We must all build on HIV/Aids success

Another View: South Africa is taking the lead in expanding prevention programmes but there can be no let-up in this war, writes Donald Gips

On World Aids Day we pay tribute to the millions who are infected and affected by HIV/Aids worldwide. We continue to spread the word that in spite of much success, too many lives are still being devastated by this deadly disease. Our task looms large, but our message is simple: we have a shared responsibility as governments and individuals to build on the success achieved by making smart investments and decisions that will ultimately save more lives.

And there is much success to build on. Globally, more than five million people in low- and middle-income countries are on HIV treatment, and the American people support more than half of these individuals through the President's Emergency Plan for Aids Relief (Pepfar). In addition, Pepfar programmes have helped more than 340000 babies to be born free of HIV. Millions more have benefited from HIV prevention and care programmes.

In South Africa, our partnership with the government is saving thousands of lives. Pepfar support from 2004 to 2009 was more than R15-billion, and is helping about 650000 people receive antiretroviral treatment. More than 2.1 million people have received HIV-related care through this programme, and nearly 500000 orphans and vulnerable children have received support services.

In addition, the embassy's community grants programme helps rural and township community-run projects by strengthening service delivery in communities affected by HIV/Aids, including orphans and vulnerable children, as well as palliative and home healthcare. The programme provided more than R13-million in funding to rural community NGOs in 2009 alone.

Building on the success of Pepfar and other global health programmes, US President Barack Obama has also put forward an ambitious global health initiative which will support co-ordinated interventions aimed at reducing lives lost from a range of other health challenges. Obama's request for Pepfar's fiscal 2011 budget demonstrates the continuing commitment by the US to provide global support to strengthen health systems through sustainable HIV/Aids and TB programmes.

In this phase of Pepfar, the US will support the prevention of new HIV infections in more than 12 million people, provide ongoing HIV treatment for more than four million people with HIV/Aids, and care for more than 12 million people, including five million children and orphans. Besides doubling the number of babies born HIV-free, through US investments in the Global Fund to Fight Aids, Tuberculosis and Malaria, millions more people will benefit from prevention, care and treatment. The US is proud to be the fund's biggest donor, having provided more than $5.1-billion to date. In October 2010, the Obama administration made an unprecedented pledge of $4-billion for 2011-13, representing a 38% increase in US support for the fund.

We are using our money wisely for greater impact. For example, one of the biggest hurdles to a rapid scale-up of treatment used to be the high price of antiretroviral drugs, generally available only as brand drugs for use in the US and other high-income countries. To support the increased availability of safe, effective, low-cost, and generic antiretrovirals, the US Food and Drug Administration is now rapidly reviewing drugs for safety and approving them for purchase under Pepfar. By 2008, generics accounted for almost 90% of the 22 million antiretroviral drug packs purchased, compared to 14.8% of purchases in 2005. That has resulted in an estimated cumulative savings of $323-million, which is helping more drugs reach more people.

Moreover, Pepfar has become more efficient in shipping medicines by water and land instead of air, reducing costs by as much as 90%. In South Africa, the US is also helping with more efficient procurement to leverage lower drug costs. As part of our technical assistance, we were able to provide these life-saving medicines at about half of the cost that the Department of Health was incurring for the same drugs. In a new tender from the ministry, which we anticipate will come soon, we believe the South African government will be able to realise these savings, thus doubling the lives saved for every rand spent.

Of course, the real challenge is prevention. South Africa is taking a global lead in expanding existing prevention programmes, such as male circumcision and a special focus on preventing pre-natal transmission of HIV/Aids between mothers and children. With the help of US co-funding, it is also pursuing research on microbicides for women that can reduce the Aids transmission rate.

Together, the US and South African governments are carefully considering the future of HIV/Aids care. The SA partnership framework is a non-binding agreement between our governments to ensure effective and sustainable care for those affected by HIV/Aids in South Africa. It includes government, development partners, civil society and healthcare providers.

If we are to prevail in this fight, all must come together and contribute their unique strengths. Every country must take the leadership role, including providing resources to the extent of its ability.

On this World Aids Day, we celebrate the lives saved, but we do not have the opportunity to rest on our laurels. We must, together, remain dedicated to building on our recent successes to save even more lives.

I am optimistic that South Africa will turn the tide, due in large part to the commitment of the South African government and the vibrant civil society. However, these gains against HIV/Aids mean nothing unless individuals take responsibility for their actions and sexual behaviour. It doesn't matter how many microbicides are developed, how many condoms are distributed, or how many adverts are aired. Every South African needs to look every other South African in the eye and say: "We, together, must unite to fight this disease."

As President Jacob Zuma says: "Together, we can do more."

• Gips is US ambassador to South Africa