President's Emergency Plan for Aids Relief Blueprint: Creating An AIDS-Free Generation


November 29, 2012

AMBASSADOR GOOSBY: Well, it’s truly my pleasure to welcome you to the Benjamin Franklin Room here at the Department of State. Let me offer a special welcome to Senator Mike Enzi, Congresswoman Barbara Lee, and Congresswoman Karen Bass. We are deeply grateful for your leadership and the bipartisan support that you represent.

This World AIDS Day is a particularly important one for us at PEPFAR. This summer, Secretary Clinton asked PEPFAR to develop a blueprint for an AIDS-free generation. Today, we will issue that document, and you’ll be hearing more about it in just a few minutes. But for me, this World AIDS Day is special for another reason, because it’s the fourth and final one that we’ll observe with Secretary Clinton on her watch. These years have been and seen a transformation for the global response to AIDS, and I can say flatly that without her leadership, we would not be where we are today.

It was Secretary Clinton who, on World AIDS Day in 2009, announced that the International AIDS Conference would return to Washington, and then, at that conference, she embodied America’s continuing leadership. She has kept us all focused on empowering women and girls to protect themselves from HIV. In her landmark address at the National Institutes of Health last year, she set an AIDS-free generation as a goal of U.S. policy, and at every step – (applause) – and at every step, she has been supportive and clear in her vision and commitment to this effort.

In public and in private – and I say this in my personal dealings with the Secretary – she brushes away the bureaucratic distractions and keeps the United States Government unified around a single goal, and that has been saving lives. It’s been truly an honor to serve and a true privilege to serve with you. (Applause.)

Saving lives requires leadership here in Washington, but our results ultimately also depend on leadership in the field. Today, it’s an honor to be joined by our first speaker, Florence Ngobeni, who has been a friend and a companion through many years of this struggle. Many of us remember Florence from last year’s World AIDS Day event, at which time President Obama set an inspiring new goal for PEPFAR. Speaking of her own experience in South Africa, Florence helped a broad audience of Americans to see the human face of this work and support.

So, Florence, I want to thank you for joining us today, and if you could come to the podium. (Applause.)

MRS. NGOBENI-ALLEN: Ladies and gentlemen, honorable guests, good morning. My name is Florence Ngobeni-Allen. I come from South Africa, in Johannesburg. I think there’s so much to be thankful for. You just celebrated Thanksgiving in America, and it’s time for giving, which is also Christmastime, [is] coming soon. And I’m sure our Christmases are going to be glorious because we’re here for a purpose.

I’m an Ambassador of the Elizabeth Glaser Pediatric AIDS Foundation, an organization dedicated to creating an AIDS-free generation. I am honored to be here to introduce Secretary of State Hillary Clinton and thank the American people for the wonderful work in making sure that they contribute to lifesaving drugs and HIV/AIDS programs around the world. I’m alive today because of the work of the American people. PEPFAR has contributed a lot in my country, in South Africa, and today it is a privilege to be here representing an incredible program, both personally as an HIV-positive person but also as an advocate.

Sixteen years ago, I was diagnosed with HIV through my daughter, Nomthunzi, who then later on passed away with HIV. My husband also passed away, and I was quite devastated. At the time, there was nothing that could be done for children like my daughter, Nomthunzi, so she died of AIDS and little more did we know that today, it could be a different story. Shortly after learning our status, both Nomthunzi and my husband passed away, but within months I lost everything; I lost my world.

Losing a child to AIDS is the worst thing that a mother can go through. I’ve told this story so many times, but it still feels like yesterday. I became a counselor at the hospital where I was working, at Chris Hani Baragwanath Hospital in Soweto. At that time, most of the drugs that we are talking about today that are available, were unavailable in our country. I remember watching so many people die of HIV, but the worst thing was to hear those screaming babies, crying and being held in their mothers’ arms, and looking at them and thinking that they are following my daughter. I could give them everything, but the one thing I could give them was only hope and my smile. People who know me, I smile a lot; try it, it heals.

But PEPFAR helped me to change that, because you can’t smile to help people and you can’t just give hope without giving anything extra. PEPFAR came to our country and brought services that were good, and they’re still good, and they have prevented so many children from dying of HIV/AIDS. A mother now has hope and they can keep their babies free from HIV, and they could stay healthy, just like me, and put [on] makeup and lipstick. And I am proud to say that a few years ago, I was able to have hope and joy myself, because today I know that with the work of PEPFAR, children don’t have to be born HIV-positive. I got married to my lovely husband, Robert, and we were both blessed with two children, two boys: Kulani and Alexander. Kulani is the youngest one. Alexander is six years old. They are all HIV-negative.

