Goosby directs the work of PEPFAR,
a federal program led by the Department of State that integrates the efforts of the Department of Health and Human Services, the U.S. Agency for International Development, the Department of Defense, the Peace Corps, the Department of Labor and the Department of Commerce to combat HIV/AIDS globally. Congress authorized PEPFAR in 2003 and reauthorized it in 2008 for 5 more years.
“We are uniquely privileged to sit at the intersection
where the worlds of science and implementation
combine to produce a public health impact. In this work, NIH is a critical partner,” said Goosby.
PEPFAR implements a wide range of interventions
to fight the AIDS epidemic around the world. In his lecture, Goosby focused on three high-priority interventions that have produced a “widespread impact to change the course of the AIDS epidemic.”
“The progress we have made in translating science into impact in order to achieve our vision of an AIDS-free generation is truly heartening,” said Goosby.
Photos: Bill Branson
First, Goosby talked about the need to scale up treatment for people already living with HIV/AIDS. Treatment is now seen as an important prevention strategy: a recent study showed that treating a person living with HIV reduced the risk of transmission to partners by 96 percent. In 2003, only about 50,000 people in sub-Saharan
Africa were receiving treatment. Today, with PEPFAR support, 3.9 million people are receiving treatment globally, the vast majority in sub-Saharan Africa.
Reducing mother-to-child transmission of HIV is another important goal of PEPFAR. Studies have found that treatment with the antiretroviral
drug AZT during pregnancy greatly reduces transmission from mother to child. From 1992 to the present, in resource-rich countries, this treatment has caused mother-to-child transmission
to drop dramatically from 25 percent to less than 1 percent of children born to mothers with HIV.
A third important intervention is voluntary male circumcision, which has been shown in clinical trials to reduce the chances of men becoming infected with HIV. Several trials also showed that circumcisions, when performed safely, can reduce sexual transmission among men by as much as 60 percent. Male circumcision
has been shown to be cost-effective and also offers indirect protection to women whose male partners are circumcised. PEPFAR has supported approximately 1 million male circumcisions
Goosby explained that the vision of an AIDS-free generation, which Secretary of State Hillary Clinton laid out at a speech at NIH last November,
had these three interventions at its core. On World AIDS Day on Dec. 1, 2011, PEPFAR announced new goals of 4.7 million male circumcisions
in the next 2 years as well as starting
1.5 million women on antiretroviral drugs to prevent mother-to-child HIV transmission.
Goosby also said PEPFAR wants to “make sure we don’t win our battles against the AIDS epidemic
but lose the larger war” of helping countries
build sustainable health systems for the future.
With this in mind, NIH and PEPFAR joined forces in 2010 for the Medical Education Partnership
Initiative, a 5-year program that provides
training and education to increase the number of doctors, nurses and midwives in Africa. “This program builds on Africa’s greatest resource of all—its people,” said Goosby.
There are challenges ahead in the fight against AIDS, but Goosby remains optimistic about the future. A recent study found that a million deaths due to AIDS were averted in the first 4 years of PEPFAR. “The progress we have made in translating science into impact in order to achieve our vision of an AIDS-free generation is truly heartening,” he said.
Goosby encouraged the audience to keep in mind a quote from Nelson Mandela as we continue
the long, but winnable, fight against AIDS: “It always seems impossible until it’s done.”
The annual Barmes Lecture, sponsored by NIDCR, honors the late David E. Barmes. He was a public health dentist and epidemiologist
by training. The lecture series was established
in 2001 to honor his lifelong dedication to research aimed at improving health for those in low-income countries.