If all goes according to plan — the plan President Obama laid out on Thursday — the HIV pandemic may reach an important tipping point by the end of 2013.
"We believe that with 2 million more people in treatment, we will reach a point where the number of new infections is less than the number going into treatment," says Dr. Eric Goosby.
Goosby, who holds ambassadorial rank, is the Obama administration's Global AIDS Coordinator. He appeared Friday at a Harvard School of Public Health symposium in Boston.
He's arguably the most important figure in the newly reinvigorated fight against HIV. It's his job to get 2 million more people in treatment with antiretroviral drugs within the next two years, bringing the total to 6 million.
Goosby says it's possible because "we have gotten really good at reducing the costs" of HIV treatment.
In 2005, it cost almost $1,200 a year to provide antiretroviral treatment to a person in the developing world, including not only the drugs but testing, counseling and personnel. Now, Goosby says, the price tag is $335 per patient per year.
"We're as low as $85 per patient per year in some countries," Goosby says. "And we believe we can reduce costs further in all sites for probably another two years."
That's how Obama and his team think they can get 2 million more people into treatment — a 53 percent increase over the current level — without an increase in funding. Of course, at a minimum, it will require Congress to sustain funding for the President's Emergency Plan for AIDS Relief, or PEPFAR.
Goosby, who spoke at a session about ending pediatric AIDS, says HIV-infected pregnant women will "absolutely" be targeted in the new push to increase those under treatment.
He thinks that 85 percent of HIV-positive pregnant women can be recruited into treatment with an aggressive new effort. "To get that last 15 percent — it's very difficult to say we have effective strategies," Goosby says.
Part of the reason is the stigma that HIV infection still carries in sub-Saharan Africa where 80 percent of infected pregnant women reside. "We have to get a woman past that barrier — in herself, her family and her community — to get her into care during the rest of her pregnancy and for the rest of her life," Goosby says.
A coalition of groups to tackle the problem will soon appeal to well-off donor nations for additional funds. "We need to challenge donor countries," he says. "Saying that it's not your problem, it's somebody else's problem, is no longer acceptable."
As for the recent pullback by the Global Fund to Fight AIDS, TB and Malaria, which last month canceled its next round of funding, Goosby says, "I do not see this as a doom-and-gloom moment at all."
Rather, he sees it as an opportunity to restructure the Global Fund to translate donations into programs-on-the-ground faster and coordinate efforts better with PEPFAR and other donors.
It's an optimistic view, for sure. But it reflects a new belief throughout the AIDS community that there's an opportunity to leave behind those days when it seemed there was no end in sight to the increase in new HIV cases.