIDS Epidemic
In the United States, roughly 1.2 million Americans are living with HIV and about 50,000 become newly infected each year. Since the beginning of the epidemic, more than 600,000 Americans have lost their lives to HIV and AIDS. The Obama Administration has mounted a comprehensive and aggressive response to refocus our collective efforts to respond to the domestic HIV epidemic:
Creating a Coordinated National Response to the HIV Epidemic
National HIV/AIDS Strategy: The National HIV/AIDS Strategy is the Nation’s first comprehensive plan to fight the domestic epidemic. The Strategy provides a roadmap for moving the nation forward in addressing the domestic HIV/AIDS epidemic with clear and measurable targets to be achieved by 2015. The development of the NHAS is an important effort to reflect on what is and is not working in order to improve the outcomes that we receive for our public and private investments.
· The Federal Implementation Plan. In conjunction with the Strategy, the White House Office of National AIDS Policy (ONAP) released the Federal Implementation Plan, which outlines initial critical actions to be taken by Federal agencies in 2010 and 2011.
· The Agency Operational Plans. Released in February 2011, these plans detail activities and new initiatives across lead federal agencies to implement the Strategy.
· Ongoing Efforts to Improve Coordination across Government. The Health and Human Services Assistant Secretary for Health was tasked with improving operational coordination across key departments and agencies, including HHS, Housing and Urban Development, Departments of Justice and Labor, the Veterans’ Administration, and the Social Security Administration.
· Engaging Communities. The Obama Administration has taken extraordinary steps to engage the public. While developing the Strategy, the White House Office of National AIDS Policy hosted 14 community discussions across the country and organized a series of expert meetings on HIV-specific topics. This fall ONAP convened five “Dialogues” across the country to support state and local implementation of the Strategy.
Increasing Access to Care
Today, President Obama announced he is directing $50 million in increased funding for domestic HIV/AIDS treatment and care because every American with HIV should have access to the highest quality of care available.
· Of the $50 million, $15 million will be directed to the Ryan White Part C program for HIV medical clinics across the country, targeting areas with HIV infections have increased and HIV care and treatment services are not readily available. This additional funding will allow services to 7,500 more patients across the country.
· $35 million in increased funding will go to state AIDS Drug Assistance Programs to support grants to states to help nearly 3,000 individuals with HIV/AIDS access life-saving HIV/AIDS drugs. Currently, there are more than 6,500 Americans with HIV/AIDS who are on waiting lists for lifesaving medications. Earlier this year, there were more than 9,000 people on waiting lists, the Administration negotiated additional funding that enabled States to reduce the size of their waiting lists by nearly one-third.
This is part of the broader effort to ensure all people with HIV get the maximum benefit from the latest treatments:
· Prioritizing HIV in the Federal Budget. President Obama has continually demonstrated his commitment to implementing the National HIV/AIDS Strategy by prioritizing HIV in the federal budget, increasing prevention funding every year fiscal year. This included a $30 million increase in FY 2011 at a time when CDC’s budget experienced a sharp reduction in total funding. The Administration has also prioritized funding for the AIDS Drug Assistance Program (ADAP), a component of the Ryan White HIV/AIDS Program. In FY 2011, the ADAP budget totaled $885 million, up from $815 million in FY2009.
· Increasing Healthcare Options through the Affordable Care Act. People living with HIV have more to gain from the enactment of health reform than nearly any other group. People with HIV have higher rates of uninsurance, they are more likely to face barriers in accessing medical care, and they often experience higher rates of stigma and discrimination than other groups. The Affordable Care Act builds on what works in our current system. It seeks to expand Medicaid for the lowest income people; it strengthens and improves Medicare, and makes private insurance work better for all Americans, including people with HIV. The Affordable Care Act also prohibits discrimination on the basis of HIV status, bans lifetime limits on insurance coverage, and is phasing out annual limits in coverage.
· Extending the Ryan White HIV/AIDS Program. In 2009, President Obama signed a four-year reauthorization of the Ryan White HIV/AIDS Program, the largest federal program specifically dedicated to providing HIV care and treatment. It funds heavily impacted metropolitan areas, states, and local community-based organizations to provide life-saving medical care, medications, and support services each year to more than half a million people: the uninsured and underinsured, racial and ethnic minorities, people of all ages.
Focusing on Reducing New HIV Infections
· Testing Makes Us Stronger. More than 200,000 Americans living with HIV don’t know it. This week, CDC launched a new initiative – Testing Makes Us Stronger – to enable more Americans get tested. If people know they are HIV positive, they can take steps to protect themselves and their partners, and live longer and healthier lives.
· Shifting Focus to High Impact Prevention. Thirty years into the epidemic, we have a full toolbox of effective HIV prevention interventions. At the same time, not all interventions are equally effective, can be taken to scale, or are appropriate for all populations. CDC has articulated a new vision for its major HIV prevention program with state and local health departments that identifies required activities, and a range of recommended optional activities to optimize impact.
· Ensuring Resources Follow the Epidemic. As part of HHS’s operational plan for 2011, the agency has started tracking how federal funds are allocated on the basis of gender, race, and risk factors to compare and better align with the demographics of the epidemic. This is a new tool for ensuring that resources follow the epidemic. Further, beginning in FY2012, CDC’s funding for health departments will be awarded using a formula, based on living HIV/AIDS cases, which gives the most current picture of the HIV epidemic and moves away from counting cumulative cases and only counting AIDS, not HIV cases.
Making Significant Policy Changes
· Elimination of the HIV Entry Ban. From 1987 to 2010 HIV-positive travelers and immigrants have been banned from entering or traveling through the United States without a special waiver. President Obama lifted this ban in January 2010. The elimination of this ban is a major step in ending the stigma associated with HIV.
· International AIDS Conference. After the elimination of the HIV entry ban, the Obama Administration worked with the International AIDS Society to announce that the International AIDS Conference will return to the United States (Washington, DC) in July 2012 for the first time in more than 20 years. This will bring more than 25,000 researchers, clinicians, individuals living with HIV, and others to Washington to engage with each other on new research, best practices in the field, and effective policy options at this premier international scientific gathering.
· Comprehensive Support for Injection Drug Users. In 2009, Congress modified its ban on federal funding for syringe services programs. In 2010, the Obama Administration issued guidance that permits federal domestic and global funds to be used for syringe services programs when they are part of a comprehensive evidence-based intervention to prevent HIV infection and reduce drug use.