As featured in Dipnote
By Ambassador Eric Goosby, U.S. Global AIDS Coordinator
As we approach World AIDS Day, many are asking difficult questions about the way forward on global AIDS. The questions are not about whether lives are being saved from the devastation of AIDS, because they are — by the millions. But some wonder whether we can continue to maintain our strong commitment and make dramatic progress when the global economy is under such strain. It’s a reasonable question, and one motivated by genuine concern for those we serve. Let us be clear: the answer is that we can, and we are fully dedicated to continuing in our fight against HIV/AIDS.
Through a range of actions, the Obama Administration is demonstrating that the U.S. commitment remains firm, even in these challenging economic times. The Administration’s budget request for the U.S. President’s Emergency Plan for HIV/AIDS Relief (PEPFAR) this year is the largest in any President’s budget to date. We are grateful for the strong foundation of success that President George W. Bush and a bipartisan Congress established when they launched PEPFAR. Building on that foundation, during President Barack Obama’s tenure PEPFAR has continued to expand, greatly increasing the number of lives saved from this destructive pandemic. Tomorrow, on World AIDS Day, we’ll announce our latest results, which will show continued, dramatic progress in saving lives devastated by HIV/AIDS.
We’re also proud of the partnerships that we built with the Global Fund to Fight AIDS, Malaria and Tuberculosis and with individual country governments. The Obama Administration recently announced the first-ever multi-year pledge to the Global Fund of $4 billion — a significant 38 percent increase.
Under PEPFAR, the U.S. government is also focused on doing business more efficiently and effectively. Years of experience in the field have taught us how to better use every dollar invested in battling AIDS. This means we are getting a bigger bang for the buck — allowing us to do more to fight not only HIV/AIDS, but other global health issues that impact communities affected by HIV. It means that our yardstick for measuring success is not dollars invested, it’s lives saved. Simply put, we’re focused on making smart investments that improve and save more lives.
Let’s look at a few examples.
• We’re saving lives and money by using more generic drugs. Recognizing that one of the biggest hurdles to rapid treatment scale-up was the high price of antiretroviral drugs, PEPFAR worked with the U.S. Food and Drug Administration to bring more generics to market. By 2008, generics accounted for almost 90 percent of the 22 million antiretroviral drug packs purchased, increasing from 14.8 percent in 2005, and resulting in an estimated cumulative savings of $323 million.
• We’re successfully implementing programs to prevent mother-to-child transmission. Prevention of mother-to-child transmission is one of the most effective — and cost-effective — interventions for HIV. By focusing on preventing mother-to-child transmission, Botswana and parts of South Africa have had extraordinary success, reducing the likelihood of infant infection to levels similar to those found in the United States, and reducing the significant costs associated with new infections. Accordingly, PEPFAR’s Five-Year Strategy set goals to reach 80 percent of pregnant women with HIV counseling and testing, and to provide antiretroviral prophylaxis or treatment, as appropriate, to 85 percent of pregnant HIV-infected women in PEPFAR countries.
• We’re changing the way we deliver medicines. We have become more efficient in shipping needed medicines in a timely fashion by using water and land delivery systems instead of air freight, reducing costs by as much as 90 percent. In 2009, sea freight charges for products PEPFAR moved through the Supply Chain Management System (SCMS) were $520,000, while moving the same volume by air would have cost an estimated $3.8 million. Similarly, road freight charges for the product PEPFAR moved through SCMS were $395,000, while to move the same volume by air would have cost an estimated $953,000.
• Last, but not least, medical male circumcision promises dramatic impact on prevention efforts. Medical male circumcision is an ideal HIV prevention investment for countries and donors, as it is a one-time intervention that provides lasting prevention benefits. The majority of the expenditure required to saturate a country with high levels of adult male circumcision takes place in the first 1-3 years, depending on the speed of the program, and expenditures drop precipitously following this initial investment to support neonatal and adolescent boys. Scaling up male circumcision to reach 80 percent of adult and newborn males in 14 African countries by 2015:
- Could prevent more than 4 million adult HIV infections over 15 years (2009 – 2025)
- Could result in cost savings of $20.2 billion between 2009 – 2025 with an overall investment of approximately $4 billion
We’ve had great success in the fight against HIV/AIDS, but the battle is far from over. The goal now must be to build on that success and continue to be smart about the investments we make.