My experience is one of the million, and it’s an example of a success story. Through PEPFAR and their partners, our partners, and many of you in this room have fought effortlessly to make sure that people like me can stand here and tell a story with hope. The success was also made possible through the leadership of our President. I call him our president because he is not just your President – our President Barack Obama, and our wonderful Secretary of State Hillary Clinton. Secretary Clinton has fought for children and women her whole career. I had sleepless nights thinking how best to share this story of hope and also to thank this incredible woman. I believe that you are a woman of hope; you are a woman that goes where the brave dare not go; you are unforgettable. We’ll never forget you for fighting for us, fighting for women and children all over the world.

Last year, the world heard and took notice of the declaration that was made, and that declaration said we can reach the end to a free – to an AIDS-free generation. I’m proud to say that in my country, as partners in meeting this challenge, I have seen the success in our community and I have experienced the same success as a mother. Our government is taking a stand to join in as a partner and with the leadership of this country.

Secretary Clinton, you have given more than you can, and I hope that our children will look at you – your children, my children, our children will look at you and not live this life that I’m living today. Our children need to be HIV/AIDS-free.

Our work is not far from over. There are still too many children and mothers, fathers and families without support and services. So let’s not give up, because the fight is not over. We should continue to advocate here at home and abroad. I dream of a generation born free of HIV. I know it’s real because my children are a part of it. I dream of a free generation – free of AIDS, because I know it’s real. I’m living it. I’m proof, and I’m part of it. And I know that working together today, we’ll make it a reality for everyone.

So, guys, do not give up. It’s not the end; it’s the beginning. Let’s fight this fight together. It’s an honor for me to be here standing today, to be sharing this news with you. Thank you very much. (Applause.)

SECRETARY CLINTON: Thank you all very much. Oh my goodness. Thank you. I think we could just end the program right now. (Laughter.) Florence, thank you. Thank you for continuing to be a smiling advocate on behalf of an AIDS-free generation. And congratulations on those two sons of yours, who are the strongest evidence of what we can achieve. I’m very grateful to you for sharing your energy, your story, and your passion with us today.

I am so pleased to have this opportunity to unveil, formally, the blueprint for an AIDS-free generation. And this could not have happened without Dr. Eric Goosby. I’ve known Eric a long time. When I decided to accept the President’s offer to become Secretary of State, I knew there was only one person that I would hope to recruit to become our Global AIDS Ambassador. Because Eric has both the firsthand experience, going back to the very beginning of his medical training and practice in San Francisco, to the vision he has as to continue to push us to do even more than we think we possibly can, and the drive to actually deliver that. He’s a unique human being, and we are so grateful for his service. And I want to return the favor, my friend, and thank you publicly for everything you have done. (Applause.)

Also sitting in the front row is the man who has been leading the government’s research efforts from the very early days of the epidemic, Dr. Tony Fauci. Thank you for being here and thank you for everything you have done. (Applause.)

From USAID, we have Dr. Ariel Pablos-Mendez, who has also been, along with everyone at USAID and the Centers for Disease Control and Prevention and other government agencies, one of those public servants who has dedicated his or her life to this work.

So I am grateful to everyone in our government who has done what has made all the difference. We could not be making this announcement had it not been for the countless hours in laboratories, at bedsides, in the field, everything that people have contributed.

And also let me thank Michel Sidibe, who has also been on the frontlines, and from UNAIDS, an absolutely essentially organization in playing the irreplaceable role in this fight. Thank you so much, Michel. (Applause.)

And Dr. Dlamini-Zuma, the first woman to chair the African Union Commission, a longtime public servant, government official, activist in South Africa. The AU is a critical partner in our work against HIV/AIDS, and I don’t think there’s anyone who is better positioned to lead the AU at this time. And the fact she’s the first women to lead the AU in its 50-year history is an additional benefit. Thank you so much, my friend. (Applause.)

And to Senator Enzi and Congresswoman Lee and Congressman Bass, who truly have been leaders, but also represent members of Congress on both sides of the aisle. This is a program that really has had bipartisan support – the leadership of President Bush in creating PEPFAR, the commitment and leadership of President Obama. This is something that I think has really made a difference for Americans and for America. It represents our very best values in practice.

