Global Engagement in Care Conference
May 8, 2013
Thank you, Nancy Mahon, for that introduction and for your leadership of the MAC AIDS Fund and service as Chair of the President’s Advisory Council on HIV/AIDS. A special thanks to everyone at Johns Hopkins and here at George Washington for hosting us today. And thanks to all the participants from across the Administration and the research community for your work and service.
Today’s meeting is a direct result of a commitment we made during last year’s International AIDS Conference. Nancy Mahon approached us with the vision for a conference that would bring together a diverse group of international leaders, scientists, researchers, doctors, and nonprofits to see what we could learn from one another. Our department enthusiastically agreed, and we are proud to join the MAC AIDS fund and the Office of the Global AIDS Coordinator today in this effort.
For decades, the nations of the world have worked together to detect and respond to pandemics. More recently, there has been a growing recognition that we can – and must – harness that same spirit of cooperation to respond to chronic diseases, which HIV and AIDS has now become.
Everywhere I travel as Secretary – from Moscow to Nairobi to neighborhoods right here in Washington, D.C. – health leaders are trying to solve the same problems. And we are realizing that solutions will come much faster if we all share successes, failures, and lessons learned.
This exchange of ideas is especially needed at this pivotal moment in our struggle with HIV and AIDS. The U.S. Government has made creating an AIDS-free generation our goal – and that goal is within reach. Yet we know that, in order to get there, we must be more effective in everything we do.
That’s especially true when it comes to the critical topic of today’s conversation: engagement and retention in care.
We’ve already learned so much from each other through the incredible success story of PEPFAR, which has now put nearly 6 million people on treatment.
PEPFAR-supported rapid testing helped dramatically improve diagnosis and life-long care in Sub-Saharan Africa. Today, countries including the United States, are using same-day testing, especially for high-risk populations, to improve the linkage between diagnosis and lifesaving services.
We’ve also learned lessons from “treatment as prevention” trials. We now know that prevention is most successful when we use all the tools available to us, whether it’s educating people about health behaviors or improving substance abuse treatment programs or breakthrough medical research on vaccines or microbicides.
But, there’s still more work to do to, including right here in the United States.
Of the estimated 1.1 million people in United States with HIV, we believe that around 200,000 don’t know their status.
But even among the 900,000 who do, we estimate that 200,000 people still haven’t been linked with care, and an additional 250,000 haven’t benefited fully from care. In total, less than a third of all people living with HIV have a fully suppressed viral load – the best indicator of successful treatment.
Put another way, nearly three out of every four people living with HIV in the United States have failed to successfully navigate the “treatment cascade.” Clearly, we have more work to do.
Identifying and reducing the obstacles along the path from diagnosis to viral suppression is one of the key goals of the President’s National HIV/AIDS Strategy. And today, I want to briefly mention three areas that are critical to improving engagement in care – and where I hope we can learn from each other over the next two days.
The first is breaking down barriers to access in the health care system. Here in the United States, we are in the midst of implementing the Affordable Care Act, one of the most important laws in the history of our fight against HIV and AIDS. Already, the law has expanded access to HIV screenings and ended some of the worst practices of the insurance industry, like dropping someone’s coverage when they get sick.
Over the next year, the law will make an even bigger impact when it expands coverage to millions. But for the possibility of this law to become a reality, we will need to find and sign up people who in many cases may not have been engaged with the health care system before. So one question I hope will be discussed over the next two days is how to reach these vulnerable people?
A second area where we can learn from each other is how to best combine care with the support services we know can be just as important. We know that the key intervention that helps someone stay on their HIV treatment might be a ride to a clinic. It might be substance abuse counseling to help deal with an addiction. It might be protection from an abusive partner. It might be a combination of these services.
We’ve seen in states like Massachusetts that when expanded coverage is combined with outreach and proper support services, we lose far fewer people along the treatment cascade.
Now, we need to work together to better understand how to scale these results. In particular, there are many innovative ways the global health community helps ensure that vulnerable populations and those living in rural areas get the HIV care they need. Sharing that information can be valuable for our retention efforts in the United States.
Finally, a third area where we can learn from each other is addressing the specific challenges faced by women with HIV and AIDS. Globally, AIDS is now the leading cause of death for women of reproductive age. And here in the United States, an estimated 280,000 women are living with HIV, though we’ve recently seen a promising drop in new infections among women.
We must all do more to address the challenges that keep women from getting the care they need. We know women are less likely to have the economic resources to pay for care. They can face higher levels of stigma. And they are too often the victims of intimate partner violence and sexual assault, which increase their risk of infection. Here in the United States, the President has appointed a working group on the these specific issues, but we must all do a better job coming up with strategies for helping women navigate the treatment cascade.
Over the last few years, we’ve made great progress in our efforts to reduce the burden of HIV and AIDS. In many places around the world, new infections are falling. The ranks of those on treatment are growing. In countries where AIDS has taken its greatest toll, life expectancies are beginning to rise once again. Here in the United States, infections among injecting drug users have dropped more than 80%. Pediatric cases of HIV are down more than 90%.
But we still lose far too many people at every step of the journey from a positive test to viral suppression, both in the United States and around the world. Closing these gaps is an urgent moral imperative.
Our goal must be to do whatever is necessary to get – and keep – people in life-saving treatment. That includes fighting stigma and discrimination. It includes advocating for the health of all communities at greatest risk for HIV, including young, black, gay men and transgendered people. It includes supporting research, in order to find more prevention and treatment breakthroughs.
And it must also include conversations like the one we are having today. If we are going to achieve our goal of an AIDS-free generation, we need to do it together. We need to do it by sharing best practices. We need to do it by learning from each other’s successes and failures. We need to do it by tackling these challenges as a global community, not just individual nations, or public and private sectors only.
So thank you all for the work you are doing and sharing it with us. And I look forward to working with all of you to apply the lessons that come out of this meeting in the months and years to come.