US Secretary of State Hillary Clinton’s announcement that the American government now prioritizes creating an AIDS-free generation could be more than just political lip-service: it may also shape the next several years of US global health programming and funding, analysts say.
Clinton’s 8 November speech at the National Institute of Health reflects recent scientific breakthroughs. She said a three-pronged approach – eliminating mother-to-child transmission of HIV, scaling up male circumcision procedures and expanding early treatment for people living with HIV and AIDS – offered a combination prevention strategy that would help reach the goal of having virtually no child born with HIV within three years.
“It’s the first time the US has outlined a policy goal on how to reach an AIDS-free generation,” explained Jennifer Kates, director of HIV policy at the Washington DC-based Kaiser Family Foundation.
“We’re starting to think about this and talk about this and with some of the recent studies, it is really changing the way we are approaching the epidemic... this provides reorientation for how programmes are approached and trying to figure out combination prevention on the ground.”
Clinton also committed an additional US$60 million to rapidly scale up combination prevention in four unspecified countries in sub-Saharan Africa to measure the impact of this approach.
About 53 percent of pregnant women living with HIV in the developing world receive antiretroviral drugs to prevent transmission to their infants, according to the UN Children’s Fund (UNICEF). Last year, the US President's Emergency Plan for AIDS Relief (PEPFAR) helped prevent 114,000 babies from being born with HIV, Clinton said.
Recent studies have shown that male circumcision can help reduce a man’s risk of becoming infected with HIV by 60 percent during heterosexual sex, according to the World Health Organization (WHO). Earlier this year, the HIV Prevention Trial Networks 052 study found that men and women living with HIV reduced their risk of transmitting HIV to their partners by up to 96 percent if they received an early initiation of combination antiretroviral therapy.
Kates cautioned that it may be too soon to tell how much these three new policy priorities – the first the US has put forth since the Bush Administration’s approach of abstinence, fidelity and condoms – will guide US foreign programmes, and that interventions will have to be tailored to different populations.
But some women’s and girls’ sexual and reproductive health advocates are concerned that these new priorities sideline reproductive rights. Clinton did not specifically discuss family planning or access to safe abortions.
That exclusion might be reflect the domestic agenda, where reproductive rights continue to play a divisive role between liberal and conservative politicians, says Serra Sippel, president of the NGO Center for Health and Gender Equity (CHANGE).
“There is a legitimate fear that Congress controls the purse strings, so if the Secretary thinks this could give them an inclination to think PEPFAR money would be supporting programmes addressing these rights, Congress can at any time step back and decide to use that as a way to pull that money back,” said Sippel.
Ann Starrs, co-founder and president of the NGO Family Care International, says Clinton’s prevention-as-treatment approach could have been furthered by presenting contraception as an option to HIV-positive women, instead of just prevention of transmission interventions.
“Studies done by a number of researchers show that 50 to 85 percent of HIV-positive women don’t want a baby,” Starrs told IRIN/PlusNews. “You provide them with contraception and you have a greater impact in terms of reducing the number of HIV-positive infants born at a greater cost.”
But programmes under the umbrella of USAID and the $63 billion Global Health Initiative, which stresses country-led ownership and focuses on women’s and girls’ health, may well continue to foster a holistic approach on their own, said Sippel.
Natasha Bilimoria, president of the Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, which advocates for US partnership with the Global Fund, says she hopes Clinton’s “incredibly strong message” will be backed by strong funding commitments for the next financial year.
America continues to be the largest donor to the Global Fund, but between 2010 and 2011, kept its contribution flat at $1.05 billion. Kates of the Kaiser Foundation says the financial crisis makes the ability to back up strong words with even bigger money unclear.
“There’s an irony of having these new tools before us to combat HIV, and at the same time there’s a downward pressure on the budget, so it isn’t clear,” she said.