Susan Blumenthal, M.D.: World AIDS Day 2012: A Roadmap for Ending HIV/AIDS

Written in partnership with Melissa Shive

Now some-more than ever, this year’s World AIDS Day outlines rare swell toward finale HIV/AIDS and providing explanation that investments in research, treatment, and impediment are agreeable lifesaving dividends. While there still sojourn poignant hurdles in achieving a universe yet AIDS, we now have roadmaps to get us there. This week, a U.S. Department of State expelled a “PEPFAR Blueprint: Creating an AIDS Free Generation,” and final year, a United Nations sealed a 2011 Political Declaration on HIV/AIDS, that is a tellurian plan to grasp concept entrance to HIV prevention, treatment, and caring by 2015. These papers are ancestral milestones and underscore that we are during a tipping indicate — a commencement of a finish of AIDS — if we feature efforts, work together, and dedicate a indispensable resources.

Here’s why: As a outcome of tellurian initiatives and programs, AIDS-related deaths have forsaken by some-more than 25 percent between 2005 and 2011 worldwide. There are now 700,000 fewer new HIV infections in a universe annually than there were a decade ago. In 25 low- and middle-income countries (most located in southern Africa), rates of HIV infection have forsaken by 50 percent or some-more given 2001. In sub-Saharan Africa, AIDS-related deaths have decreased by one-third in a past 6 years and a series of people on HIV remedy has increased by 59 percent in a final dual years alone. Recent studies have demonstrated that diagnosis of HIV/AIDS with antiretroviral (ARV) remedy reduces delivery rates by 96 percent, underscoring that diagnosis is also prevention. By ensuring that some-more people have entrance to ARVs, new HIV infections can be dramatically reduced.

Furthermore, several other milestones outrider a wish for a universe yet AIDS in a future: a find and FDA capitulation of ARV drugs to use as pre-exposure diagnosis (PrEP) to forestall HIV infection in high risk groups, poignant declines in mother-to-child delivery of HIV, enlargement of extensive preparation programs, contrast and counseling, and a scale-up of other proven impediment measures, including unchanging condom use and medical circumcision.

However, notwithstanding these advances, a widespread of HIV/AIDS is distant from over. According to a most new statistics from UNAIDS, there are still 2.5 million new HIV infections worldwide and 1.7 million deaths annually from this disease. Globally, there are 34 million people vital with HIV and half do not know their HIV status. Nearly half of a people in need of antiretroviral diagnosis (6.8 million) do not have access to these life-saving medications, and as many as 50 percent of them will die within 24 months if they do not accept therapy. Sub-Saharan Africa continues do lift a jagged weight of disease, where scarcely 1 in 20 people are vital with HIV, representing 69 percent of all people putrescent with a pathogen worldwide. The United States and countries opposite a creation contingency continue to take movement opposite this lethal virus.

Moving forward, an effective vaccine and a heal for HIV/AIDS will be indispensable to finally finish a tellurian pandemic. On this front, scientists are creation poignant swell in building an HIV vaccine. HIV’s ability to mutate has thwarted vaccine development, yet new studies have shown prejudiced potency of new vaccines. An vicious investigate was conducted in Thailand with a support of a Army’s Walter Reed HIV Research Program. Recently, a National Institute of Allergy and Infectious Diseases (NIAID) comparison Duke University and a Scripps Research Institute to lead a new Centers for HIV/AIDS Vaccine Immunology and Immunogen Discovery and awarded this new module $31 million in FY2012, with approximately $186 million or some-more in projected appropriation over a subsequent 6 years. The commencement will support a consortium of multi-disciplinary researchers during universities and medical centers focused on multi-pronged approaches to accelerate HIV vaccine development. The group will chateau pivotal immunological pathways and roadblocks, including defence responses that competence strengthen opposite HIV infection or conceal it in people vital with a virus, providing scientists with a substructure for conceptualizing a protected and effective HIV vaccine in a future.

