Historic opportunity to "change the face of AIDS", says Bill Gates
26 July 2010
Bill Gates has called on all countries to keep up the fight
against HIV/AIDS in a keynote speech at the 18th International AIDS
Conference, saying the world has an historic opportunity to
"change the face of AIDS".
Mr Gates said current efforts to treat people with HIV are saving
millions of lives, and urged a renewed focus on reducing annual new
HIV infections up to 90% by 2031, the year that will mark 50 years
of the AIDS epidemic.
"The past few years of AIDS tell a story of remarkable progress,"
Mr Gates said at the conference, noting that more than 5 million people
currently receive antiretroviral treatment for the disease, a
12-fold increase in just six years. "By bringing attention to HIV,
we have also awakened the world to other health problems of the
poor, like malaria and tuberculosis, where we are seeing phenomenal
But Mr Gates, co-chair of the Bill & Melinda Gates Foundation,
stressed that future progress against AIDS depends on aggressively
preventing new HIV infections: "We can drive down the number of new
HIV infections dramatically and start writing the story of the end
While new HIV infections are already on the decline — the number
of annual new infections dropped 17% from 2001 to 2008, according to
UNAIDS — the pace of decline is not fast enough to have a
significant impact on the course of the epidemic, Mr Gates said.
Today, for every two people with HIV who gain access to treatment,
another five people become newly infected.
Call to get the most every AIDS dollar
Mr Gates said that while new funding is critical for achieving
further progress on AIDS, the world also needs "a new focus on
efficiency in AIDS funding in prevention and treatment".
"We have to be honest with ourselves: We can't keep spending AIDS
resources in exactly the same way we do today," Mr Gates said. "As
we continue to advocate for more funding, we also need to make sure
we're getting the most benefit from each dollar of AIDS funding and
every ounce of effort."
In his speech, Mr Gates outlined key opportunities for AIDS
investments to be more cost-effective and have greater impact:
- Rapid scale-up of the most cost-effective prevention
tools: Mr Gates urged much more rapid scale-up of HIV prevention
tools that are "cheap, effective, and easy to apply." He noted
that some prevention tools — such as male circumcision and
prevention of mother-to-child transmission — "are so effective
that in endemic countries it is more expensive not to pursue
them." Yet in the case of male circumcision, while more than 41
million men in sub-Saharan Africa could benefit from the
procedure, just 150,000 have been circumcised in the past few
- Better use of data to make prevention decisions: Mr Gates
emphasized the need to target prevention efforts based on data
showing where transmission rates are the highest. He urged
countries that have cut back on prevention for high-risk groups
— such as injection drug users — to restore funding to effective
programs: "If you're afraid to match your prevention efforts to
the populations at the highest risk, then you're wasting money,
and that costs lives."
- Reductions in the cost of delivering treatment: citing new
research that treating people with HIV reduces transmission to
others, Mr Gates said it is imperative to continue lowering the
cost of treatment so more people can receive it. While the cost
of HIV drugs is already low, the cost of delivery can be many
times higher. "If we could limit delivery costs to no more than
twice the cost of the drugs themselves, we could treat more than
twice as many people for the same amount of money," Mr. Gates
- Greater investment in vaccines and other breakthrough tools:
Mr Gates called for greater investment in promising research
that could lead to breakthroughs in preventing HIV, including an
HIV vaccine, pre-exposure prophylaxis (PrEP), and microbicides.
Although scientists have reported encouraging progress toward an
HIV vaccine, only three vaccine concepts have ever undergone
clinical efficacy testing. "We need to speed up the development
process for new prevention tools, and when we get results from
these studies, we should be ready to act on them right away."
Effect of smarter AIDS investments
Mr Gates presented new modelling projections developed for the
Gates Foundation by researchers at Imperial College London that show
the dramatic impact smart AIDS investments could have by 2031.
The projections focus on two parts of Africa that illustrate
different types of HIV epidemics:
- Rural Zimbabwe: In rural Zimbabwe, where HIV is generalized
across a large part of the population, more than 700,000 new
infections are projected to occur over the next two decades.
Scaling up existing prevention tools appropriate for generalized
epidemics — including male circumcision and antiretroviral
treatment — could reduce annual new HIV infections in rural
Zimbabwe by 38% by 2031. The addition of an effective vaccine,
PrEP, and microbicides within this timeframe
could cut annual
new infections up to 90%.
- Urban Benin: In urban Benin, HIV is concentrated among sex
workers and their clients, and more than 100,000 new infections
are projected to occur over the next two decades. Scaling up
existing prevention tools targeted to sex workers — such as
promoting condoms and providing treatment — could reduce annual
new HIV infections in urban Benin by 46% by 2031. By also
delivering a vaccine, PrEP, and microbicides to most sex
workers, Benin could cut annual new infections up to 90%.