Statement as Prepared of Ambassador Eric Goosby, U.S. Global AIDS Coordinator, U.S. Department of State, at the U.S. Mission to the United Nations World AIDS Day Panel Discussion, "Smart Investments, Building on Success"


November 30, 2010

New York, New York

It's a pleasure to be here at the U.S. Mission to the United Nations joined by distinguished colleagues from the Mission, UNICEF, the Government of Uganda and BD. I want to thank everyone for making time for this event today.

World AIDS Day is a time to remember those we've lost and reflect on where we're going.

I am pleased to say that the U.S. commitment to HIV/AIDS is unwavering. President Barack Obama's PEPFAR budget request for this year is the largest in any President's budget to date.

A key principle of the President's Global Health Initiative is support for country ownership. We're aggressively working with governments and civil society in our partner countries, to build their capacity to oversee, manage, and ultimately - according to their resources - finance their programs. I'm glad the Ambassador from Uganda is here today and look forward to dialogue on this issue. I was pleased to hear that the Government of Uganda led a meeting last week with its development partners and Ugandan civil society to review the health sector's performance, and that the importance of country ownership and government leadership was emphasized during this meeting.

For the U.S., our World AIDS Day theme this year is "Smart Investments, Building on Success." The smarter we are about the prevention, treatment and care we provide, the greater the number of lives saved.

Our yardstick for measuring success is not dollars invested, but lives saved. Years of experience in the field have taught us how to better use every dollar invested in battling AIDS. These smart investments mean we are getting more value for our money - allowing us to do more on HIV/AIDS and the whole range of global health issues.

Let me offer a few examples of how we're maximizing the impact of our investments through PEPFAR.

First, we're saving lives and money by using more generic drugs.

  • Recognizing that one of the biggest hurdles to rapid treatment scale-up was the high price of ARVs, PEPFAR worked with the FDA to bring more generics to market.
  • Now, generics are over 90% of all the drugs we procure.

Second, we're successfully implementing Prevention of Mother-to-Child Transmission programs.

  • UNICEF is a key partner, and I know Jimmy Kolker will have more to say on this topic.
  • PMTCT is one of the most effective, and cost-effective, interventions for HIV.
  • For example, Botswana and parts of South Africa have reduced the likelihood of infant infection to levels similar to those found in the U.S., which in turn reduces the significant costs associated with new infections.
  • Accordingly, PEPFAR's Five-Year Strategy set goals to reach 80% of pregnant women with HIV counseling and testing, and to provide ARV prophylaxis or treatment, as appropriate, to 85% of pregnant HIV-infected women in PEPFAR countries.

Third, we're changing the way we ship medicines and pooling our procurement.

  • As an example, we have become more efficient in shipping needed medicines by using water and land delivery systems instead of air freight, reducing costs by as much as 90%.

Fourth, we're staying on the cutting edge of prevention - for example, medical male circumcision promises a dramatic impact.

  • Medical male circumcision is a smart prevention investment for many countries, as it is a one-time intervention that provides lasting prevention benefits. The majority of the expenditure required to saturate a country takes place in the first 1-3 years, and expenditures drop precipitously thereafter. Modeling shows that rapidly scaling up male circumcision could prevent more than 4 million adult HIV infections and save over $20 million
  • And we're seeing very positive results from the trials for new microbicides and pre-exposure prophylaxis. These can be real game-changers for prevention, and we are closely following the science so we can be ready to add these to the toolkit when they are ready.

Finally, we're collaborating with other partners through the Global Fund mechanism.

  • The Administration recently announced an unprecedented multi-year pledge of $4 billion, a 38 percent increase in U.S. support.
  • The U.S. currently provides nearly 60% of donor government funding for HIV/AIDS.
  • This is a shared responsibility, and the Global Fund is a vehicle for others to do more.

We've had great success in the fight against HIV/AIDS, but the battle is far from over. The goal now must be to build on that success and continue to be smart about the investments we make.

This goal must be a shared responsibility of all of us concerned about defeating this devastating disease. We all have a shared responsibility to make smart investments that save more lives.

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