Research is also underway to find a heal for AIDS, fueled by a believe of a “Berlin patient,” a male who had both leukemia and HIV. He was treated in 2007 with a bone pith transplant from a chairman with healthy shield to AIDS, that is found in 1 percent of Caucasian blood pith donors. The procession not usually marinated this patient’s leukemia yet also appears to have separated a HIV pathogen from his body, and he no longer requires remedy to yield a illness. This landmark box has supposing vicious clues in a query for a heal and a spark of what augmenting appropriation and clever efforts competence yield. amfAR, a Foundation for AIDS Research, is providing vicious systematic instruction in ancillary innovative work to learn a cure, including substantiating multi-site collaborations to grasp this goal. The NIH is appropriation studies to find a heal and has determined investigate consortia to promote new discoveries. However, heal investigate contingency accept a poignant boost in appropriation and joining from countries around a universe if we are to grasp a universe yet HIV/AIDS in a years ahead.

To yield a roadmap for serve accelerating swell toward a universe yet HIV/AIDS, on Thursday, U.S. Secretary of State Hillary Rodham Clinton expelled a U.S. government’s “PEPFAR Blueprint: Creating an AIDS Free Generation,” that provides a roadmap to grasp this goal. The PEPFAR blueprint’s aim is to control a AIDS widespread in a subsequent 4-5 years by providing some-more people with drugs to yield a disease, circumcising group in countries that have a high HIV prevalence, and ensuring that all profound women who are HIV-positive accept treatment. When these interventions are supposing in combination, a series of new HIV infections annually could be reduced subsequent a series of people who are put on ARVs. This would tip a beam on a widespread and set a arena to grasp an HIV-free era with 0 new AIDS-related deaths, 0 new infections, and no children who are orphaned given their relatives have died of this disease. The plans includes 5 primary goals with movement stairs to grasp them:

1. Scale adult multiple impediment and treatment:

  • Work toward a rejecting of new HIV infections among children by 2015 and gripping their mothers alive.
  • Increase coverage of HIV diagnosis both to revoke AIDS-related mankind and to raise HIV prevention.
  • Increase a series of males who are circumcised for HIV prevention.
  • Increase entrance to and uptake of HIV contrast and counseling, condoms, and other evidence-based and appropriately-targeted impediment interventions. PEPFAR now provides 5.1 million people with drugs and a Global Fund has supposing 4.2 people with these drugs given it was determined in 2002.

2. Going where a pathogen is: Target evidence-based interventions for populations during biggest risk

  • Target HIV-associated illness and revoke co-morbidity and mortality.
  • Increase entrance to and uptake of HIV services by pivotal populations.
  • Partner with people vital with HIV to design, conduct and exercise HIV programs manageable to and deferential of their needs.
  • Strengthen PEPFAR ‘s continued concentration on women, girls, and gender equality.
  • Reach orphans and exposed children (OVC) influenced by AIDS and support programs that assistance them rise to their full potential.
  • Strengthen programmatic joining to and importance on reaching and ancillary immature people with HIV services

3. Promoting sustainability, efficiency, and effectiveness

  • Strengthen PEPFAR supply bondage and business processes to boost a potency of U.S. investments.
  • Increase efficiencies by creation and larger formation of services with other U.S., common and multilateral tellurian health investments, including a Global Fund.

4. Creating an AIDS-free era requires a tellurian effort

  • Partner with countries in a corner pierce to country-led, managed, and implemented responses.
  • Increase support for polite multitude as a partner in a tellurian AIDS response.
  • Expand partnership with multilateral and common partners.
  • Increase private zone mobilization toward an AIDS-free generation.

5. Science contingency continue to beam a efforts

  • Leverage biggest impact by stability to deposit in doing science.
  • Support doing research.
  • Evaluate a impact of optimized multiple prevention.
  • Support innovative investigate to rise new technologies for impediment (e.g., microbicides, vaccines) and caring (e.g., new treatments or diagnosis regimens).
  • Develop evidence-based approaches to reaching people early adequate in their illness course to assistance say a clever defence system, wand off opportunistic infections, quite TB, and revoke new HIV infections.
  • Support a deployment of suitable record for dimensions of viral load, both by tiered laboratory networks and “point-of-care” tests as they spin available.
  • Assist countries in adopting breakthrough new technologies with proven impact, such as new molecular-based TB tests that have dramatically reduced time to diagnosis and diagnosis for people vital with TB and HIV.

The PEPFAR Blueprint reflects a Obama Administration’s investments in “smart power,” with a collection of health, education, and growth as essential components of a inhabitant unfamiliar policy. It underscores that we now have a collection to finish a epidemic, yet we contingency scale-up what works and muster these collection strategically to strech a many exposed populations worldwide. Investments in finale AIDS are also building a health systems to chateau and forestall other spreading and ongoing diseases — saving lives and resources as well.

