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.

BIll Gates"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 success."

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 of AIDS."

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 said.
  • 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%.


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