Vienna – Bill Gates told a packed audience at IAS 2010 that his Foundation is committed to AIDS for the long haul, while highlighting the need to maximize resources by scaling up the prevention strategies we can count on; male circumcision, prevention of mother to child transmission (PMTCT) and HIV treatment as prevention.
Gates characterized PMTCT and male circumcision as interventions that are more expensive not to do, noting that the $1.4 million spent in Kenya to circumcise 36,000 men would translate into a treatment cost ten times as much if those men became HIV infected. He called the 45 percent coverage of PMTCT a “disgrace” given the low cost of the intervention and the human cost of HIV-infected children. He also challenged the audience to press for interventions targeted to populations most at risk including MSM, injection drug users and commercial sex workers. He worried that some countries are not targeting their prevention funds because of stigma and offered Russia’s shifting of resources from drug users to the general population as a decision that “wastes money which costs lives.”
Notably, Gates highlighted antiretroviral therapy (ART) as prevention and suggested it was especially important to ensure treatment of individuals who have CD4 counts less than 200, because their higher viral load makes them more likely to transmit the virus to others. Underscoring the need to maximize treatment resources, he said simplifying treatment and minimizing personnel costs was imperative and was more likely than decreases in drug costs.
Referring to soon-to-be-released clinical trial data on microbicides and a partially effective vaccine trial last year, Gates expressed optimism about the evolving tools to fight the epidemic. He cited a modeling study showing that implementing current evidence-based prevention tools could reduce HIV incidence by 38 percent. Moreover, the addition of pre-exposure prophylaxis (PrEP) and a partially effective vaccine could trigger a 90 percent reduction in cases of HIV infection.
Acknowledging that fighting AIDS was a huge challenge, Gates noted that HIV was likely to remain the largest part of the Bill & Melinda Gates Foundation’s global health portfolio for another decade, ensuring the audience of his continuing commitment to the cause.