Opening Remarks for Combination Prevention Event

February 1, 2012

Amb. Eric Goosby
Opening Remarks for Combination Prevention Event
February 1, 2012

Thank you all very much for joining us today. Thanks to Senator Gillibrand, amfAR and the Center for Global Health Policy for partnering with us on this event.

Today’s forum is the first in a series of events highlighting aspects of PEPFAR in the months leading up to the July IAS meeting here in Washington.

The conference is a critical time to showcase to the world, and especially to the American people, what we have been able to accomplish through PEPFAR. In a bipartisan fashion, Congress has been generous to this effort. In tight budget times, it’s critical for us to be accountable, and to show that we are having an impact.

Many of you have the ability to tell this story from your own perspectives, and we encourage you to do so. I’m delighted to note that we’re joined today by Kay Warren of Saddleback Church, an extraordinary leader. Kay is here this week working to ensure that the contributions of faith communities are fully represented at AIDS 2012. We must all realize that we will not meet our prevention goals if faith communities are not full partners. In PEPFAR, they are.

For today’s discussion of combination prevention, I have a bit of a handicap: the most important points were already made by President Obama and Secretary Clinton! In their November and December speeches, they explained the tremendous opportunity the new science has given us to pursue the goal of an AIDS-free generation.

Today I want to briefly update you on how PEPFAR is following through on the vision they established.

First, let me make a few overarching points. Our PEPFAR guidance affirms the central role of behavior in all of prevention. Prevention programs are only accessed when a person makes the choice to do so. Thus comprehensive prevention always means addressing behavior.

Also central is HIV testing and counseling. PEPFAR supported testing of about 40 million people last year, and that number will increase. If people don’t know their status, none of this will work.

In addition, our prevention work must always respond to the gender dynamics of HIV. In the hardest-hit countries, women bear the brunt of the disease. PEPFAR has done a great deal of work to make sure our programs are meeting their HIV needs, and working together seamlessly with the programs that address their other needs.

And finally, even as we focus on prevention, we will also maintain our focus on other crucial areas of work. For example, we will not turn away from our commitment to orphans and other vulnerable children. PEPFAR is one of the largest global efforts to address their needs, and that is not going to change.

With that, let me turn to some of key elements of our prevention work.

In terms of treatment, the proof that it is a highly effective form of prevention has given us another reason to push to expand treatment access. When the President announces a 50 percent increase in your goal, that is both an affirmation of what you’ve done and a challenge to you to meet the goal.

It’s natural for people to wonder if we can really get to six million. The answer is yes. Starting well before World AIDS Day, we were working with our interagency PEPFAR country teams. Every country has its unique challenges, and we’ve been in an intensive dialogue with governments and civil society about how best to overcome them. I want to note the key role of our U.S. Ambassadors in country in this effort – they are the ones best placed to lead this crucial dialogue with the countries.

We are finding that our teams have excellent ideas on how to overcome the obstacles to treatment they face. And we also see continued opportunities to become more efficient– we’ve driven the cost to PEPFAR down, from over $1100 dollars per patient per year to $335 dollars, and we can do even more. I can say with confidence that the progress over these next two years will be dramatic.

This is also a time of great progress on prevention of mother-to-child transmission or PMTCT. Throughout the last decade, PEPFAR has been the global leader on PMTCT. Last June, we joined with UNAIDS and the 22 highest-burden countries in launching the Global Plan toward elimination of new HIV infections in children by 2015 and keeping their mothers alive.

On Friday at the World Economic Forum in Davos, I was honored to stand with leaders of the private sector as they committed to join forces to reach the goal of virtually eliminating pediatric AIDS by 2015.A new Business Leadership Council and Social Media Syndicate will converge their assets around this goal. These leaders have unique core competencies to bring to this effort.

For our part, in the countries with the highest prevalence of HIV, we have increased investments and worked with the Ministries of Health to develop Acceleration Plans to address critical bottlenecks in national PMTCT programs. Like all our efforts, this work must be owned and led by the countries themselves, so our PEPFAR teams are working side-by-side with Ministries of Health to build the capacity they need. That’s how we were able to prevent 200,000 pediatric infections last year, and we know we can do much more.

Voluntary medical male circumcision is another scientifically proven game-changer. In areas where rates of HIV are high and rates of circumcision are low, it is a very good investment and one for which we see great demand. Not only are men lining up at our voluntary male circumcision sites, they are often being encouraged to attend by their mothers, wives and girlfriends. Of course, as HIV prevalence decreases among circumcised men, mathematical models indicate an indirect protective effect for women, and ultimately the entire population at risk. In December, I was pleased to join UNAIDS and former President Festus Mogae of Botswana, who leads the Champions for an HIV-Free Generation, in endorsing a "Call for Action" for expansion of male circumcision to combat HIV.

PEPFAR has supported over one million male circumcisions for HIV prevention since 2007. PEPFAR is now supporting circumcision activities in 14 countries as part of a comprehensive package of prevention services. In our country teams’ dialogue with partner governments, we are seeing growing enthusiasm for doing much more. PEPFAR country teams are rapidly increasing the amount of funding for this, so that over the next two years, we can meet the goal the President set of supporting over 4.7 million male circumcisions in eastern and southern Africa.

Under PEPFAR’s combination prevention guidance, the engine for all our work must be a deep understanding, fully shared with the country leadership, of the drivers of infection in each country. That includes gathering data on the groups at highest risk, including people living in HIV-discordant relationships, men who have sex with men, people engaged in prostitution, injecting drug users, and others. Some governments are reluctant to engage with these groups, but we are helping them understand, from a public health perspective, the threat to their population at large if they don’t.

Finally, let me note the importance of building an evidence base. We need to know more about the best mix of interventions to reduce new infections, and have recently awarded three groundbreaking grants for trials of combination prevention. We also need to know more about how best to implement effective programs, and so we have also rapidly funded three large implementation science studies that will answer key implementation questions quickly and with rigor.

Let me stop there. I regret that I won’t be able to stay through the end of this event. My boss, Secretary Clinton, has invited me to a 1:30 meeting, and I don’t say no to her! But I do want to note that Dr. Caroline Ryan and Dr. Charles Holmes from my office, who lead our work in this area, will both be here.

Thank you very much.