In this regard, it is vicious to note that unfamiliar assist has traditionally been a vital source of appropriation to quarrel a AIDS widespread worldwide, yet for a initial time in history, UNAIDS reports that domestic investments by low- and middle-income countries to chateau their possess HIV/AIDS epidemics surpassed tellurian giving for these programs. From 2001-2011, 81 countries have insincere some-more common responsibility in addressing a illness by augmenting their possess nation’s contributions by some-more than 50 percent notwithstanding a tellurian mercantile crisis.

The United States, however, is a largest source of tellurian health appropriation to finish a AIDS epidemic. While surveys uncover that many Americans trust that 25 percent of a nation’s bill is spent on tellurian health and development, a volume is indeed rebate than 1 percent. Congress is now debating an 8.2 percent across-the-board appropriation cut to many non-defense discretionary programs regulating FY 2012 appropriations levels. amfAR, a Foundation for AIDS Research, has conducted an investigate that relates confiscation cuts to U.S. supervision tellurian health programming, and it reveals there would be minimal impact on necessity reduction, yet it would fleece a lives of tens of thousands of people globally. For example, the news estimates that if a confiscation of U.S. supervision common tellurian health support should occur:

  • HIV/AIDS diagnosis for 276,500 people will not be available, potentially heading to 63,000 some-more AIDS-related deaths and 124,000 some-more children apropos orphans.
  • 112,500 fewer HIV-positive profound women will receive services to forestall maternal-to-child transmission, heading to some-more than 21,000 infants being putrescent with HIV.
  • Funding for food, education, and provision assistance will not be accessible for scarcely 359,000 children.
  • About 60,000 fewer people with illness (TB), a heading means of genocide for HIV certain people, will accept treatment, heading to 7,000 some-more deaths due to TB, and 300 fewer people with multi-drug-resistant TB will accept treatment. About 1.3 million fewer pentavalent vaccines for children will be accessible by GAVI, heading to 14,000 some-more deaths from diphtheria, tetanus, pertussis, Haemophilus influenza form B, and hepatitis B.

On a tellurian front, leaders convened final year for a 2011 U.N. General Assembly High Level Meeting on AIDS and adopted a 2011 Political Declaration on HIV/AIDS. Listed subsequent are 10 specific targets in a stipulation that are vicious components of a tellurian plan to grasp concept entrance to HIV prevention, treatment, and caring by 2015. Turning a waves on HIV/AIDS in a subsequent 1,000 days to accommodate these 2015 targets will need augmenting research, financial investment, and domestic joining to finally finish a widespread in a years brazen by 1) creation a indispensable systematic discoveries, 2) scaling adult effective interventions, and 3) building a health systems infrastructure indispensable to renovate what has been an puncture response to a widespread into a postulated multi-faceted, multi-sector response in all countries.

1. Reduce passionate delivery of HIV by 50 percent by 2015.
Sexual delivery stays a primary track of new HIV infection globally and is a pivotal area of concentration for expelling new HIV infections. Female sex workers are 13.5 times some-more expected to be vital with HIV than women in a ubiquitous population. Based on a survey conducted in collateral cities worldwide, HIV infection among group who have sex with group (MSM) is, on average, 13 times aloft than that of a ubiquitous population. A median of usually 38 percent of MSM have been tested for HIV in a before 12 months. Condoms are essential collection to forestall passionate delivery of HIV, nonetheless it is estimated that low- and middle-income countries procured only 2 billion condoms in 2010, distant brief of a estimated 13 billion condoms compulsory to strech a HIV impediment goals for 2015. PrEP contingency be deliberate as plan for preventing HIV/AIDS among these high risk groups.

2. Reduce delivery of HIV among people who inject drugs by 50 percent by 2015.
About 3 million of a estimated 16 million people who inject drugs are vital with HIV, and these people have an HIV superiority rate that is 22 times aloft than a ubiquitous population. In particular, women who inject drugs are during a many high risk of bearing to HIV given they are also some-more exposed to other risk factors like partner violence, homelessness, and comorbid mental disorders that boost disadvantage to infection. In a U.S., an vicious step brazen is to lift a sovereign anathema on syringe exchange, that is an evidence-based, proven involvement that decreases delivery rates of blood-borne diseases including HIV and hepatitis.