So to all the members of Congress, the advocates and activists, the scientists, people living with HIV, thank you for joining us as we take this next step in the journey we began years ago, but which we formally announced a year ago, to change the course of this pandemic and usher in an AIDS-free generation.

Now, make no mistake about it: HIV may well be with us into the future. But the disease that it causes need not be. We can reach a point where virtually no children are born with the virus, and as these children become teenagers and adults, they are at a far lower risk of becoming infected than they are today. And if they do acquire HIV, they have access to treatment that helps prevent them from not only from developing AIDS, but from and passing the virus on to others.

Now earlier this year, at the International AIDS Conference here in Washington, I described some of the steps we have taken to achieve an AIDS-free generation. And today, I want to step back and make two broad points about this goal.

First, let’s remember why, after so many years of discouraging news, this goal is now possible. By applying evidence-based strategies in the most effective combinations, we have cut the number of new infections dramatically. Just last week, UNAIDS announced that, over the past decade, the rate of new HIV infections has dropped by more than half in 25 low-and-middle-income countries, most of them in Sub-Saharan Africa. Just listen to these numbers: In Zimbabwe, a 50 percent reduction; in Namibia, a 68 percent reduction; and in Malawi, a 73 percent reduction in the rate of new infections.

So as we continue to drive down the number of new infections and drive up the number of people on treatment, eventually we will be able to treat more people than become infected every year. That will be the tipping point. We will then get ahead of the pandemic, and an AIDS-free generation will be in our sight. Now, we don’t know how long it will take to do this everywhere, but we know that we can do it.

And that brings me to the second point: We’ve set the goal. We know it’s possible. Now we have to deliver. That may sound obvious, but it isn’t, because the history of global health and development is littered with grand plans that never panned out. And that matters, because if we make commitments and then fail to keep them, not only will our credibility be diminished, but people will lose heart. They will conclude, wrongly, that progress just isn’t possible, and everyone will lose faith in each other. That will cost lives. And in the fight against HIV/AIDS, failing to live up to our commitments isn’t just disappointing, it is deadly.

That’s why I am so relentlessly focused on delivering results. In July, I asked Eric Goosby and his team to produce a plan to show precisely how America will help achieve an AIDS-free generation. As I said then, I want the next Congress, the next Secretary of State, and our partners everywhere to know how we will contribute to achieving this goal. And the result is the blueprint we are releasing today. It lays out five goals and many specific steps we will take to accomplish those goals.

First, we are committing to rapidly scaling up the most effective prevention and treatment interventions. And today, I can announce some new numbers that show how far we’ve already come. This year, through PEPFAR, we directly supported nearly 5.1 million people on antiretroviral treatment. (Applause.) That is a 200 percent increase since 2008.

Now, think for a moment what this means. What did Florence say was the only hope she could give her fellow women living with HIV? She said it was the ARVs. And this year, the American people gave that hope to more than 5 million of their fellow citizens on this earth. And through them, we gave hope to their families and communities, and I think that should make every American profoundly proud.

Now, our second goal is that the blueprint says we have to go where the virus is, targeting the populations at the greatest risk of contracting HIV, including people who inject drugs, sex workers, and those trafficked into prostitution, and men who have sex with men. (Applause.)

When discrimination, stigma, and other factors drive these groups into the shadows, the epidemic becomes that much harder to fight. That’s why we are supporting country-led plans to expand services for key populations, and bolstering the efforts of civil society groups to reach out to them. And we are investing in research to identify the interventions that are most effective for each key population.

As part of our effort to go where the virus is, we are focusing even more intently on women and girls, because they are still at higher risk than men of acquiring HIV because of gender inequity and violence. So we are working to ensure that HIV/AIDS programs recognize the particular needs of women and girls, for example, by integrating these efforts with family planning and reproductive health services. (Applause.) We are also working to prevent and respond to gender-based violence, invest in girls’ education, address gender inequality, and take other steps that have been proven to lower their risk of contracting the virus.

Third, we will promote sustainability, efficiency, and effectiveness. We’ve already saved hundreds of millions of dollars by switching to generic drugs in our treatment regimen. And we will continue to ensure that we get the most out of every dollar spent.

