A Blueprint For An AIDS-Free Society

It’s been about a year since US Secretary of State Hillary Clinton, whose department oversees the President’s Emergency Plan for AIDS Relief (PEPFAR), set a goal of achieving an AIDS-free generation (see VAX Global News,With HIV Incidence Plateauing, a Push for an AIDS-Free Society, Nov. 2011).  

On Nov. 29, two days before World AIDS Day, Clinton unveiled a 64-page blueprint that provides a bit more clarity on how PEPFAR—which was launched by former US President George W. Bush and has continued under President Obama—can achieve this goal with its partners. 

“HIV may well be with us into the future, but the disease that it causes need not be,” said Clinton, who was joined during the announcement by US Global AIDS Coordinator Eric Goosby and Michel Sidibé, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). 

The blueprint is actually four separate roadmaps that fall under the titles “Saving Lives,” “Smart Investments,” “Shared Responsibility,” and “Driving Results with Science.”  The roadmap to saving lives, for  instance, outlines a plan to eliminate HIV infections among children by 2015, and expand access to antiretroviral drugs, adult male circumcisions, HIV testing and counseling, and condoms by continuing to support the scale-up of combination prevention and treatment interventions in countries bearing the biggest burden of HIV.   

Clinton said the goal is to get these countries to the point where the annual increase in HIV-infected individuals receiving ARVs exceeds the annual number of new HIV infections, thus putting them “on the path toward achieving an AIDS-free generation.”   Clinton said the world can reach a point where “virtually no children are born with HIV,” and that when these children reach adolescence and adulthood they will be at a far lower risk of becoming infected.
 
“If they do acquire HIV they will have access to treatment that not only prevents them from developing AIDS but also from passing on the virus to others."

While prevention of mother-to-child transmission, expanding adult male circumcision programs, and more widespread treatment of HIV-infected individuals to curb transmission are being touted in the blueprint as current-day tools to help achieve an AIDS-free generation, the document also set a goal of supporting new technologies, such as vaccines, to end the pandemic.
 
“Science and evidence must continue to guide our work,” said Clinton. “We will support research on innovative technology for prevention and treatment, such as microbicides, and those that stave off opportunistic infections, and we will set clear benchmarks. It is science that has brought us to this point and science will allow us to finish the job.”   

Mitchell Warren, the executive director of AVAC, a global organizatin advocating for a vaccine and other biomedical prevention tools such as microbicides and ARV-based prevention strategies, said in advance of Thursday’s announcement that the blueprint needed to provide a clear, feasible ambitious program with achievable targets. Yesterday, he issued a statement saying that the blueprint has enormous potential to accelerate global HIV prevention efforts, drawing particular encouragement from the fact that the blueprint focuses on translating scientific breakthroughs into lives saved. Still, the information is lacking on which combination prevention strategies work best for which communities. 

“Urgent questions about the real-world use of new prevention tools in combination have been clear for months or even years, yet the work to answer them is barely under way. That’s as unconscionable as it is unnecessary.’’  

Some were unimpressed with the blueprint. The AIDS Healthcare Foundation in California, a treatment advocacy group, criticized the blueprint for its lack of detail. “In terms of targets, the Office of the US Global AIDS Coordinator said it will work toward elimination of new HIV infections among children by 2015 and keeping their mothers alive, a worthy goal but lacking specifics,” said AHF President Michael Weinstein in a written statement.
 
“There is also a notable absence of any plan on drug pricing, given the high cost of newer and second-line AIDS drugs. The blueprint simply points out that the vast majority of drugs currently used in the program are older generics, which has saved money. However, there is no discussion of how US trade policy impacts access to these generic medicines going forward. 

Clinton’s remarks come on the heels of the latest UNAIDS report, released Nov. 21, which offered both encouraging and sobering statistics about the state of the epidemic. On the plus side, 25 countries reported at least a 50% drop in new infections over the past year (www.unaids.org). However, the report also found the number of people newly infected in the Middle East and North Africa has increased by more than 35% since 2001. New infections have also increased in Eastern Europe and Central Asia in recent years while the epidemic remains static in the United States.