Secretary of State Hillary Clinton spoke November 8 at the NIH about United States AIDS policy. She began the policy announcement by speaking about prevention of mother-to-child transmission, and reducing transmission by male circumcision in Africa, two evidence-based approaches to reducing trasmission through medical intervention.
In June, I visited the Buguruni Health Center in Tanzania, and there I met a woman living with HIV who had recently given birth to a baby boy. She had been coming to the clinic throughout her pregnancy for medication and information because she desperately wanted her boy to get a healthy start in life, and most especially, she wanted him to be born HIV-free. When we met, she had just received the best news she could have hoped for. Her son did not have the virus. And thanks to the treatment she was getting there, she would live to see him grow up.
This is what American leadership and shared responsibility can accomplish for all mothers and children...
In addition to preventing mother-to-child transmission, an effective combination prevention strategy has to include voluntary medical male circumcision. In the past few years, research has proven that this low-cost procedure reduces the risk of female-to-male transmission by more than 60 percent, and that the benefit is life-long.
Here in Long Beach, thanks to the Bickerstaff Clinic at Long Beach Memorial, there hasn't been a case of mother-to-child transmission. Here in the developed world, anti-viral therapy is the standard of care for HIV-positive pregnant women.
We probably won't be seeing male circumcision here in the West. Studies in the devloped world haven't shown the same protective effect, either due to the different strains of HIV, the different routes of transmission, or other confounding factors.
Clinton third method is something that isn't being done in the United States, and shows great promise for reducing new cases of HIV here at home; it's what will be known as "test and treat":
Thanks to U.S. Government-funded research published just a few months ago, we now know that if you treat a person living with HIV effectively, you reduce the risk of transmission to a partner by 96 percent.
Of course, not everyone takes the medication exactly as directed, and so some people may not get the maximum level of protection. But even so, this new finding will have a profound impact on the fight against AIDS.
For years, some have feared that scaling up treatment would detract from prevention efforts. Now we know beyond a doubt if we take a comprehensive view of our approach to the pandemic, treatment doesn’t take away from prevention. It adds to prevention. So let’s end the old debate over treatment versus prevention and embrace treatment as prevention...
Treating HIV-positive people before they become ill also has indirect economic benefits. It allows them to work, to support their families, contribute to their communities. It averts social costs, such as caring for orphans whose parents die of AIDS-related illnesses. A study published just last month weighed the costs and benefits and found that – I quote – “the economic benefits of treatment will substantially offset, and likely exceed, program costs within 10 years of investment.” In other words, treating people will not only save lives, it will generate considerable economic returns as well.
This is great news for developing countries currently receiving PEPFAR funding for HIV treatment. What's so unfortunate is that here in the United States, we have thousands of HIV-positive people on ADAP waiting lists. Just last week I received a call from someone who has my job in Florida, and she said it can take two years from intake before a new patient can receive life-saving medications. I know that for person with an impacted immune system, help may come too late.
As George Ayala pointed out in is opinion piece in the Advocate, for treatment as prevntion to succeed, a concerted effort needs to be made to target populations most severly affected by the virus. When you come in to the CARE Program for a free rapid HIV test, we'll ask about risk factors--specific behaviors that put you at risk. But just as importantly, we'll be asking about the types of people you may be having sex with. Transgenders, men-who-have-sex-with-men (no matter how they identify), the recently incarcerated, sex workers, and injection drug users--are all groups with high percentages of people living with HIV.
Since one in five of people with HIV don't know they're infected, it's essential that folks in high risk groups get tested on a regualar basis--and have quick access to medications.
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