Fourth, we will promote a global effort to achieve an AIDS-free generation, because this must be a shared responsibility. That means our partner countries must step up to the responsibilities of country ownership. And we look to our partner countries to define the services their people need the most, set priorities, and convene funding partners to coordinate. Donors must meet their funding commitments while also doing more to support country ownership.

To drive all these efforts, the United States will continue to support the Global Fund, we will invest in global health diplomacy, and use our diplomatic leverage to support our goals and bring others to the table.

And I have to say I was so impressed when I was in South Africa this summer. I went to Cape Town. We – Eric and I went together, Ambassador was there, along with the South African Minister of Health, who has been an exemplary leader. Let’s give the Minister of Health of South Africa a round of applause. (Applause.)

He has worked so hard with a great team and with President Zuma’s full support to really take on the responsibility of country ownership and management. And when we were in the clinic in Cape Town, we saw some really impressive developments, including a more efficient way to dispense the drugs that are needed. And it was a great tribute to what the South African Government has been able to do in the last four years.

Now finally – and this is really a call for the entire global health community – science and evidence must continue to guide our work. For our part, the United States will support research on innovative technologies for prevention and treatment, such as microbicides and approaches that stave off opportunistic infections like TB. We will set clear, measurable benchmarks and monitor our progress toward them so we can focus our funding on what works. It is science that has brought us to this point; it is science that will allow us to finish this job.

So with this blueprint, I firmly believe we have laid out a plan that every American president and secretary and Congress will want to build on. And I urge other countries to develop their own blueprints, because to reach and AIDS-free generation, we have to keep moving forward.

So if we have any doubt about the importance of this work, just think of the joy and that big smile on Florence’s face when she told us about giving birth to her two healthy HIV-negative sons. And think of that same sense of joy rippling out across an entire generation, tens of millions of mothers and fathers whose children will be born free of this disease, who will not know the horror of AIDS. That is the world we are working for, and nothing could be more exciting, more inspiring, more deserving of our dedication than that.

So I thank everyone across our government, because I know this was a whole-of-government effort. I thank you all for everything you have done, are doing, and will do to deliver on this important goal.

And now it’s my great pleasure to welcome my friend and partner in the effort to the stage, the leader of UNAIDS, Michel Sidibe. (Applause.)

MR. SIDIBE: Thank you. Thank you. Honorable friends, ladies and gentlemen, Madam Secretary, in the past 12 months you have transformed the global dialogue on AIDS. You have challenged world leaders to change the course of this epidemic. You have inspired both skeptics and believers to reach an AIDS-free generation. And now, with this blueprint, you are showing how the United States will support countries to start the end game to end this epidemic. None of this would have been possible without your pivotal leadership, the solidarity of American people, and the dedication of my brother, Eric Goosby.

This blueprint is timely, topical, and catalytic. This is not just another plan, like you said. It is a clear, practical way to move the world towards the goals adopted at the UN high-level meetings on AIDS. It shows how making smart investment is a priority for PEPFAR. Just by streamlining its approach to procurement and supply of HIV drugs, this blueprint will save $39 million over four years. This approach to getting more from every dollar spent will save more lives.

The presence of Madam Dlamini-Zuma is a strong expression of the African Union’s commitment to lead the AIDS response in Africa. Never in history of AIDS have we been so allied in our priorities, mutual respect, and shared motivation for results. This launch today is about what we’ll do with urgency tomorrow. In support of this blueprint, UNAIDS is responding immediately. Taking fast action, we will work with countries, with African Union/NEPAD to advance the war and share responsibility and global solidarity. We’ll empower country partners to assess and fill national capacity gap so they can accelerate access to lifesaving services. We will optimize the return from AIDS investment, particularly by ensuring greater efficiency, equity, and equality. We will strengthen the link between HIV and human rights, violence against women and girls, and community empowerment. This blueprint gives us a new unity of direction with greater focus and determination.

For me, one of the most important aspects of the blueprint is its power to restore a sense of hope for people. The moving story of Florence remind us all that we will only get to zero if we restore the dignity of people. Our latest report is a showing that we are making unprecedented progress. But like you said, this epidemic is not over. We need to mobilize our effort in each corner to make sure that we continue with this trajectory. We are breaking, of course, this trajectory of this epidemic, but we need to sustain. We need to make sure that people don’t feel that it’s over. (Applause.) By this time next year, we’ll meet to review how we have used this blueprint to lay a solid foundation for country to reach this ambitious goal.

