Clinton Presidential Center "My Quest to Improve AIDS Care"

Around the world: the cost of treating AIDS has fallen in recent years, but millions still die for the lack of medicine. My goal is to change that.
By Bill Clinton
Newsweek

May 15, 2006

For the past 14 years, I've had a photo of a young man named Ricky Ray in my office. I met Ricky and the rest of the Ray family on the campaign trail in 1992. Ricky and his brothers were hemophiliacs who contracted HIV through blood transfusions. When I first met Ricky, it was clear that he was very ill. After I was elected, I spoke to Ricky on the phone and invited him and his family to my Inauguration. His family came, but sadly, Ricky died just weeks before. When I was president I worked to get the resources necessary to turn back the tide of AIDS in America and to triple our meager contribution to fighting the global epidemic. I also kept Ricky's photo in my office in the White House. Now I keep it in my office in Harlem to remind me of the 40 million Rickys in the world today who live with HIV/AIDS but, because of breakthroughs in medicine, shouldn't have to live abbreviated lives.

The face of AIDS treatment has changed dramatically over the past 25 years. Before I was elected president, Hillary and I had close friends who had died of AIDS, and when I first got to the White House, there was little effective treatment for people living with the disease. By the start of my second term, the introduction of three-drug antiretroviral therapy had transformed AIDS from a death sentence into a manageable chronic illness for people who had access to the drugs. Treatment reduced AIDS-related mortality by nearly 80 percent in the United States. Unfortunately, almost no one could afford the drugs in Africa, where between 1992 and 2000 the number of HIV infections rose from 7 million to over 22 million.

When I left the White House, I wanted to do more to stem the number of deaths from AIDS in the developing world, especially in Africa, home to more than two thirds of the people with the virus, and in Asia, Eastern Europe and the Caribbean, where HIV/AIDS was spreading rapidly. It was clear that the

Cover of May 15, 2006 Newsweek

prices for medicines and tests, which fell substantially between 2000 and 2002, needed to come down even more. Under the leadership of Ira Magaziner, who worked with me in the White House on health care, generic pharmaceutical companies agreed to cut prices dramatically in the developing world in return for larger volumes and assistance to lower production costs. Generous commitments by Ireland, Canada, Norway, Sweden, Australia, France, the United Kingdom and private donors assured that the companies would be paid for growing volumes. For the 55 countries that have joined our procurement consortium, the annual price for the most common drug cocktail is now less than $140—an over 50 percent reduction from the lowest previous prices—and the cost of necessary tests to monitor a patient's response to treatment has fallen by as much as 80 percent. Other companies have lowered their prices in response to these cuts.

Lower prices and greater competition have increased the buying power of the new money invested by governments, foundations and international agencies. Overall, the number of people accessing treatment in the developing world has increased from less than 400,000 to over 1.3 million since the beginning of 2004; about 25 percent of those new recipients are receiving medicine through the contracts we negotiated. If all nations in the developing world were purchasing AIDS drugs at these prices, we could dramatically increase the number of lives saved for the same amount of money.

As treatment becomes more accessible, people at risk have stronger incentives to get tested for HIV. We can't stem the tide of new infections until the already-infected people know their status. It is an urgent priority because 90 percent of HIV-positive people don't know they are infected. Last year my foundation negotiated a 50 percent reduction in the HIV test that provides results within a few minutes. This year the southern African country of Lesotho, with a third of its adults living with HIV, will begin an aggressive program to offer testing to everyone older than 12.

Over the past few years, it has been especially gratifying to see political leaders in the developing world take ever-stronger stands against AIDS, a movement I have tried to encourage. At an AIDS conference at Beijing's Tsinghua University a few years ago, a courageous young man, Peng Fei Song, stood up in the audience and identified himself as HIV-positive. I invited him onstage and gave him a hug. Then I brought him over to shake hands with a group of government officials who were also onstage. This was all on national television. Soon afterward, the premier met with AIDS activists, and the president visited AIDS patients in a hospital. Now government officials at all levels are working to strengthen China's response to the epidemic.

China is one of 23 nations in Africa, Asia, the Caribbean and Eastern Europe where my foundation has been invited to work to help build care, treatment and prevention programs. Our staff of over 400 is assisting in whatever ways our host governments request. Perhaps the most daunting challenge is building health-service networks in poor rural areas. With the help of people like Dr. Paul Farmer and his Partners in Health group, we are making headway.

I love returning to places I have visited to witness the effects of AIDS treatment. Years ago, I met two young twins in the Caribbean who were born with HIV and were probably only a few weeks from dying. Last year when I saw them, they were healthy, smiling and able to give me big strong hugs. Moments like those are too rare. Despite these flashes of hope and the very real progress being made, millions are still being left behind. For every child we save in the Caribbean, India, China and Africa, thousands are dying every day because they are not getting treatment. Last year at this time, my foundation pledged to double the number of children receiving AIDS treatment outside of Brazil and Thailand (which are ahead of other countries in providing pediatric care). We have met that goal by reducing drug prices, getting funding from private philanthropists and helping to train health workers. That may sound good, but only 40,000 of the 660,000 children who now need treatment are getting it. Even if we add another 50,000 this year, and other donors do more, hundreds of thousands of children will still die needlessly. My goal is to increase the number on treatment fivefold.

While I am heartened by the progress we are making, I am grieved by how few children are receiving treatment. I am encouraged by the fact that we can provide a woman in rural Africa with AIDS medicines from the other side of the globe, but impatient that we cannot empower her sufficiently to protect herself from getting HIV in the first place. I am frustrated when I see AIDS medicines delivered without food or clean water. I am unhappy that we are not doing more to keep the people who deliver essential care in Africa.

Don't get me wrong: there are many thousands of people within NGOs, governments and multilateral agencies working tirelessly to combat and treat this disease. The Global Fund to Fight AIDS, TB and Malaria, the Bush administration, the Gates Foundation and others have dramatically increased funding. It is thanks to these efforts that there are now 1.3 million people getting the medicines they need to stay alive. But 1.3 million isn't enough when millions more need treatment.

I couldn't save Ricky Ray in 1992, but we turned the epidemic around in America and made access to lifesaving care and treatment universal. Now we can do the same thing around the world and save millions of lives by the end of the decade. I hope you will join me in this effort.