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

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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

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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

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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