World AIDS Day 2012: PEPFAR's Blueprint for an AIDS-Free Generation

We cannot do it alone, but together we can make an AIDS-free generation a reality. The blueprint is driven by five key principles that are the foundation of PEPFAR's work with partner countries.
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Success motivates action. All of us are much more willing to continue to invest in something that has produced results than in something that hasn't.

As we approach World AIDS Day, we now have a tremendous track record of success from U.S. investments in fighting global AIDS. A decade ago, an HIV diagnosis in Africa was essentially a death sentence. Today, through the President's Emergency Plan for AIDS Relief (PEPFAR), the American people support nearly 5.1 million people on antiretroviral treatment. That treatment is the difference between life and death, allowing people to continue to raise and provide for their families -- and build their nations.

Seeking to build on this success, Secretary of State Hillary Rodham Clinton called for PEPFAR to develop what she called a "Blueprint for an AIDS-Free Generation."

She asked us to provide the next Congress, the next Secretary of State and all of our partners with a clear picture of everything we've learned and a road map that shows what the United States will contribute toward achieving an AIDS-free generation.

You can read the blueprint at It sends an unequivocal message that the U.S. commitment to the global AIDS response will remain strong, comprehensive and driven by science. It provides a roadmap for what the U.S. will do to achieve an AIDS-free generation. Equally important, it calls upon the world to share in the responsibility to reach this goal. We cannot do it alone, but together, we can make an AIDS-free generation a reality.

The blueprint is driven by five key principles that are the foundation of PEPFAR's work with partner countries:

• Making strategic, scientifically-sound investments to rapidly scale-up core HIV prevention, treatment and care interventions and maximize impact.

• Working with our partners to effectively mobilize, coordinate and efficiently use resources to save more lives sooner.

• Focusing on women and girls to increase gender equality.

• Ending stigma and discrimination against people living with HIV and key populations.

• Setting benchmarks that are regularly assessed to assure goals are being met.

When President George W. Bush and a bipartisan Congress created PEPFAR almost a decade ago, it was rightfully an emergency response. As the epidemic's tide has stemmed, PEPFAR has been moving to a more sustainable response with countries in the driver's seat. That's essential to keep the AIDS response effective, efficient and durable.

The U.S. will continue its leadership role but, increasingly, countries must own their epidemics. All partner contributions must adhere to and support the principle of country ownership, with partner countries leading, managing, coordinating and over time increasingly financing the efforts needed to achieve an AIDS-free generation.

This won't happen overnight -- nor should it. All partners must remain committed to this fight if we are to achieve an AIDS-free generation.

Here are the five goals the PEPFAR blueprint establishes, with specific action and implementation steps the U.S. will take with partner countries to reach these goals.

• First, we remain committed to scaling up combination prevention and treatment. As Secretary Clinton said last year, if we scale up prevention of mother-to-child-transmission, treatment as prevention, voluntary medical male circumcision, and access to HIV testing and counseling, condoms and other evidence-based prevention interventions, we can put countries -- and the world -- on a path to achieving an AIDS-free generation.

• Second, we will be smart about our investments -- going where the virus is and targeting evidence-based interventions for populations at greatest risk. And we will not support interventions that fail to target the epidemic. Understanding how the virus moves through a population is directly informed by understanding where new infections are occurring.

• Third, we will promote sustainability, efficiency and effectiveness. We will continue to ensure that we are getting the most out of every PEPFAR dollar spent in terms of saving even more lives.

• Fourth, we believe that creating an AIDS-free generation requires a global effort. No one country or entity can do it alone, but together, as you will see in the modeling we present in this blueprint, we can achieve our shared goal.

• Last, but certainly not least, science must continue to guide all of our efforts. It is science that has brought us to this historic point and it is science that will guide us home.

One way of measuring progress toward an AIDS-free generation, in a country or globally, is to compare the annual number of new HIV infections with the annual increase in new patients on treatment. By bringing this ratio below 1.0, through reduced infectivity and rapid treatment expansion, it is possible to achieve what many have called a programmatic "tipping point" in the epidemic.

In the blueprint, we used data from four countries that are at different stages of the response to assess the impact of various scenarios for intervention. What we found is that through robust scale-up, with support from all partners, it is possible for countries to get on the path toward achieving an AIDS-free generation in the next three to five years. They can reach -- and move beyond -- that tipping point where the number of people newly on treatment exceeds the number of new infections.

On this World AIDS Day, the success we have achieved to date provides powerful motivation to push on to an AIDS-free generation. Together, let's seize this moment.

For more by Ambassador Eric Goosby, M.D., click here.

For more on HIV/AIDS, click here.