On the Road to an AIDS-Free Generation

Posted by Eric Goosby
January 3, 2013
Women at Clinic Supported by PEPFAR

2012 was an extraordinary year.

As of September 30, 2012, PEPFAR directly supported lifesaving antiretroviral treatment (ART) for nearly 5.1 million people -- a nearly three-fold increase since 2008. PEPFAR also supported drugs to prevent mother-to-child transmission for nearly 750,000 HIV-positive women in 2012 alone, allowing approximately 230,000 infants to be born HIV-free, and HIV testing and counseling for more than 46.5 million people over the same time period.

These are not just statistics but they represent lives saved, and hope renewed for millions of families and communities. A decade ago, almost no one in Africa was receiving treatment. Today, over 8 million men, women, and children in developing countries are on ART, with the vast majority of them being in sub-Saharan Africa.

Every American should be profoundly proud of the United States' role in supporting this progress. Both President Obama and Secretary Clinton have repeatedly reaffirmed America's commitment to the global fight against AIDS through PEPFAR. In November 2011, the Secretary declared that the world is at the point where an AIDS-free generation is in sight. On World AIDS Day 2011, the President announced ambitious new PEPFAR prevention and treatment targets, which we are on track to reach by the end of 2013.

This past July, the 19th International AIDS Conference came to the U.S. for the first time since 1990. During the Conference, Secretary Clinton called on PEPFAR to develop a blueprint to inform the next Congress, the next Secretary of State, and all of our partners about all that we have learned, and how the U.S. will contribute to creating an AIDS-free generation moving forward. And in recognition of World AIDS Day 2012, the Secretary unveiled the PEPFAR Blueprint: Creating an AIDS-free Generation, which sends an unequivocal message that the U.S. commitment to the global AIDS response will remain strong, comprehensive, and driven by science.

Through the contributions of many partners, a new day has dawned in the global AIDS response. New HIV infections and AIDS-related deaths are on the decline, and national health systems have been strengthened to deliver a broader range of essential health services to the populations that they serve. Partner countries are increasingly assuming the central leadership in coordinating their AIDS response. Thankfully, long gone are the overcrowded medical wards that I witnessed as a clinician in San Francisco in the early 1980s, when we had little to offer patients beyond a more dignified death; or the time just a decade ago when AIDS was wiping out an entire generation in Africa. Today, while the fight is far from over, we are on the road to achieving an AIDS-free generation.

Now, we must redouble our efforts to get there. As outlined in the PEPFAR Blueprint, we will continue our focus on: saving lives by investing in proven HIV interventions; making smart investments by targeting interventions to populations at greatest risk; promoting sustainability, efficiency, and effectiveness across our programs to maximize the impact of each dollar we spend; partnering with countries in a joint move to country-led, managed, and implemented responses, and working closely with the Global Fund to Fight AIDS, Tuberculosis and Malaria and other partners around a shared global responsibility to reach more of those in need; and driving results with science by using the knowledge we already have, and supporting continued innovation.

As we enter the tenth year of PEPFAR, we do so filled with great hope for a future where an AIDS-free generation is, as Secretary Clinton stated, not just a rallying cry -- it is a goal within our reach. And I am confident that 2013 can be another extraordinary year.

For updates on PEPFAR's work, please visit www.pepfar.gov. You can also interact with PEPFAR on Twitter and Facebook.



N D.
January 7, 2013

Evie writes:

2012 may have been an extraordinary year. But what is definitely extraordinary is that Dr Goosby begins 2013 by writing a posting without the word 'evidence' in it. Or even a passing reference to it.

Greg B.
United States
February 7, 2013

To stop AIDS, stop HIV testing. The tests are fraudulent and test for nothing. They are used as medical "profiling" only and the lucky "winners" get put on drugs that kill.

Dorje S.
February 19, 2013

Dorje S. in Nepal writes:

Yes let's make a world of aids free togethter.

Rachel C.
United States
April 13, 2013

Dr. Rachel C. in the U.S.A. writes:

You will never achieve an AIDS-free generation until you begin to provide safe houses, medical care, legal representation and alternative means to earn a living away for adolescent male children servicing the sex trade in boys (under 18 year olds).

You will never achieve an AIDS-Free generation in the USA until you treat these children compassionately and humanely. Beginning with, acknowledging they exist in huge numbers to service the sex trade in boys and meet the demand: Too Many American Males Like Their Boys Young. The vast majority of men who rape boys and buy boys live in all our communities as "married""family" men.

Adolescent male sex workers are four times at risk for becoming infected with HIV than any other group of youth.

Why are you not creating safe houses for these children where they can receive treatment, food so the ARVs work more effectively, and legal counsel and representation (these kids have a breathtaking history of abuse).

The kids need our support and to be treated with dignity and respect. Yet, I see little evidence that any "official" organization controlling the purse strings (deciding who gets what and how), showing any compassion for adolescent male sex workers (survivors of the international sex trade in boys; surviving sex work and sex trafficking).

It's as though there is a conscious decision to pretend these children don't exist. Why.

The boys need URGENT safe places to grow in. Safe Houses permit survivors better access to and more success in committing to the rigorous medical regimes they will need to take for the rest of their lives.

Ignoring these significant group of children in an HIV/AIDS/TB pandemic seems to be public health policy madness, as well as be an extraordinarily inhumane way to perceive and treat young people who endure such horror on our collective watch.

Rachel C.
United States
April 15, 2013

Dr. Rachel C. in the U.S.A. writes:

Survivor-led and peer-mentored safe houses are the only thing that gets acutely vulnerable adolescent male sex workers off the streets. They provide a SAFE place for the children to disclose their stories in environments that stigmatize these children. Survivors are intelligent and experienced care-givers, well versed in the diverse ways that trauma is manifest for male-survivors and good designers of strategies that assist young people to cope with committing to rigorous medical regimes and compliance to medications, which they will have to access and take for the rest of their lives.

It is essential that PEPFAR stop making it so difficult for NGOs to work to bring adolescent male sex workers off the street and provide them with safe houses to grow and an alternative means to earn a living as they reach for their adulthood. The anti-prostitution pledge simply antagonizes an already fragile context in which it is hard to reach these children. Reaching them is a process.

Even when a boy reaches a safe house he is still unsure if it is safe for him to disclose his story because of the response from the communities surrounding him. Few people would welcome into their lives and homes or communities a boy with a history of sexwork and HIV/AIDS/STDS/TB, self-hariming behaviours, addictions and suicide ideation.

The children need trauma programs that are designed by survivors, who are not frozen with disbelief or disgust and who do not experience debilitating vicarious trauma so often experienced by professionals.

We have much to learn from survivors' compassion and creativity. If we are to impact HIV and reach for an AIDS-free generation (that includes ALL our children) we must begin to listen to survivors and urgently slash through the Kafkaresque red tape that prevents sensible funding for programs that have a higher success rate at getting the kids off the street.

Many of these children have done sexwork to survive and all of the children have a history of abuse.


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