Senior Fellow, Global Health Policy Center
The words ‘AIDS-free Generation’ followed us all week throughout AIDS 2012. What does it mean? Clearly the notion of an AIDS-Free Generation within our reach is a powerful one. Is the meaning it inspires powerful enough to attract and keep the attention of national policy makers, already burdened with competing priorities in a tight economic environment? Clever enough to conquer the growing apathy of the American public, who may be eager to move on? Inspirational enough to counter the disbelief of public health professionals, weary from decades of battle? Most of us at the conference certainly hope so, because so many lives depend on it.
Charged by Secretary of State Hillary Clinton with developing a blueprint for the next phase of the USG’s involvement in the fight against HIV and AIDS, Ambassador Goosby of the Office of the Global AIDS Coordinator (OGAC) will lead an interagency effort to give clearer meaning to the term, AIDS-free Generation, and provide a basis for programming. And he must do so by World AIDS day, on December 1.
Secretary Clinton laid out her vision in a carefully crafted speech. An AIDS-free Generation means, “a time when, first of all, virtually no child anywhere will be born with the virus. Secondly, as children and teenagers become adults, they will be at significantly lower risk of ever becoming infected than they would be today no matter where they are living. And third, if someone does acquire HIV, they will have access to treatment that helps prevent them from developing AIDS and passing the virus on to others.”
Other public health leaders provided their definition of what AIDS-free Generation means. According to Ambassador Mark Dybul, former head of OGAC under the Bush administration, there is a clear, technical answer. An AIDS-free Generation means that new infections no longer out-pace the rate of AIDS-related deaths. The world wins because there are fewer and fewer people living with the virus and its awful consequences. Dr. Chris Beyrer, an epidemiologist who has tracked the epidemic both in the U.S. and abroad, added an important qualification by noting that all countries experience not one but multiple HIV/AIDS epidemics. Knowing your HIV epidemic means knowing about the HIV epidemics occurring among young people and adults in the general population, as well as in other vulnerable populations, such as fishing communities, sex workers, and men who have sex with men. This is important because these groups are likely to have different disease prevalence, modes of transmission, and risk factors that must be countered with different public health measures. Beyrer’s definition also means that it may be possible to achieve a low and stable rate of new infections in the general population, while epidemics rage unabated among the most vulnerable populations.
At the conference, we also learned about excessive rates of HIV infection in the United States, with AIDS epidemics rising in Washington D.C., in the South, and in other economically disadvantaged areas. We were reminded of the U.S.’s own continuing struggle against the HIV virus and the people who have been–and continue to be—left behind, especially African-American men who have sex with men and women of color. An AIDS-free generation means that we have to keep a critical focus on our most vulnerable. In the words of Secretary Clinton, “If we’re going to create an AIDS-free generation, we also must address the needs of the people who are at the highest risk of contracting HIV”, at home and abroad. It is an expression of human compassion, a test of American values, and good epidemiology to do so.