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Winning a Global Fight

January 5, 2017

A photo of about two dozen South Sudanese children
The leader of the largest effort by any nation in history to combat a single disease, U.S. Ambassador-at-Large Deborah Birx told a packed house on Dec. 20 that the overall rate of new HIV infections in affected nations has tumbled by more than half -- and that 2 million newborns worldwide have been spared from the virus.

 

A tryptich of Dr. Deborah Birx, U.S. Special Representative for Global Health Diplomacy
Agent in a worldwide cause: A virologist and former U.S. Army Colonel, Dr. Birx rose to become director of the military HIV Research Program at Walter Reed in 1996, then director of the CDC Division of Global HIV/AIDS for nearly a decade, before being confirmed ambassador by the U.S. Senate in 2014.

 

Dr. Deborah Birx oversees the President's Emergency Plan for AIDS Relief (PEPFAR). The $6.8 billion program provides prevention, screening and treatment in 65 countries where the virus once ran unchecked. Staff from HRSA's HIV/AIDS Bureau have supported PEPFAR since its creation, working with host countries to assess public health and design customized assistance programs.

​Launched in 2003 by President Bush and carried forth by President Obama, the program provides care and support for 6.2 million orphans and vulnerable children; HIV testing and counseling for 74.3 million people, including 14.7 million pregnant women; treatment for 11.5 million men, women and children; and training for more than 190,000 new health care workers in the hardest hit regions of the world. (For an overview, see PEPFAR-at-a-glance.)

"It was those patients who took to the streets, it was those patients who taught us not only humility, but also the power of individual voices and the need for compassion ... When it seemed like ‘the darkness of the day is going to last forever,’ they stood up -- when they were dying themselves -- and said, 'We want a different future for the people behind us.'" - Dr. Deborah Birx, on the progress made since the groundbreaking AIDS 2000 Conference in Durban, South Africa. Her remarks were webcast live nationwide from HRSA headquarters.

 

Pictured from left to right: Austin Demby, Dpty Dir., HRSA Office of Global Health; RADM Deborah Parham Hopson, HRSA/OA Senior Health Advisor; Ambassador Jimmy Kolker, HHS Asst. Secretary, Office of Global Affairs; Jim Macrae, HRSA Acting Administrator; Ambassador Birx; Dr. Mitchell Wolfe, HHS Dpty. Assistant Secretary, Office of Global Affairs; RADM Kerry Paige Nesseler, Dir., HRSA Office of Global Health; Carl Dieffenbach, Director, NIAID/DAIDS, NIH.
Veterans of the fight: (left to right) Austin Demby, Dpty Dir., HRSA Office of Global Health; RADM Deborah Parham Hopson, HRSA/OA Senior Health Advisor; Ambassador Jimmy Kolker, HHS Asst. Secretary, Office of Global Affairs; Jim Macrae, HRSA Acting Administrator; Ambassador Birx; Dr. Mitchell Wolfe, HHS Dpty. Assistant Secretary, Office of Global Affairs; RADM Kerry Paige Nesseler, Dir., HRSA Office of Global Health; Carl Dieffenbach, Director, NIAID/DAIDS, NIH.

 

Jim Macrae noted that "83 percent of Ryan White HIV/AIDS Program clients are virally suppressed -- up from 70 percent in 2010."

"But we know that even here in our own country, we have to work together – across the Department, with partners in federal, state and local government, and with grantees and stakeholders – to reach those outside of care. That message of working together is also critically important in our HIV-AIDS work globally."

Much of the success of the PEPFAR program, he said, owes to the fact that it is a data-driven enterprise that regularly assesses "where we are," allowing federal agencies and international partners to "change or improve strategies, and focus on effective program execution … making sure that every dollar has the most impact.

"Moving from counting outputs to focus on true outcomes," he said, is now a hallmark of both the program and HRSA itself -- PEPFAR's third largest funder.

 

A photo of HRSA Acting Administrator Jim Macrae next to a slide showing the expansion of lifesaving PEPFAR services with flat budgets, from 2004 to 2016
Proven results: Jim Macrae applauded the program's "focus on true outcomes."

 

Added Ambassador Birx: "Seventy-five percent of the epidemic, more or less, is in sub-Saharan Africa, but 92 percent of the PEPFAR dollars are there."

Within Africa broadly, she said, "we were reaching less than a third of the children a couple of years ago, so we really worked to increase our investment in finding children and getting them treated … We now have 1.1 million children under 19 years old on treatment; we've tested between 8 and 10 million children just in the last two years ... That's really quite extraordinary."

And, as in the Ryan White program, the metrics of the once-lethal disease have tipped in favor of survival.

CDC-supported surveys measuring the reach and affect of HIV programs in PEPFAR-supported countries confirm that federal, international and non-profit public health campaigns by such organizations as the Gates Foundation have been especially successful in three African nations.

Since the beginning of the epidemic, HIV prevalence has declined more than 30 percent in Zimbabwe and Malawi, and 21 percent in Zambia -- while at the same time, the decline in rates of new infections in each of those countries over the last 12 to 13 years is between 50 and 75 percent, a "remarkable" drop, Birx said.

When data from all countries are put together, she added, it is apparent that “we really have very different epidemics.

"We have an epidemic over 30 (years of age) -- where people know their status, they are on treatment, they’re virally suppressed … We have an epidemic that has much declined in pediatrics under one year old" that continues to fall. "And then we have 15 to 30 year olds.  And they’re not tested, they don’t know their status, they are not virally suppressed and they are transmitting the virus.”

 

Photo of UNAIDS Executive ​Director Michel Sidibé​ and Dr. Birx
A long-time partnership: UNAIDS Executive ​Director Michel Sidibé​ and Dr. Birx.

 

Ambassador Birx serves as the U.S. Special Representative for Global Health Diplomacy, which includes oversight of all U.S. Government engagement with the Global Fund to Fight AIDS, Tuberculosis and Malaria. She harmonizes government diplomacy with foreign assistance programs that address global health and speed progress toward achieving an AIDS-free generation; ending preventable child and maternal deaths; and preventing, detecting, and responding to infectious disease threats..

Date Last Reviewed:  July 2017