TOPICS > Health

When Will We See an AIDS-Free Generation?

December 1, 2011 at 12:00 AM EDT
On World AIDS Day, President Obama pledged Thursday to provide HIV treatment for millions more around the world. Jeffrey Brown discusses the state of the epidemic with U.S. Global AIDS Coordinator Ambassador Eric Goosby, clinic director Dr. Patricia Nkansah-Asamoah and David Ernesto Munar of the AIDS Foundation of Chicago.

JEFFREY BROWN: And we come back to World AIDS Day and the president’s announcement now with Dr. Eric Goosby, the U.S. global AIDS ambassador in the Obama administration. Dr. Patricia Nkansah-Asamoah is the director of clinic in Ghana that works to prevent transmission of the virus from mother to child. And David Ernesto Munar is the president and CEO of the AIDS Foundation of Chicago, which works to improve health care and services for people with HIV. He himself tested positive for HIV in 1994.

Ambassador Goosby, I will start with you.

How close are we today to seeing what the president referred to as an AIDS-free generation, that great hope?

DR. ERIC GOOSBY, U.S. Global AIDS coordinator: Well, thank you.

We’re very close to understanding the science of prevention interventions that, when combined in the appropriate way, allow us to drop the number of new infections or incidents precipitously. The ability to use male circumcision to prevent mother to child transmission, and now with distribution in targeted populations at high risk with condoms, behavioral modifications that complement and enable that, matched with the new data that came in last summer showing that treatment drops the risk of infecting another individual by 96 percent, all in combination really give us an opportunity to drop that incidence curve precipitously.

JEFFREY BROWN: When you say close, I mean, give us — do you actually put years on it or a time frame?

DR. ERIC GOOSBY: The modeling that we have been able to do shows that we will begin this process over the next three years by moving our numbers of people with a concentration of treatment, matched with an expansion of our prevention portfolio, so moving our prevention strategies to a maximum, and now adding a more vigorous treatment component to it.

We’re looking at three to five years for our — in our ability to actually have more people getting on treatment than are actually becoming newly infected.

JEFFREY BROWN: And clear up one thing for us.

In the president’s announcement today, are there actually — is there actually new money going into these programs, or is it more from savings from existing programs? In the current budget climate, can you guarantee new funds being directed to this?

DR. ERIC GOOSBY: We are in a position where we have gotten so good at saving resources, money, in our current programs at our current level of funding, that we have been able to calculate that if we increase our numbers by $2 million, we have the resources to do that in our current funding window, and anticipate that that will be the case if that funding is maintained.

JEFFREY BROWN: Now, Dr. Nkansah-Asamoah, where — what do you see on the ground every day? And what do — you were at the event today.

DR. PATRICIA NKANSAH-ASAMOAH, Tema Hospital in Ghana: Yes.

JEFFREY BROWN: What do you take from that as the hope that translates to what you see on the ground?

DR. PATRICIA NKANSAH-ASAMOAH: Yes, I was very excited when the president announced that even — he would like to go beyond the 4,000 people they were anticipating to put on ARVs to 6,000.

There has been a lot of disappointment when Global Fund canceled some proposals that were sent because of funding issues. And, for me, it just takes me back to the time when we didn’t have access to ARVs, when you went into…

JEFFREY BROWN: Those are the antiretrovirals, yes.

DR. PATRICIA NKANSAH-ASAMOAH: Exactly, yes — when you went into the clinic and all you had to tell someone was that, I know you have HIV, but it like, there isn’t much I can do to help you, when there was a sense of helplessness for you as a clinician to even tell someone what they had to do.

And so, with all the cuts, it was almost as if, are we going to go back to those days? But today’s message was very, very hopeful. And it made me very excited that what I was doing wasn’t just going to come to an end, as I was probably thinking, and that there was still some hope that in the next few years, there will be funding to support what we were doing.

JEFFREY BROWN: But what you are doing depends so much on the funding?


JEFFREY BROWN: And we are still in this very tough global financial situation.


JEFFREY BROWN: So, most countries may have a hard time coming up with the funds.


And what usually happens is that what countries pledge as their support to Global Fund is sometimes so small out of their budget, sometimes giving less than 1 percent, but a lot of the population sometimes have the feeling that this is such a huge amount. Some people even think it is about 10 percent or 20 percent of their budget.

And they think that, in such difficult times, such money shouldn’t go to help other people; it should be given back into the country. But it is so, so small, looking at the budgets governments have, in what they have pledged to support Global Fund. So what we are saying is that it may look small, but when it comes to saving lives, these moneys really go a long way and improve the lives of a lot of people.

