Call to Arms

When she walked on stage to deliver her plenary address at the International AIDS Conference being held here in Washington, D.C., US Secretary of State Hillary Clinton, whose call for an AIDS-free generation last year has become a rallying cry for the global AIDS community, was greeted with a standing ovation—but some catcalls and protests as well.

This was not surprising. Demonstrations of all sorts are standard fare at this typically boisterous conference, which has over the years consistently had—at least by the sedate standards of scientific meetings—something of a circus atmosphere. In this case, at least, the protestors appeared to be disgruntled about something to do with international trade negotiations, not HIV. 

At any rate, Clinton took it all in stride. “Now, what would an AIDS conference be without a little protest,” she said, without addressing the specific complaints of the protestors. She then launched into a 20-minute talk touting more than US$150 million in new funding for global AIDS programs. 

The Secretary also sought to reassure the audience that the Obama administration is committed to sustaining the President's Emergency Program for AIDS Relief (PEPFAR), which was launched by the last Bush administration and is up for reauthorization in 2013. 

Acknowledging the long-awaited lifting of the travel ban on people infected with HIV, the Secretary began by welcoming the HIV-positive members of her audience to the US. She then outlined the goals the Obama administration has laid out toward achieving its stated objective of an AIDS-free generation. Clinton said the largest chunk of the new US spending on HIV—about $80 million—will support innovative approaches to helping HIV-positive and pregnant women to “protect themselves, their babies, and their partners.”  

The US will also contribute $40 million to support the South African government’s efforts to scale up the provision of adult male circumcision as a strategy for HIV prevention. The Obama administration will, further, award $35 million to help poor countries expand services to key populations and to conduct implementation research. “If you are not getting excited about this, please raise your hand and I’ll send someone to check your pulse,” said Clinton. 

Dr. Anthony Fauci, the longtime director of the US National Institute of Allergy and Infectious Diseases, opened the morning plenary sessions. He noted that extraordinary gains have been made in HIV treatment over the past three decades—there are now 30 antiretroviral drugs approved to treat this virus alone. Gains in health and longevity have been equally remarkable. Fauci observed that doctors delivering HIV-positive diagnoses to young, HIV-positive men today “can look them in the eye and tell them that if they adhere to the drug regimen they live an additional 50 years.” 

Fauci also ticked off the growing arsenal of HIV prevention strategies—antiretroviral-based treatment as prevention, pre-exposure prophylaxis, adult male circumcision—and said that if we can add to that list a vaccine, even one with just partial efficacy, we will finally have in hand a “robust combination prevention package” with which to curb the pandemic. “Ending the HIV/AIDS pandemic is an enormous and multifaceted challenge, but we now know it can be done,” said Fauci. “It will require continued basic and clinical research, and the development and testing of additional treatment and HIV prevention interventions and, importantly, implementing those interventions on a much wider scale.” 

On the other hand, Phill Wilson, founder and executive director of the Black AIDS Institute, who spoke about the US AIDS epidemic—and specifically its impact on black Americans—said the new biomedical strategies are potent weapons against HIV, but “we need to figure out how to make them available.” Wilson said the data suggests that about 942,000 of the 1 million HIV-infected Americans likely know their status. Yet only about 328,000 have very low viral loads, suggesting that a relatively large percentage of the HIV-positive population in the US is not accessing treatment.  

At a session several hours later, US Sen. Lindsey Graham of South Carolina said the world may have turned the corner in the fight against HIV, but the news isn’t all good.