creating an aids-free generation the beginning of the end of aids
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Creating an AIDS-Free Generation
The beginning of the end of AIDS
Center for Strategic & International StudiesWashington, DC
March 22, 2012
Thomas R. Frieden, MD, MPHDirector
Centers for Disease Control and Prevention
2012 is a tipping point for the global HIV epidemic
• Increasing coverage, decreasing costs• Recognition of global shared responsibility
and accountability• New evidence that
• Treatment is prevention• PMTCT and voluntary male medical
circumcision can be scaled up for population reach and impact
• Infection rates and deaths can be driven down
CDC provides assistancethroughout the world
CDC Direct Assignees
Global DiseaseDetection Centers
DoDCollaborations
CDC InfluenzaInternational Assignees
CDC Global AIDSProgram
CDC Malaria Assignees
CDC Field EpidemiologyTraining Program (FETP)
Global Immunizations Assignees
Nearly 400 assignees in 50+ countries 1,500 host country national staff
Global Sub-Saharan Africa
1990 1993 1996 1999 2002 2005 2008
5
3
2
1
0
Num
ber (
mill
ions
)
4
Source: UNAIDS/WHO
HIV incidence is decreasingNumber of people newly infected with HIV,globally and in Sub-Saharan Africa, 1990-
2008
2.5
2.0
1.5
0.5
1.0
3.0
0
Num
ber (
mill
ions
)
1996 1998 2000 2002 2004 2006 20081997 1999 2001 2003 2005 2007
HIV-related mortality is also decliningNumber of AIDS-related deaths, globally and in
Sub-Saharan Africa, 1996-2008
Source: UNAIDS/WHO
Global Sub-Saharan Africa
U.S. government calls for anAIDS-free generation
AIDS-free generation• Virtually no children born with HIV infection• Adults living with HIV don’t develop AIDS• Accelerated declines in HIV incidence
Combination prevention• Antiretroviral treatment as prevention• Prevention of mother-to-child transmission (PMTCT)• Voluntary medical male circumcision• Correct & consistent condom use
National HIV/AIDS Strategy for the United States
• Reduce new HIV infections
• Increase access to care and improve health outcomes for people living with HIV
• Reduce HIV-related disparities andhealth inequities
• Achieve a more coordinatednational response to the HIV epidemic
New CDC approach to HIV preventionin the U.S.
Funding to places most in need, for populations most in need, for programs that work• Funding determined by number of people living
with HIV• Supports innovative demonstration programs by
Health Departments• 75% of proposed activities in 4 program areas
• HIV testing and linkage to care• Comprehensive HIV Prevention with Positives• Condom distribution• Initiatives to promote prevention and accountability,
particularly viral load
Effective prevention interventionsCoverage of these evidence-based interventions
remains limited
Intervention Efficacy Coverage
PMTCT With effective PMTCT programs, HIV transmission can be reduced to 2-4% 48%
Antiretroviral Treatment as Prevention
96% reduction in HIV transmission 47%
Male Circumcision >60% efficacy4.6%
(14 priority countries)
HIV Vaccine ?31% efficacy
Vaginal Microbicide 39% efficacy; 54% among high adherers
Pre-Exposure Prophylaxis
Trial #1: MSM (44% efficacy; 74% among high adherers)
Trial #2: High-risk women (no evidence of efficacy)
Adult male circumcision provides long-lasting protection against HIV infection
Rakai, Uganda
PEPFAR has driven down costs of HIV treatment
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
4,000,000
4,500,000
$-
$200
$400
$600
$800
$1,000
$1,200
2005 2006 2007 2008 2009 2010 2011
PEPFAR Per-Patient Annual Treatment Cost No. of PEPFAR Direct ART Patients
Note: Per-patient budget allocation is estimated as lagged treatment allocation divided by end-of-reporting direct patients.
Modeling combination prevention and reductions in HIV incidence
Incidence in Swaziland in 2014 by scenarioC
urre
ntLo
w A
RT,
No
MC
Low
AR
T, M
C 8
0%C
onst
ant A
RT,
No
MC
Con
stan
t AR
T, M
C 8
0%H
igh
ART,
no
MC
Hig
h AR
T, M
C 8
0%M
id A
RT,
mid
MC
ART<
500
ART<
500,
MC
Test
&Tre
atTe
st&T
reat
, MC
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Modeled scenarios
Ann
ual i
ncid
ence
(per
100
per
son/
year
s)
ART = antiretroviral treatmentMC = male circumcision
Sustainable public health progressCDC helps develop local capacity domestically & globally
• Guidance, technical assistance, direct funds
• Applied epidemiology
• US direct hires and host country national staff
• Labs systems and quality
• Health security
Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333
Phone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov
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