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Global Health: A Historic and Momentous Movement

I just returned from listening to a brilliant and inspiring speech by Secretary of State Hillary Clinton. Secretary Clinton traced the history of the HIV/AIDS pandemic, from the dark days of the 1980s, when little to nothing was understood about the disease and how to fight it, to today, when, armed with the tools made possible by science, great strides are being made in bringing HIV/AIDS under control. As she correctly pointed out, United States (US) leadership and investment have been at the forefront every step of the way. Investments in science led to understanding the virus, developing treatment, and building evidence-based prevention programs. The result has been a marked decline in the incidence of the disease, millions of infections prevented and millions under treatment. Many institutions and people have contributed to this remarkable change. That said, the contribution of the US government to the fight against HIV/AIDS has been essential to the progress achieved. The US contribution to the cause of fighting HIV/AIDS, and global health more generally, has been a pillar of US leadership in the world.

In addition to the health and humanitarian gains realized, there have also been economic benefits. The costs of providing HIV/AIDS prevention, care, and treatment services have been more than offset by the positive economic impact on households and national economies. In part, this is due to the rapid decline in the cost of providing treatment, which has dropped from about $1,100/person a decade ago to about $300/person today.

With that as background, the Secretary announced a new goal for US HIV/AIDS policy—an AIDS-Free Generation. Looking to the future, she spoke of the possibility of the next generation being free from AIDS through widespread use of a combination prevention approach. Without neglecting other effective strategies, such as voluntary counseling and testing and condom use, she gave particular emphasis to preventing mother-to-child transmission of HIV, voluntary male circumcision, and treatment as prevention. Given the powerful evidence that has emerged about these three strategies, she called for ramping up global investment in combination prevention, adapting the mix of interventions to the dynamics of the disease in different contexts.

While the US must sustain its leadership role, other partners must increase their contribution. Countries that have the means to do so must maintain or increase their support to HIV/AIDS programs, including wealthy countries that have been missing in action. The countries with high rates of HIV infection, especially in Africa, must truly own and invest in their own HIV/AIDS programs; country ownership means both controlling the agenda and taking responsibility for making an appropriate contribution of national resources.

HIV incidence has already dropped 25% from its peak. Research cited by Secretary Clinton suggests that a further decline of 40%-60% is possible if combination prevention is made widely available. This has now become an achievable goal unfathomable only a few years ago. She ended by saying, “An AIDS-free generation would be one of the greatest gifts we could give the future. Let’s not stop now.”

It can be easy to become lost in the weeds of our day-to-day work. Secretary Clinton’s speech reminds us that we are all part of a historic and momentous global movement.