Madam Secretary, my friend, Hillary Clinton, we’ll always miss you. You will be remembered as certainly the person who have been helping to change the face of this world. Your daily commitment for a people without voice, for those women who have been certainly struggling for their dignity, will always be with us. And we know you will not drop the ball. You will continue – (applause) – because we need you. Thanks for your leadership. You have been the visionary architect of this blueprint. We’ll all continue to continue this role, now and in the future. Your leadership and the support of American people remain essential to help us to end this epidemic. Thank you very much. (Applause.)

Is my duty to introduce Mrs. Dlamini-Zuma. I think I could not do it better than Mrs. Hillary Clinton. She was just talking about the leadership, the first lady who – the first woman to lead the African Union. I think she’s not just that one. She is the person who is committed to change, to change for better, for different Africa, for Africa who is capable to take certainly the leadership role and by owning their place in the map of the world. And I am sure, with her experience, former Foreign Minister, former Minister of Health, she will be certainly helping us to make sure that Africa will not have babies born with HIV by 2015.

Mrs. Zuma (inaudible). (Applause.)

CHAIRPERSON DLAMINI-ZUMA: Thank you very much for that introduction. Secretary of State Hillary Clinton, Florence, and Ambassador Goosby, ladies and gentlemen, I’m very pleased to be part of this unveiling of the blueprint, because for me it shows that America and all of us believe that humanity is indivisible, that what bothers a child and a woman in one corner of the world is felt by the women and children and men of this country. So we have to work together. This epidemic actually has shown the best of human beings, because it has solidarity in it, which is a very important aspect, because if it was not for solidarity, the Americans would have looked after their own. They would not have reached out to the rest of the world. And we thank you for that. (Applause.)

But we also thank all the people, like Florence, who live with HIV, but who have – who didn’t give up, who reached out into their inner strength and reached out to their fellow human beings, and kept smiling. (Applause.) Because that smile meant that you still had the will to live and to save other lives, and to bring in new life to the world. And we thank you and all the people who are in your situation, because you make us human ourselves by your own strength. Thanks very much. And we hope that they will continue working with all of us in making sure that we reach the goal of an HIV generation free.

So from the AU side, we will do all we can, working with our member states, to ensure that they do everything, one, to keep focused both on prevention, and also on treatment, and making sure that there is no stigma attached, and making sure there is no discrimination. Because as the Secretary of State said, once you start discriminating, we are driving the epidemic underground, and you won’t be able to deal with it. So as long as everyone knows that whatever their status, whatever their orientation, they are taken as human beings with no discrimination and they’ll be treated with dignity.

We also want to thank the scientific world. The scientists who sit on their own in the laboratories, working hard to support and to give scientific evidence on what needs to be done, and supporting the work that ordinary citizens out there do. And that is why it’s important to keep putting money in research, innovation. And we will be encouraging our countries. And I’m glad that they are countries in Africa who are already – who have realized and who are putting such a percentage of their budget for innovation, not only around issues of HIV/AIDS but generally, because without innovation we will not reach an HIV-free generation.

And of course, our member states and our governments have a shared responsibility. But they are encouraged by the support. And we want to stress that once we will take responsibility, we also still need global solidarity. And these must go hand-in-hand. And I’m glad, from what I’ve heard this morning, that that is the way we are going.

And I think if we all take responsibility, put whatever we can, join hands with others, have own our plans, but taking into account the global drive to a HIV-free generation, I think we will all get there. And from our side, we’ll spare no effort. We’ll do everything we can.

But lastly, we will also work hand-in-hand in empowering women, because we cannot get to that point of an HIV-free generation without empowering women to be able to take and make the right decisions, because many a woman gets infected or are not able to take treatment because of the power relations, that they are not able to navigate on their own within the family. So we will continue working with member states, working with yourselves, to make sure that women get empowered day by day until we reach the state of an HIV-free generation.

But thank you. Humanity is indivisible, and we must continue working together for the best of humanity. Thank you. (Applause.)

MR. GOOSBY: Well, thank you so much, Madam Zuma. And it was really inspiring to hear your words.

Well, I want to thank everybody for coming today. This is the launch of the blueprint but the beginning of a long journey to the finish line. It’s been proud for all of us to have an opportunity to convene such an illustrious group, but I want to thank you all for taking time to document this moment with us. So thank you. (Applause.)

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