U.S. Pledges More Funding To Fight AIDS World-Wide

Secretary of State Hillary Clinton on Monday pledged new funding from the U.S. to curb the global HIV/AIDS pandemic and said the administration has significantly accelerated the pace at which it is getting lifesaving AIDS drugs to developing countries.

The initiatives are part of a priority the administration set late last year for what Mrs. Clinton calls an "AIDS-free generation"—in which HIV infections are virtually eliminated in newborns, risk of infection in adults is far lower than it is today, and treatment is readily available. The new moves also come as U.S. funding for global AIDS work could be reduced substantially in fiscal 2013.

"We will not back off, we will not back down, we will fight for the resources necessary to achieve this historic milestone," she told thousands of political and public-health leaders, researchers and activists from around the world gathered at the XIX International AIDS Conference in Washington. The gathering is being held in the U.S. for the first time in 22 years after the U.S. lifted an entry ban on travelers infected with HIV. Washington as host is significant for another reason: The District of Columbia has one of the highest HIV rates in the U.S.

After a series of breakthroughs over the past two years that identified ways to prevent HIV infection, governments and public-health leaders now face the task of figuring out how to scale them up amid limited funding. Globally donors spent $16.8 billion in 2011, but only about eight million people are on treatment, while 34.2 million are infected with HIV, according to the Joint United Nations Program on HIV/AIDS.

In the current fiscal year, the U.S. added 600,000 people over a six-month period to its tally of those receiving antiretroviral treatment, Mrs. Clinton told the delegates. That is up from 700,000 added over the whole of fiscal 2011, she said. That means Washington is now funding drug treatment for 4.5 million people—roughly half the number currently receiving AIDS drugs in low- and middle-income countries—and is on track to meet a goal President Barack Obama set in December of providing drugs to six million people by the end of 2013. The U.S. launched its program to offer drug treatment in developing countries in 2003.

The U.S. also will invest $157 million in several programs to prevent or reduce infection. The money includes $80 million to help pregnant women with HIV get care. The goal, Mrs. Clinton said, is to eliminate mother-to-child transmission of HIV by 2015. The new money is meant to find a way to get treatment to women who test positive for HIV, but are then referred to another clinic—sometimes too far away to reach, she said.

Another $40 million will go toward scaling up an effective but underutilized HIV prevention strategy: medical male circumcision, which studies have shown reduces a man's risk of acquiring HIV by more than 60%. The money will support a program in South Africa to offer circumcisions to nearly half a million boys and men over the next year, Mrs. Clinton said. The U.S. has already supported more than 400,000 male circumcisions since December, she said.

The final $37 million will go toward research and services to prevent and reduce infections among those groups of people who are at highest risk of contracting HIV, such as sex workers and injection-drug users. "If we want to save more lives, we need to go where the virus is and get there as quickly as possible," Mrs. Clinton said.

Ending the AIDS pandemic completely isn't possible without a vaccine or cure. "Without new tools, it's not realistic to think we're going to end the epidemic," billionaire philanthropist Bill Gates said in an interview. "Thank goodness the prospect for new tools is—not overnight—but is good."

Still, infections can be curtailed sharply. Models show that offering treatment to many more Zambians and scaling up male circumcision in the country will drive down the number of new infections there by more than 25% over the next five years, Mrs. Clinton said. "As the number of new infections in Zambia goes down, it will be possible to treat more people than are becoming infected each year," she said.

Advocates and analysts generally praised the new U.S. investments. The money for high-risk populations is a "down payment" and "desperately needed initiative," said Chris Collins, vice president and director of public policy at the nonprofit Foundation for AIDS Research, known as amfAR.

But they said more specifics are needed on how donors and governments will implement new science. "We need more examples like Zambia," Mr. Collins said. Mrs. Clinton said a strategic blueprint will be ready in December.

The administration's budget request for its global bilateral HIV/AIDS programs for fiscal 2013 was $546.6 million less than it was funded for fiscal 2012, according to an analysis by the Kaiser Family Foundation. Both the House and Senate have proposed more, and it is unclear what the final amount will be. The U.S. also proposed $350 million more for its annual contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Sen. Lindsey Graham (R-S.C.), the ranking Republican on the Senate Appropriations subcommittee for foreign aid, told the conference he supports a continued strong funding stream for research and services.

"My goal is to go back to a conservative state like South Carolina and say the money is being well spent, results are promising, and now is the time to pour it on," he said. "If you can make a case, people will follow. The case is there to be made."