Last month, nearly 24,000 participants from 183 countries –  including over half from the U.S. – attended the 2012 International AIDS Society Conference (IAC) “Turning the Tide Together” in Washington, D.C. Thanks to President’s Obama’s lifting of the ban on visas for people living with HIV/AIDS, the conference was held for the first time in the U.S. in over 20 years – presenting a remarkably unique platform for the United States to highlight its accomplishments under PEPFAR and vision for an AIDS Free Generation.

President Obama’s video address at the opening ceremony re-affirmed the U.S. commitment to fighting HIV/AIDS. Secretary Clinton electrified the audience with her keynote address — highlighting PEPFAR’s progress, legacy and vision for the future. She announced increased funding to eliminate mother-to-child transmission of HIV and laid the groundwork to develop a blueprint for achieving an AIDS-Free Generation.

Other high profile notables, including President Clinton, bipartisan congressional leaders, including House Minority leader, Nancy Pelosi and Rep. Barbara Lee, former First Lady Laura Bush, and celebrities including Elton John, Annie Lenox, Deborah Messing and Whoopi Goldberg were also present — making their continued support and commitment to fighting AIDS loud and clear.

All in all, AIDS 2012 was an all-star event and an extraordinary opportunity for the vastly diverse participants to hear about game-changing scientific discoveries and state-of the-art technical updates, and to experience the lively booths and personalities at the global village.

USAID was visible throughout the week. Agency leadership, staff and partners contributed to satellite sessions, posters and abstracts. The Agency’s flagship Emerging Issues in Today’s HIV Response Debate Series – cosponsored with the World Bank – held its seventh and final debate on ‘Funding Allocations for HIV/AIDS’. Administrator Shah made multiple high profile appearances.  Alongside World Bank president Jim Kim and former Botswana President Festus Mogae, Dr. Shah opened the debate with commitments of future collaboration. In a symposium on Country Ownership alongside Minister of Health Dr. Kesete Berhan Admasu of Ethiopia, the Administrator explained USAID Forward.  At an elegant session at the Museum of American Women Art – alongside Ambassadors Melanne Verveer and Eric Goosby, GHI Executive Director Lois Quam, CDC Director Tom Frieden and Zimbabwe’s Deputy Prime Minister, Thokozani Khupe – he spoke about gender.

My Takeaway

Eight million people are now on treatment and the goal for 15 million by 2015 seems within reach. There has been so much progress; 30 years ago HIV was considered a death sentence, but now the life expectancy of a person living with HIV who adheres to treatment is similar to a person with a chronic illness, similar to diabetes. We now have a broad range of tools for prevention, including those we have been using – like circumcision, condoms, and PMTCT – and new ones that have just been introduced – like treatment for prevention and possibly future interventions like Pre Exposure prophylaxis (PrEP). A vaccine is closer to development. Costs have continued to decline: ARVs are less expensive and programs increasingly efficient. Treatment in many African countries now costs around $200 per year.

Country ownership is growing as lower and middle income countries are picking up increasing shares of the financial burden. The launch of the new PEPFAR guidance on Orphans and Vulnerable Children provides updated coverage for households, communities and social services.

Challenges still lie ahead.  There is an estimated $7 billion funding gap over the next three years. Incidence is declining, but the rate of decline is not sufficiently steep. To move the needle, we need to close the treatment gap, scale up access to voluntary male circumcision, and enroll more expecting mothers with HIV in PMTCT programs. And, while we have a broad range of tools, we must work with country leaders to apply them appropriately given the epidemic and the local context.

Recent microbicide and PrEP trials have underscored the challenges of adherence and retention, and the need to work outside as well as inside facilities to influence changes in behavior. Key populations are stigmatized and often have alarmingly high infection rates and limited access to critical services. Middle income countries with concentrated epidemics feel they are losing support as donors increase focus on high prevalence, low income countries.

The epidemic is aging. By 2015, in North America and Western Europe, half of the HIV population will be over 50 and new approaches to care and support will be needed – especially as those infected at birth become young adults and those in their 20s and 30s become senior citizens.

With all that lies ahead, the future looks bright – and USAID, as witnessed during the conference – will continue to be a leading technical force in the fight against HIV/AIDS. Our commitment to global health and HIV/AIDS, as seen since the beginning of the epidemic and over the past 30 years, will continue to lead to major contributions and progress in the field.