Clinton Presidential Center "Editorial: The Fight Against a Human Tragedy has just Begun"

When I left office in 2001, more than 33 million people around the world were living with HIV, with 95 percent of these cases concentrated in developing countries. Since then, despite considerable international effort to combat the problem, that number has grown to more than 40 million even as 15 million men, women and children have died of AIDS. When one takes into account the current HIV/AIDS crisis in Africa and the Caribbean, combined with the potential explosion of infections in China, India and eastern Europe and the fact that AIDS kills 8,500 people every day, we must redouble our efforts to reverse the tide.

I have reached the point in my life where what matters most to me is that no child or young person die prematurely from preventable causes. It is the belief that motivates much of the work of my foundation, especially my work through the Clinton HIV/AIDS Initiative (CHAI). Every time I meet a child in Lesotho or a mother in rural China or a teenage boy in Kenya – all of whom, once on the brink of death, now glow with the promise of life afforded simply by access to antiretroviral (ARV) medicines – I know we can prevail with will, resources, and organized, consistent effort.

On this World AIDS Day there is some good news. In early 2003 in Africa, ARV drugs reached only one person for every 100 who needed them. Today, thanks to the tireless work of ministers of health, doctors, nurses, community health workers and all those who support them – including the Global Fund, the Bush Administration’s AIDS program, the Gates Foundation, CHAI and many others – more than 500,000 Africans living with HIV now have access to drugs: a tenfold increase. My foundation’s biggest contribution has been to achieve a drop in the price of medicines and diagnostics from $500 or more a year to $150.

Though the world fell short of the United Nations’ ambitious goal of treating 3 million people by the end of 2005, more than 1m people worldwide are being treated today – a positive step. Still, there are 5 million more who need treatment, including 700,000 children.

First, we need to build clinics, strengthen distribution systems and recruit and train healthcare workers. This will only be possible with more money, which is why it is important that the Global Fund get resources to fund a new round of grants next year. To this end, CHAI is extending technical support we give to 17 countries in Africa, Asia and the Caribbean to Ethiopia, Ukraine and Vietnam. We are also expanding the pediatric and rural initiatives we launched in April, recognizing that children and people living in rural areas were being left behind in the rapid pace of treatment scale-up. At the beginning of the year, only 10,000 children (outside Brazil and Thailand) were receiving treatment. My foundation and its partners are doubling that number in one year and are committed to treating 50,000 more next year.

Second, we need to keep the costs of treatment affordable. I am profoundly grateful that a quarter of those on treatment today in Africa, Asia and the Caribbean are benefiting from the drug and diagnostic price reductions my foundation brokered. Still, as access increases, so does the price tag to countries and donors. Small costs, like those for HIV diagnosis, become big when we need to test tens of millions of people. Large costs, like those for the second-line treatments which today cost at least 10 times the price of first-line medicines, could threaten our ability to keep patients on treatment.

Third, we need to redouble our efforts to prevent new HIV infections. Only prevention can end the AIDS pandemic. Of course, we cannot lose sight of the need for a vaccine as a long-term solution and a microbicide in the interim. But we must also remember that AIDS is preventable and behavioral choices can make all the difference. A large majority of those most at risk are still not being reached by education efforts. Too many young people are still being infected by contaminated needles. Too many women are infected during sexual acts that are not voluntary. We must do better by empowering girls and educating adults to change practices that put children at risk. The First Ladies of Africa are announcing today a campaign “to treat every child as your own,” challenging adults to take collective responsibility for the welfare of children.

Sitting in the west, it is easy to think that only the rich and powerful can meet these challenges. The Group of Eight industrial nations gives billions of dollars in aid. Foundations and philanthropists give hundreds of millions more. But everyone has a role. Yesterday in Banda Aceh, I saw again the power of individuals to give relief to victims of the Asian tsunami. They sent blankets and food. They gave money and time – building new homes or caring for the sick. Volunteers have also been at the forefront of responding to hurricanes in America and the earthquake in Kashmir. Individual generosity has made a difference to thousands of lives as the world responded to these natural tragedies, and it can affect millions as we fight AIDS, especially in education, prevention and provision of health care in remote areas.

Every voice matters. So does every dollar and every hour of time you can volunteer. Your generosity supports the tireless work of people whose efforts to fight AIDS are succeeding. We have got a long way to go but we are making progress. Together we can beat this human tragedy.

Published in the Financial Times December 1, 2005