Creating an AIDS-Free Generation The beginning of the end of AIDS Center for Strategic & International Studies Washington, DC March 22, 2012 Thomas R. Frieden, MD, MPH Director Centers for Disease Control and Prevention

2012 is a tipping point for the global HIV epidemic Increasing coverage, decreasing costs Recognition of global shared responsibility and accountability New evidence that Treatment is prevention PMTCT and voluntary male medical circumcision can be scaled up for population reach and impact Infection rates and deaths can be driven down

CDC provides assistance throughout the world CDC Direct Assignees Global Disease Detection Centers DoD Collaborations CDC Influenza International Assignees CDC Global AIDS Program CDC Malaria Assignees CDC Field Epidemiology Training Program (FETP) Global Immunizations Assignees Nearly 400 assignees in 50+ countries 1,500 host country national staff

GlobalSub-Saharan Africa Number (millions) 4 Source: UNAIDS/WHO HIV incidence is decreasing Number of people newly infected with HIV, globally and in Sub-Saharan Africa,

Number (millions) HIV-related mortality is also declining Number of AIDS-related deaths, globally and in Sub-Saharan Africa, Source: UNAIDS/WHO GlobalSub-Saharan Africa

U.S. government calls for an AIDS-free generation AIDS-free generation Virtually no children born with HIV infection Adults living with HIV don’t develop AIDS Accelerated declines in HIV incidence Combination prevention Antiretroviral treatment as prevention Prevention of mother-to-child transmission (PMTCT) Voluntary medical male circumcision Correct & consistent condom use

National HIV/AIDS Strategy for the United States Reduce new HIV infections Increase access to care and improve health outcomes for people living with HIV Reduce HIV-related disparities and health inequities Achieve a more coordinated national response to the HIV epidemic

New CDC approach to HIV prevention in the U.S. Funding to places most in need, for populations most in need, for programs that work Funding determined by number of people living with HIV Supports innovative demonstration programs by Health Departments 75% of proposed activities in 4 program areas HIV testing and linkage to care Comprehensive HIV Prevention with Positives Condom distribution Initiatives to promote prevention and accountability, particularly viral load

Effective prevention interventions Coverage of these evidence-based interventions remains limited InterventionEfficacyCoverage PMTCT With effective PMTCT programs, HIV transmission can be reduced to 2-4% 48% Antiretroviral Treatment as Prevention 96% reduction in HIV transmission47% Male Circumcision>60% efficacy 4.6% (14 priority countries) HIV Vaccine?31% efficacy Vaginal Microbicide39% efficacy; 54% among high adherers Pre-Exposure Prophylaxis Trial #1: MSM (44% efficacy; 74% among high adherers) Trial #2: High-risk women (no evidence of efficacy)

Adult male circumcision provides long- lasting protection against HIV infection Rakai, Uganda

PEPFAR has driven down costs of HIV treatment

Modeling combination prevention and reductions in HIV incidence Incidence in Swaziland in 2014 by scenario ART = antiretroviral treatment MC = male circumcision

Sustainable public health progress CDC helps develop local capacity domestically & globally Guidance, technical assistance, direct funds Applied epidemiology US direct hires and host country national staff Labs systems and quality Health security

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