The Power of a Bill (or 2)

Monday was the first full day of the International AIDS Conference here in Vienna, and two speakers who needed no introduction spoke to a full room with thousands of participants and press.

President Clinton and Bill Gates Address International AIDS Conference

Today was the first full day of the International AIDS Conference here in Vienna and two speakers who needed no introduction spoke to a full room with thousands of participants and press.

Former US President BIll Clinton speaks at AIDS2010
”Health is a good economic investment with a high rate of return.” -Former US President BIll Clinton at AIDS2010

Former President Bill Clinton and Bill Gates each spoke and, in their own way, both rallied, encouraged, and challenged the audience with their words. President Clinton spoke about “false choices”–in particular the false choice between choosing between expanding funding for antiretroviral therapy and funding for maternal-child health and health systems strengthening.  He noted how synergistic these are…for example improving access to MCH also improves access to HIV testing and treatment for mothers and babies. This made me think of the synergy between family planning and HIV programs. President Clinton specifically addressed the critics of the Obama Administration by stating that he saw no retreat from the White House on prior commitments to expanding AIDS funding. What has complicated matters is the global financial crisis and an American public and Congress that will not readily agree to tax increases to spend more money on foreign aid.  He challenged the audience to not only advocate, but educate….educate the public and lawmakers that our programs are cost-effective and making a difference and that we are wisely investing every dollar invested in the fight against AIDS.  He said that “every dollar wasted puts lives at risk,” and noted that lowering the delivery costs of HIV programs is a priority for the Clinton Foundation, as it is for the Bill and Melinda Gates Foundation.

President Clinton also spoke powerfully of the need for investments in harm reduction programs in countries where injecting drug use fuels the HIV epidemic.  He applauded Ambassador Goosby and PEPFAR for issuing guidelines last week on how PEPFAR programs can begin to implement needle and syringe programs and opioid substitution therapy programs.

Bill Gates spoke in the afternoon to the conference delegates and admonished us all to scale up the easy, effective prevention practices that we know work. He mentioned male circumcision and PMTCT as two such practices and said it is more costly to not do these two interventions …they are that cost effective. He also showed a brief video of an MC program in Swaziland. Mr. Gates reminded the audience that only 150,000 men in sub-Saharan Africa have been circumcised so far, out of some 41 million who could benefit from it. He contrasted this sorry state with the theoretical existence of a vaccine with 60% efficacy (about the same as for male circumcision) and predicted that if we had such a vaccine we would be doing everything in our power to make sure that it was provided to all who needed it.

Mr. Gates also addressed the state of harm reduction activities in the fight against AIDS and criticized the Russian government that has cut all funding for harm reduction programs in spite of their proven efficacy. He also touched on HIV treatment and how to expand access and effectiveness of treatment. Touching on a controversial question, he stated that the focus of expanding treatment access should be on first treating everyone with a CD4 count under 200.  He offered his opinion that that drug costs are not likely to go down much in the coming years and that a better alternative to increasing access is to improve treatment delivery (i.e. reaching more people for the same amount of funding by being more efficient in how drugs reach people). He didn’t mention the word “task shifting” (e.g. getting auxiliary health personnel or community volunteers to do some of the work previously done by physicians), but I believe this is one example of what he had in mind.

Finally, Mr. Gates spoke optimistically about some of the ARV-based microbicide trials underway (the results of some of these will be announced tomorrow he said!), as well as the promising results from last year’s vaccine trial in Thailand.

I came away from these two presentations energized and with lots of food for thought. I later saw excerpts of President Clinton’s speech on CNN and was reminded of how important it is for worldwide celebrities like President Clinton and Bill Gates to come to these conferences and not only “preach to the choir”, but have their messages transmitted through local and international press and television to challenge a global audience that the fight against AIDS is not over, nor near the end, but rather entering a new phase that requires a continued commitment for the long term, and greater investment in what has been working.

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