The Common Good

Two Steps Obama Can Take to Defeat AIDS

We are making historic progress against HIV/AIDS: The global rate of new HIV infections has leveled, and the number of annual AIDS deaths has decreased by nearly a third since 2005. Antiretroviral drugs are driving these gains by stopping progression of the disease and, we now know, preventing the spread of HIV infections.

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WHO recommends early and preventive treatment of AIDS/HIV with antiretrovirals. Spirit of America/Shutterstock

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Yet AIDS remains the leading cause of death in sub-Saharan Africa, where poverty limits access to lifesaving treatments and 25 million people are living with HIV —representing 70 percent of cases worldwide. President Barack Obama should be commended for uniting the world behind the goal of creating an AIDS-free generation. I share his passion and believe we can achieve this in the next decade — but only if we accelerate the provision of antiretrovirals to the poorest and most vulnerable people.

The opportunity has never been clearer. New data published in the New England Journal of Medicine project that early treatment with antiretrovirals in South Africa, my home country, would prove very cost-effective over a lifetime (costing $590 per life-year saved) and generate both public health and economic benefits. The World Health Organization now recommends early and preventive treatment with antiretrovirals, including administration to children and uninfected partners of people living with the disease. The WHO estimates that this could save an additional 3 million lives and prevent at least as many new HIV infections through 2025.

When Obama and I met in South Africa in June, I reminded him that, given his deep familial roots in the continent, his success is our success — his failure, our failure. With that in mind, there are two decisions Obama can make before the end of this year to fulfill the promise of an AIDS-free generation.

The first is to commit to doubling the number of people receiving antiretroviral treatment through the President’s Emergency Plan for AIDS Relief. Through PEPFAR, the U.S. government has already made treatment available to 6 million people living with HIV — an increase from only 50,000 when Congress authorized the program in 2003. Millions of lives have been saved, and at least 1 million babies have been born HIV-free thanks to the program.

Analysis in PEPFAR’s own blueprint for creating an AIDS-free generation has demonstrated that rapid scale-up of antiretrovirals is among the most effective ways to interrupt HIV transmission at the community level in hard-hit countries like Kenya and Uganda. Because PEPFAR has helped build the capacity in many African countries to massively scale up access to antiretrovirals, it should be possible—with proper funding and sustained political commitment—to treat 12 million people by the time Obama leaves office in 2017. This swift attack would deal a devastating blow to the virus where it is spreading most aggressively.

The second decision Obama could make concerns America’s role in expanding access to antiretrovirals through the Global Fund to Fight AIDS, Tuberculosis, and Malaria. In just over a decade, the Global Fund has provided antiretrovirals to 5.3 million people, including 2.1 million pregnant women living with HIV. It is aiming to raise $15 billion through its third “replenishment” cycle — the centerpiece of which is a pledging conference next month in Washington, D.C. — to support its work over the next three years.

As the conference host, the United States is leading a diplomatic effort to urge other donors to increase their contributions to the Global Fund. The implicit promise from the United States, based on previous contributions, to give $1 for every $2 contributed by other donors in the lead-up to the December conference has already produced encouraging results. Among other recent pledges, the United Kingdom has announced it will double its already sizable commitment, and several Scandinavian countries have agreed to increase their contributions by 25 percent.

The donor meeting next month is not the end of this important fundraising drive, so I hope the president will agree to provide up to one-third of the total Global Fund’s donations — up to $5 billion — over the next three years. A matching grant from the United States would encourage those countries that have not yet pledged, or that make unambitious commitments, to do more — or risk leaving U.S. dollars on the table. Bold commitments from Australia, Canada, Germany, Japan, and the European Commission, backed by a one-third U.S. match, could quickly turn the tide against AIDS.

We can defeat this disease and create an AIDS-free generation over the next decade if we remain focused and driven.

 Desmond Tutu is archbishop emeritus of Cape Town and honorary chairman of endgame, a global campaign to defeat AIDS, tuberculosis and malaria. This article first ran in Politico Nov. 18.

Photo: Spirit of America/Photostock

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