JEFFREY BROWN: Now, David Ernesto Munar, one of the things the president said today that might be surprising to people, he said — I quoted here — “The rate of new infections may be going down elsewhere, but it’s not going down here in the United States.”

And we cited that statistic that just two in five here get the care they need. Now, why — why is that happening?

DAVID ERNESTO MUNAR, The AIDS Foundation of Chicago: That’s correct. And we are very concerned about the state of the epidemic in the U.S.

And we know today that there’s 1.2 million Americans living with HIV. A quarter-of-a-million of them don’t even know they’re infected. And half-a-million do know they are infected and are not receiving the medical care and treatment they need that could save their lives and help slow new infections.

And this is a huge problem. And that’s being driven by a variety of issues. Poverty is a big one. Lack of access to health care and un-insurance is another. And stigma — stigma still contributes to individuals so fearful of others learning their status, that they don’t come forward to receive the care and support that they need.

JEFFREY BROWN: And who’s most affected?

DAVID ERNESTO MUNAR: Well, in the U.S., we continue to see an epidemic that increasingly is affecting people of color. So two-thirds of those living with HIV are African-American and Latino.

Principally, the African-American community is very hardly affected. About half of all living cases are individuals in the African-American community. And looking at it by modes of transmission, gay men and male-to male sexual contact continues to drive about half of all new infections.

And about a quarter of new infections are heterosexually transmitted. We have seen some progress reducing HIV transmission through contaminated needle and sharing equipment, and need to sustain our work in that area, and actually could eliminate those if we stay the course.

JEFFREY BROWN: Dr. Goosby, you have been in this fight for a long time yourself, including here in the U.S. What do you see happening in the United States in particular?

DR. ERIC GOOSBY: I think that the administration has developed a national strategy that identifies the populations that are at highest risk for acquiring HIV.

It requires a concentration, concerted effort to identify, enter and retain these populations in care and treatment that requires health workers and individuals that are in and of and trusted by the community to bring them in and retain them over time.

The stigma is a real issue. The awareness and ability to reveal oneself, sometimes participating in illegal behavior in terms of the injection drug user, in terms of the gay population, a population that has not been embraced in mainstream medical delivery systems.

JEFFREY BROWN: Is it surprising to you, though, to see these numbers this late in the game of the number of people that aren’t getting adequate treatment?

DR. ERIC GOOSBY: It — you know, I have been following this epidemic for many years. And, since 1994, these patterns were really present.

The population can be immobilized by the stigma associated with revealing yourself to your family or to your community. And that barrier is a real barrier that medical delivery systems have to have specific strategies to overcome.

JEFFREY BROWN: Now, Dr. Nkansah-Asamoah, how do you — how do you maintain the enthusiasm of a day like today?

We look at this every — at least every year. And there have been such patterns of optimism and pessimism and concerns about — frustrations over a lack of vaccine one year, and then some hope the next year. How do you maintain the enthusiasm and go on?

DR. PATRICIA NKANSAH-ASAMOAH: Right. I think one way, one very powerful way is to look at your own work.

And sometimes we deliver services, and we don’t even look at the things we have done to be able to look at trends and patterns, like Dr. Goosby said. He has been following the trends since 1994, so he can look at it and be able to say clearly that we are making progress in those areas, we need to do this in that area.

Usually, when you are providing care, sometimes you get a little overwhelmed. Sometimes, I feel the numbers are just growing. But as you look at your own work and you look at how much impact you are making, of course, sometimes you realize that there are places that you are not doing so well.

You just add to those places, and you deliver more care. So it’s important, as we do these things, to go back, to look at what you’re doing, look at the impact you are making. If we are able to save, you know, avert, let’s say, 20 million babies from becoming infected, and we have the data to show for it and everything, it kind of energizes you to want to do more.

JEFFREY BROWN: And, David Munar, we just have about 45 seconds here, but as someone living with HIV, how do you assess the situation in maintaining the positive movement forward?

DAVID ERNESTO MUNAR: Well, I am enthusiastic.

I know that we have made progress. We are seeing it in our own community here in Chicago. We need to stay the course. And I think today’s call for getting to zero and starting the beginning of the end of the epidemic is so important. And we have all the tools at our disposal now to make enormous differences in the lives of people affected by HIV.

But it will require greater political and economic leadership. And that’s what I hope today brings. And we need to stay focused and deliver the best of the tools that we have. And doing so will reap enormous benefits for not only those affected, but really improve entire societies, communities, and really help our economy.

JEFFREY BROWN: All right, David Ernesto Munar, Patricia Nkansah-Asamoah, and Ambassador Eric Goosby, thank you, all three, very much.



DR. ERIC GOOSBY: Thank you.