Senior Associate, Global Health Policy Center
Former President Bill Clinton delivered an energizing “call to action” at the closing session of AIDS 2012, encapsulating the high hopes and the sobering challenges facing the fight against global HIV/AIDS. Calling for renewed commitment despite the difficult economic environment, he told the packed conference hall: “If you scale it up and it works, the money will be there to fund it.” For the nearly 24,000 participants, the two Clinton speeches – by the Secretary of State and the former President – served as notable bookends to the conference’s long-awaited return to the United States.
While praising the Obama administration, Clinton laid out his vision of the road ahead to achieve an AIDS free generation. In order to build the necessary political momentum going forward, he focused on certain key areas: supporting greater commitments from affected countries, driving down the costs of treatment, and creating innovative financing mechanisms to accompany traditional donor funding.
Clinton reminded the audience of how far the AIDS movement has come from the days before PEPFAR and the Global Fund. He contrasted that with the “amazing progress” he saw on his recent trip to Africa, with leaders committed to expanding treatment and to eliminating mother to child transmission. In fact, of the $16.8 billion spent annually for HIV/AIDS, he said that more than half now comes from affected countries themselves. Still, he noted the challenges ahead; to meet the treatment goals by 2015, the numbers of those on treatment will have to be increased by 30% per year, and 1.5 million more children will have to be enrolled.
Much progress has been made in reducing treatment costs, making universal access far more attainable. In the past two years, citing the work of his foundation, Clinton said that South Africa alone has saved $700 million on drug costs, while adding 340,000 people to the treatment rolls. And more savings are on the way; the reduction in prices of Tenofovir will mean $500 million in savings by 2015. Declaring that “smart investments save money,” he focused on the need to scale up “test and treat” strategies, which could save lives and lower costs in five years. He recalled the skepticism around the launch of Jim Kim’s 3x5 initiative through WHO, but said the world responded to the challenge and now 8 million are on treatment. “Sometimes,” he noted, “you have to make a commitment before you know how you’re going to get there.”
Clinton expressed confidence that the Global Fund is “back in business” and that other donors will step up. “Governments, even in this difficult time, I believe will do more if we prove that we’re maximizing the impact of what they’ve given us,” he said, and then added: “Do not minimize the possibility that we’ll have more private giving.” He called for a “new level of openness about how every last dollar is spent by countries, by donors and by NGOs.”
Clinton made strong arguments for more innovative financing and for targeting money more effectively, especially in prevention. He cited a UNAIDS study showing that 30% of new infections are driven by high-risk populations, but less than 1% of the prevention funding is targeting those groups. “We need investments based on evidence, not politics and vested interests that too often drive spending decisions,” he said.
Clinton then turned to the situation in the United States. With 1.2 million people living with HIV, barely one quarter in adequate care, and an “exploding” epidemic among young black gay men, he said that too many in this country are being “left out and left behind.” He emphasized the importance of ensuring that all Americans have access to affordable HIV medications, and called for greater focus on HV/AIDS in the South, which has thrived on stigma against MSM, sex workers, and drug users.
In closing, Clinton reserved particular praise for the conference participants, noting that “millions of people, and an AIDS free generation, still depend on your tenacity and courage.” People around the world “are nourishing their dreams and their children’s dreams instead of giving up,” he said. “We have to deliver for them.”