International AIDS Conference
August 13, 2006
Prepared remarks by Bill and Melinda Gates, co-chairs
Bill Gates: Good evening.
Thank you, Helene, for that kind introduction, and for everything you’ve done in the fight against AIDS. Melinda and I are honored to be with all of you here in Toronto to open the 16th International AIDS Conference.
Melinda and I have made stopping AIDS the top priority of our foundation. We can make this commitment — and make it with serious hope of success — because of the talent and energy of the people here tonight. Whether you are working to prevent the spread of HIV, caring for people who live with the disease, or doing scientific research on the virus, we want to say: Thank you for dedicating your lives to ending AIDS.
Melinda and I would also like to thank thousands of people around the world who are an indispensable part of the fight against AIDS. I’m talking about the people who are participating in clinical trials as we try to find new ways to treat and prevent HIV. Science can do nothing without their help — and we want to offer them our deepest thanks and respect.
Tonight, Melinda and I want to talk about some encouraging signs we see in the battle against AIDS, and some signs that are more disturbing. But ultimately, we want to call on everyone here and around the world to help speed up what we hope will be the next big breakthrough in the fight against AIDS — the discovery of a microbicide or an oral prevention drug that can block the transmission of HIV.
This could mark a turning point in the epidemic, and we have to make it an urgent priority.
If we can discover these new preventive tools and deliver them quickly to the highest-risk populations – we could revolutionize the fight against AIDS.
Melinda and I returned recently from Africa. We felt a new sense of optimism there — because the world is doing far more than ever before to fight AIDS. The Global Fund is active in 131 countries. It gets HIV drugs to more than half a million people. It provides access to testing and counseling to nearly 6 million people. It offers basic care to more than half a million orphans.
The Global Fund is one of the best and kindest things people have ever done for one another. It is a fantastic vehicle for scaling up the treatments and preventive tools we have today — to make sure they reach the people who need them. That’s why, last week, our foundation announced a $500 million grant to the Global Fund. We’re honored to be a part of their work.
The Global Fund is not the only dramatic advance in the world’s efforts against AIDS. Shortly after the Global Fund’s launch, President Bush promised $15 billion over five years to fight AIDS, the largest single pledge ever made to fight a disease. There were a lot of skeptics at the time, and a lot of them are probably here tonight.
But today, PEPFAR is supplying antiretroviral drugs to more than half a million people in 15 countries in Africa, Asia, and the Caribbean. The President’s Emergency Plan for AIDS Relief has done a great deal of good, and President Bush and his team deserve a lot of credit for it.
The expansion of treatment is making a life-saving difference all around the world. On our trip to Rwanda last month, Melinda and I went to a clinic, where they showed us a picture of a thin, sickly man, clearly suffering from AIDS. I was staring at this picture when a healthy, smiling man walked into the room and said hello. It took me a minute to realize — it was the same man.
This is what treatment is doing for more and more people in the developing world. We have to build on it — by seeking more funding, creating cheaper drugs with fewer side effects, and designing more practical diagnostics.
At the same time, we have to understand that the goal of universal treatment — or even the more modest goal of significantly increasing the percentage of people who get treatment — cannot happen unless we dramatically reduce the rate of new infections.
Between 2003 and 2005, with the infusion of funds from Pepfar and the Global Fund, the number of people in low and middle income countries receiving anti-retroviral drugs increased by an average of 450,000 each year. Yet over the same period, the number of people who became infected with HIV averaged 4.6 million a year. In other words, for each new person who got treatment for HIV, more than 10 people became infected. Even during our greatest advance, we are falling behind.
Let’s consider what this means for universal treatment. Right now, nearly 40 million people are living with HIV. The lowest price for first-line treatment drugs is about $130 per person per year; in many cases the cost is much higher. And the cost of personnel, lab work, and other expenses easily exceeds another $200 per person per year.
That means — even when you assume the lowest possible prices — that the annual cost of getting treatment to everyone in the world who is HIV positive would be more than $13 billion a year, every year. To put that number in context, remember that Pepfar — an historic expansion in funding — designates about $1.5 billion a year for treatment.
This $13 billon figure doesn’t count the cost of much more expensive second-line therapies, which many patients will need. Moreover, these figures assume no increase in the number of people living with HIV — yet we’re averaging 4.6 million new infections a year.
We need to do everything possible to bring down treatment costs, and I’m sure we will make progress there. But even if you take very optimistic numbers, when you extrapolate 5 to 10 years, you quickly see that there is no feasible way to do what morality requires — treat everyone with HIV — unless we dramatically reduce the number of new infections.
The harsh mathematics of this epidemic proves that prevention is essential to expanding treatment. Treatment without prevention is simply unsustainable.
We have to do a much better job on prevention.
Right now, one of the most widely practiced approaches to prevention is the ABC program, for Abstain, Be faithful, use Condoms. This approach has saved many lives, and we should expand it. But for many at the highest risk for infection, ABC has its limits.
Abstinence is often not an option for poor women and girls who have no choice but to marry at an early age. Being faithful will not protect a woman whose partner is not faithful. And using condoms is not a decision that a woman can make by herself; it depends on a man.
Another promising approach is male circumcision. One new study found that it could significantly reduce the spread of HIV. This is exciting — and if male circumcision truly is effective, we should make it widely available.
But, like using condoms, circumcision is a procedure that depends on a man.
That isn’t good enough.
We need to put the power to prevent HIV in the hands of women.
We need tools that will allow women to protect themselves. This is true whether the woman is a faithful married mother of small children — or a sex worker trying to scrape out a living in a slum. No matter where she lives, who she is, or what she does — a woman should never need her partner’s permission to save her own life.
Let me be clear: As we discover and distribute preventive tools that women can use without a man’s cooperation, we are not excusing men from their obligations to be sexually responsible and to protect their partners. We are just reducing the consequences to women if they don’t.
In a moment, Melinda is going to discuss the research underway in microbicides and oral prevention drugs — products that women could use to protect themselves from infection.
While there is promising research to report, the world, in my view, has not done nearly enough to discover these new tools — and I include our foundation in that assessment. All of us who care about this issue should have focused more attention on these tools, funded more research, and worked harder to overcome the obstacles that make it difficult to run clinical trials. Now we need to make up for lost time.
We believe that microbicides and oral prevention drugs could be the next big breakthrough in the fight against AIDS. We are determined to help medical science discover these new drugs and get them to the people who need them. Melinda?