WASHINGTON -- Some of Washington's most powerful people delivered to the 19th International AIDS Conference pretty much the same message: Fighting AIDS is a good investment that is getting better every year, but current spending isn't enough to end the epidemic.
Whether the world's richer countries, and especially the United States, will decide to increase spending or alternatively wring more from current investment is a matter of much discussion among the 25,000 researchers, clinicians and activists meeting in the nation's capital through Friday.
The United States spends $22 billion a year domestically on prevention and treatment of AIDS, up $2.5 billion since the start of the Obama administration. It spends $6.6 billion a year on AIDS-related activities overseas -- more than six times total U.S. spending on global health in 2000.
All told, $17 billion is spent each year on AIDS in the developing world, where 8 million people are on life-extending antiretroviral drugs. To get 15 million people on those drugs by 2015 -- the current goal -- donor and recipient countries will together have to come up with $24 billion a year.
"Why can we continue to pour $100 billion a year into Afghanistan, but we can't find a quarter of that to end a global pandemic?" asked Sen. John Kerry, D-Mass., in one session. "This is precisely the moment we need to invest more, so that past investments are not lost and we don't slide back."
Sen. Lindsey Graham, R-S.C., noted that Congress' appropriation for HIV/AIDS this year exceeded President Barack Obama's request. "To the American taxpayer, your money is going to a good cause," he said.
Mr. Graham praised George W. Bush, whose President's Emergency Plan for AIDS Relief (PEPFAR) launched this country's big-ticket international AIDS spending in 2003. Of such far-flung spending he said, "It's OK for Republicans to get involved in this. This is a worthy cause for both parties."
Secretary of State Hillary Clinton got a standing ovation when she addressed 7,000 people in the conference center's largest hall in a morning plenary session.
She reinforced her call last November for an "AIDS-free generation" -- a phrase that's becoming a battle cry. She described it as a time when there would be no child born with the virus, young adults would have a significantly lower risk of becoming infected and life-extending antiretroviral treatment would be available for anyone who needs it.
"HIV may be with us into the future until we finally achieve a cure [and] a vaccine, but the disease that HIV causes need not be with us," she said.
She said three interventions will be necessary:
Antiretroviral drugs need to be used much more widely so that infected people have little chance of transmitting HIV to others -- so-called "treatment as prevention." Circumcision, which reduces female-to-male transmission, must be practiced more widely. All pregnant HIV-infected women need to be treated with antiretrovirals in order to protect their babies during birth and breast-feeding.
Her address was also an opportunity for Ms. Clinton to detail renewed American financial investments through PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
She said the United States has spent $1 billion in recent years to prevent mother-to-child transmission, and that $80 million more will be spent to bring infected pregnant women into long-term care. She also said that PEPFAR will devote an additional $40 million to circumcise about 500,000 men and boys in South Africa. An additional $15 million will go for "implementation research."
She said that Zambia, one of PEPFAR's 12 "focus countries" in Africa, cut the number of new infections in half from 2009 to 2011.