3. Eliminate new HIV infections among children by 2015 and almost revoke AIDS-related maternal deaths.
In usually a final dual years, rates of new infections in children have forsaken by 24 percent, yet 72 percent of children vital with HIV who are authorised for HIV drugs still do not have entrance to them. Pregnancy-related deaths in women vital with HIV have declined from 46,000 to 37,000 globally from 2005 to 2010. However, still usually 30 percent of treatment-eligible profound women perceived antiretroviral diagnosis in 2011. To grasp an AIDS-free generation, it is essential to yield ARV therapy to profound women to forestall delivery to their babies as good as to guarantee that all children worldwide who are HIV-positive accept treatment.

4. Reach 15 million people vital with HIV with lifesaving antiretroviral diagnosis by 2015.
Antiretroviral therapy has saved an estimated 14 million life years in low- and middle-income countries, and a series of people accessing antiretroviral diagnosis has augmenting by 63 percent from 2009 to 2011. However, 7 million people authorised for HIV diagnosis still do not have entrance to these life-saving medications. The U.S. has affianced to guarantee that 6 million people are on ARVs by PEPFAR programs by 2013 to assistance strech this goal.

5. Reduce illness deaths in people vital with HIV by 50 percent by 2015.
While tuberculosis-related deaths have depressed by 25 percent from 2004, it stays a heading means of genocide for people vital with HIV, even yet it is famous that starting antiretroviral therapy immediately on diagnosis can revoke a risk of TB illness by adult to 65 percent.

6. Close a tellurian AIDS apparatus opening by 2015 and strech annual tellurian investment of $22-24 billion in low- and middle-income countries.
Spending on HIV/AIDS programs augmenting by 11 percent from 2010 to 2011, with domestic spending by low- and middle-income countries rising by 15 percent and now accounting for a infancy of sum HIV spending globally for a initial time in a story of a epidemic. However, tellurian investment on a illness in 2011 was $16.8 billion, that is still significantly brief of a $22-24 billion idea for 2015.

7. Eliminate gender inequalities and gender-based abuse and assault and boost women and girls’ ability to strengthen themselves from HIV infection.
Women comment for 58 percent of people vital with HIV in sub-Saharan Africa and paint 68 percent of people with entrance to antiretroviral therapy in low- and middle-income countries. Gender inequalities and energy imbalances in family between group and women make it formidable for women to negotiate safer sex practices or use interventions that could strengthen them from HIV infection. In 26 of 31 countries with concept epidemics, fewer than half of immature women have accurate believe about HIV transmission, diagnosis and prevention. And while 57 percent of profound women vital with HIV in low- or middle-income countries perceived antiretroviral medicines to forestall maternal-to-fetal transmission, usually 30 percent of them accept these drugs to yield a illness to guarantee their possess health. Ensuring that women accept diagnosis after giving birth to a baby is essential for advancing women’s health in a building universe as good as to forestall a era of children flourishing adult yet mothers who have died from HIV/AIDS.

8. Eliminate tarnish and taste opposite people vital with and influenced by HIV by graduation of laws and policies that guarantee a full fulfilment of all tellurian rights and elemental freedoms.
Fear, ignorance, stigma, and taste continue to criticise efforts to yield services to prevent, diagnose, and yield HIV/AIDS, and these amicable and constructional barriers to caring continue to be vital hurdles for many exposed populations. For example, 52 percent of people vital with HIV in Zambia reported written abuse given of their HIV status, and 1 in 5 people vital with HIV in Nigeria and Ethiopia reported suicidal thoughts and behaviors. As of 2012, about 60 countries have laws that privately criminalize HIV transmission, and 40 percent of U.N. member states criminalize same-sex passionate relations. Nearly 40 percent of countries do not have laws in place that strengthen people vital with HIV from taste and a laws that do exist are mostly inadequate. Efforts to break tarnish surrounding HIV/AIDS, quite among high-risk exposed populations including MSM, LGBT, sex workers, and people who inject drugs are indispensable to support a tellurian rights-based AIDS response.

9. Eliminate HIV-related restrictions on entry, stay, and chateau in countries around a world.
Current restrictions on a entry, stay, and chateau of people vital with HIV in countries miss a systematic basement and are mostly corpse of a fear and taste dating from early in a epidemic. While many countries have carried these old-fashioned policies, including a United States in 2010, 45 countries still have laws restricting entry, stay, and chateau for people vital with HIV and will need accordant efforts to teach policymakers and a open to order legislation that permits transport and immigration for people who are vital with HIV.

