Clinton Calls for Sweeping Changes in AIDS Response

Blog Post — July 24, 2012

Janet Fleischman
Senior Associate, Global Health Policy Center

In a rousing address to the AIDS 2012 conference on Monday, Secretary of State Hillary Clinton opened with “five words we have not be able to say for too long: welcome to the United States!” She then proceeded to dazzle the crowd with her passionate command of the issues and her direct discussion of many of the most fundamental and sensitive issues surrounding the HIV/AIDS response. If this is to be her legacy speech on HIV/AIDS, she will surely have left her mark.

After tracing the trajectory of the AIDS response, noting that “caring brought action and action has made an impact,” Clinton outlined how PEPFAR is shifting out of an emergency mode toward support for building the sustainable health systems necessary to deliver an “AIDS free generation.”  This shift will require sweeping, crucial changes in the way the U.S. and its global partners do business, involving ministers of health and finance of partner countries as well as prime ministers and presidents in charting the way forward and in addressing the difficult issues of corruption and dealing with injecting drug users.  Clinton also pointed to “vastly improved” coordination with the Global Fund.

Turning to the issue that has animated her throughout her career, Clinton focused on the situation of women and girls in the AIDS crisis. She described one of the biggest hurdles being that women are often diagnosed with HIV when they are pregnant, and they face barriers in accessing treatment for themselves. As critical as prevention of mother-to-child transmission is to the achievement of an AIDS-free generation, this was a welcome acknowledgment that PMTCT programs too often overlook the mother’s health and focus only on preventing transmission to her child. To address this gap, she announced that the U.S. will invest $80 million to “support innovative approaches to ensure that HIV-positive pregnant women get the treatment they need to protect themselves, their babies, and their partners.”

Clinton went further. Saying that PEPFAR has to become part of a more comprehensive effort to address the health of women and girls, she highlighted the particular role that women play in the AIDS epidemic, especially in Africa. She noted that that these women want to protect themselves and access appropriate health care.  “We have to answer their call,” she declared. This means working not only on HIV, but on maternal and child health, reproductive health, and family planning, as well as gender-based violence. “Every woman should be able to decide when and whether to have children. This is true whether she is HIV-positive or not….There should be no controversy about this. None at all.”

Clinton emphasized the importance of addressing the needs of those populations at highest risk for HIV infection, including sex workers, men who have sex with men, and injecting drug users. “Now over the years, I have seen and experienced how difficult it can be to talk about a disease that is transmitted the way that AIDS is. But if we’re going to beat AIDS, we can’t afford to avoid sensitive conversations, and we can’t fail to reach the people who are at the highest risk.” And she made clear that very few countries are doing what needs to be done in this area, pointing particularly to Eastern Europe and Southeast Asia, which drives these groups more into the shadows making the epidemic harder to fight. She announced a new $15 program in implementation research to identify specific interventions for each key population, and $20 million in a challenge fund for countries to expand services to these groups, as well as $2 million to support civil society efforts.

Clinton acknowledged that some are raising questions about the U.S. commitment to an AIDS free generation. She assured the crowd that the U.S. will not back down, citing: U.S. support for 400,000 male circumcision procedures and an additional $40 million for South Africa’s program; U.S.-supported PMTCT programs reaching 370,000 in the first half of this fiscal year; and doubling the numbers on treatment since 2009, reaching almost 4.5 million and aiming for President Obama’s goal of 6 million. Still, many in the audience undoubtedly were left wondering whether the next administration and the next secretary of state would share her approach.

At the end, Clinton announced that she has charged Ambassador Eric Goosby with developing a blueprint by World Aids Day this year on goals and objectives for the next phase of the AIDS fight for the next administration. If that blueprint proves to be a bold and forward-looking document that galvanizes concrete action on global HIV/AIDS, it may well serve as a key part of Clinton’s legacy.

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