US embraces treatment as prevention policy to achieve global 'AIDS-free generation'

Keith Alcorn
Published: 08 November 2011

The United States is now committed to a policy of creating the first AIDS-free generation by using antiretroviral treatment as the central tool in a strategy to radically reduce new infections, US Secretary of State Hillary Clinton said today.

“HIV may be with us well into the future.  But the disease that it causes need not be,” said Secretary of State Clinton.

“This is an ambitious goal, and I recognise that I am not the first person to envision it.  But creating an AIDS-free generation has never been a policy priority for the United States government—until today”, she said.

“This goal would have been unimaginable just a few years ago.  Yet it is possible, because of scientific advances largely funded by the United States and new practices put in place by this administration and our many partners around the world.  While the finish line is not yet in sight, we know we can get there, because we know the route we need to take.”

Her remarks follow months of internal debate within the US government about how to respond to the results of the HPTN 052 study, which showed that antiretroviral treatment reduced the risk of HIV transmission to regular partners by 96%.

“If we take a comprehensive view of our approach to the pandemic, treatment doesn’t take away from prevention,” she said. “It adds to it.  So let’s end the old debate over treatment versus prevention and embrace treatment as prevention.”

Clinton emphasised the importance of three measures:

  • Prevention of mother to child transmission using antiretroviral drugs. One in seven new infections worldwide occur from mother to child; the United States has worked with other global partners including UNAIDS to develop a strategy to virtually eliminate new infant infections by 2015, by expanding testing and treatment.

  • Voluntary male circumcision reduces the risk of a man acquiring HIV infection by around 60%. PEPFAR has financed three-fourths of the one million male circumcisions for HIV prevention around the world since 2007.

  • Treatment as prevention. The HPTN 052 study showed that earlier treatment massively reduced the risk of HIV transmission, and another US-funded study has shown that treatment before the onset of serious AIDS-defining illness or immune deficiency substantially reduces the risk of developing AIDS or dying.

The announcement was welcomed by activists.

“Secretary Clinton laid out a bold vision today,” said Matthew Kavanagh, Director of US Advocacy for Health GAP. “Her speech could be the foundation for the US administration to lead the world to end the AIDS crisis. And it raises high expectations among all those who heard it: we expect that President Obama will now take leadership and dramatically ramp up PEPFAR antiretroviral treatment targets as well as scaling up other highly impactful prevention technologies.”

“In several countries where we work, we are seeing governments that are ready to act on the new science in order to turn back the toll the virus has taken on their people and their communities. If the US and other governments ramp up their investment in HIV treatment now, we know that millions of lives will be saved and millions more new infections will be averted,” said Dr. Unni Karunakara, International President of Médecins Sans Frontières.

In her remarks, Secretary Clinton called on other donor nations to do more, including by supporting and strengthening the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Partner countries must also take more responsibility for their AIDS programmes, including spending more on fighting their own epidemics.

But Secretary Clinton’s remarks were also addressed to a national audience that is growing increasingly sceptical about overseas aid spending at a time when the United States is engaged in bitter debates about how to limit government spending.

The frontrunner for the Republican presidential nomination, Mitt Romney, has questioned whether the United States should be spending money on poverty relief overseas, and Republicans in Congress are attempting to trim global health spending and prevent any increases in US expenditure on HIV treatment.

“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," Clinton said.