10. Eliminate together systems for HIV-related services to strengthen formation of a AIDS response in tellurian health and growth efforts, as good as to strengthen amicable insurance systems.
A extensive proceed to finale AIDS means integrating HIV-related services into existent health systems structures, permitting countries to precedence HIV-related achievements into broader health and growth programs, that will, in turn, urge a long-term sustainability of these programs and interventions in nations globally. Furthermore, clever efforts are indispensable to chateau a amicable and mercantile drivers of a widespread including improving essential services like housing, education, and practice opportunities.


Global achievements on these 10 U.N. targets and on a goals for a PEPFAR Blueprint so distant denote that with continued appropriation for research, treatment, care, and fast scale-up of programs that have proven effective, a idea of concept entrance to remedy and caring as good as rejecting of new HIV infections is attainable. While tellurian swell is accelerating toward these goals, there is still many some-more work left to be done. Greater bid contingency be done to strech exposed populations who are disproportionately influenced by a widespread that programming has unsuccessful to effectively strech (including MSM, sex workers, and people who inject drugs) so far. Investments in scholarship are indispensable to learn a heal for AIDS as good as to rise a safe, effective vaccine to forestall HIV infection.

This World AIDS Day is a jubilee of a achievements that have been done and a acceleration of swell in new years, providing explanation that finale a HIV/AIDS widespread is not usually possibly yet achievable. The PEPFAR Blueprint is an vicious roadmap to get us there. However, continued open and policymaker support and augmenting resources are urgently indispensable to scale-up programs that work and to deposit in innovative investigate so that we can grasp a universe yet AIDS in a future.


amfAR. “September 2012 Update: The Effect of Budget Sequestration on Global Health: Projecting a Human Impact in mercantile year 2013.” The Foundation for AIDS Research. Sep 25, 2012.

UNAIDS. “2011 Political Declaration on HIV/AIDS.”

UNAIDS. “2012 UNAIDS Report on a Global AIDS Epidemic.” Nov. 20, 2012.

UNAIDS. “Global AIDS Epidemic Facts and Figures.” Nov. 20, 2012.

United States Department of State. “PEPFAR Blueprint: Creating an AIDS-free Generation.” Nov. 29, 2012.

Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is a open health editor of The Huffington Post. She is also a comparison process and medical advsior during amfAR, a Foundation for AIDS Research, a senior associate in health policy during a New America Foundation in Washington, D.C., a clinical highbrow during Georgetown and Tufts University Schools of Medicine, and chair of a Global Health Program during a Meridian International Center. Dr. Blumenthal served for some-more than 20 years in comparison health care positions in a sovereign supervision in a administrations of 4 U.S. presidents, including as Assistant Surgeon General of a United States, a initial Deputy Assistant Secretary of Women’s Health, and as comparison tellurian health confidant in a U.S. Department of Health and Human Services. She also served as a White House confidant on health. Prior to these positions, Dr. Blumenthal was arch of a Behavioral Medicine and Basic Prevention Research Branch and conduct of a Suicide Research Unit during a National Institutes of Mental Health and chair of a Health and Behavior Coordinating Committee during a National Institute of Health. She has chaired countless inhabitant and tellurian commissions and conferences and is a author of many systematic publications. Admiral Blumenthal has perceived countless awards including titular doctorates and has been flashy with a top medals of a U.S. Public Health Service for her pioneering care and poignant contributions to advancing health in a United States and worldwide. Named by a New York Times, a National Library of Medicine and a Medical Herald as one of a many successful women in medicine, Dr. Blumenthal is a target of a 2009 Health Leader of a Year Award from a Commissioned Officers Association and was named a Rock Star of Science by a Geoffrey Beene Foundation. Her work has enclosed a concentration on HIV/AIDS given a commencement of a widespread in a early 1980s.

Melissa Shive is now a medical tyro during a University of California, San Francisco and a Master of Public Health Degree claimant from Harvard University. She served as a investigate partner during amfAR, The Foundation for AIDS Research and was a Fulbright Fellow. Ms. Shive is an honors connoisseur from a University of Pennsylvania.

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Via: Health Medicine Network