NEW ORLEANS, LA—Twenty years after antiretroviral therapy (ART) was initiated for HIV, more than 17 million people worldwide are receiving this life-saving treatment, which has become safer, easier to use, more effective and long-acting, IDWeek attendees were told in a Special Opening Plenary Session.

“But our work is far from done,” said Ambassador-at-Large, Deborah L. Birx, MD, Coordinator of the United States Government Activities to Combat HIV/AIDS and U.S. Special Representative for Global Health Diplomacy, U.S. Department of State, Washington, DC.

For example, more than 1,000 new HIV infections per day occur in girls and young women in sub-Saharan Africa, accounting for 71% of new HIV infections among adolescents. And, without lifesaving ART for HIV-infected children, 50% will die before their second birthday—and 80% will die before the age of 5 years.

As the U.S. Global AIDS Coordinator, Ambassador Birx oversees the implementation of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the largest commitment by any nation to combat a single disease in history. President George W. Bush initiated PEPFAR in 2003 to combat global HIV/AIDS, and the first 5-year, $15 billion legislation was approved.

Ambassador Birx said the HID/AIDS response is driven by advocates and civil society, policy makers and government leaders, pharmaceutical companies and the private sector, and leaders in scientific research. She said civil society plays a critical role in HIV response: “we would not have a global HIV response if not for civil society groups that demanded it.” 

This response includes individual programs that focus on women, children, and men. 

The DREAMS Partnership, launched on World AIDS Day 2014 to reduce new HIV infections among adolescent girls and young women in 10 sub-Saharan countries, was created “to help girls develop into Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe women,” the program states. The 10 countries are Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. 

The initial $385 million partnership included PEPFAR, the Bill & Melinda Gates Foundation, and Girl Effect; in 2015, DREAMS was joined by Johnson & Johnson, ViiV Healthcare, Gilead Sciences. DREAMS countries also received additional funding requests to scale up voluntary medical male circumcisions and treatment for men. 

Also in 2014, the Accelerating Children’s HIV/AIDS Treatment (ACT) Initiative was launched, a 2-year effort to double the number of children receiving ART in sub-Saharan Africa. In just 12 months, 189,000 additional children were on treatment, up from 300,000. Also during the first year of ACT, PEPFAR has more than doubled HIV testing for children, to 4.3 million. What’s needed is a better antiretroviral formula for babies and children under the age of 2 years, she said. 

Previously, men with HIV with higher CD4 cell count were not treated until they were sicker, which now seems counterintuitive. This led to “Test & Start for ART,” a 2015 World Health Organization (WHO) recommendation and single public health message for treatment. 

At the United Nations (UN) High Level Meeting in June 2016, PEPFAR launched a $100 million Key Populations Investment Fund to support innovative, tailored, community-led approaches to address critical issues and gaps that exist for key populations in the HIV/AIDS response. Key populations vary by location and include men who have sex with men, people who inject drugs, young women, sex workers, transgendered people, migrant workers, and prisoners. 

Other PEPFAR financial commitments include $10 million to the Robert Carr Civil Society Networks Fund over the next 3 years to build the capacity of civil society; a $4 million, 2-year PEPFAR/UNAIDS faith initiative; and in partnership with Elton John AIDS Funds, $10 million to support key population advocacy.