1. Towards an AIDS-Free Generation Women & Girls and HIV in PEPFAR
Opening:
Thank you for that gracious introduction.
I am pleased to be here today with all of you as we begin what I hope will be a productive three days together.
I want to thank Ambassador Gaspard, Counselors General Taylor Ruggles and Erica Barks Ruggles, DCM Virginia Palmer, PEPFAR Coordinator James Maloney and the entire South African PEPFAR Country Team for their incredible hospitality. I know this meeting was delayed, but I am delighted that we’re all here!!
My goal for this meeting is to begin a dialogue that continues throughout my tenure as Global AIDS Coordinator….31 months and 19 days…but who is counting?!
Ambassador Deborah Birx
Global AIDS Coordinator
US Department of State
September 9, 2014

2. History of the Epidemic & Response1
Where We Were:
This morning, I’d like to talk about the history of our response to the epidemic (which we touched on a bit in some of the agency meetings yesterday) and the challenges and opportunities as we move toward an AIDS Free generation…. and then share some thoughts about my vision for PEPFAR.
Like some of you in this room, I’ve been on the frontlines of the fight against HIV/AIDS since the early days of the epidemic—when I was treating young soldiers at Walter Reed Army Hospital who had an illness we didn’t have a name for at the time. Being on the frontlines has its highs and lows.
In the U.S., we managed our way through the first decade of AIDS without effective treatment as we struggled to contain the spread of the disease in our own communities.
After more than a decade of tireless work by scientists, activists and people from all walks of life working together to provide prevention, care and treatment we forged our way to the advent of the lifesaving medicines that changed the course of the disease in America and other countries around the world that could afford the cost of care.
At the same time, we were facing the enormity of the AIDS crisis as it raced around the globe and wrought then untold devastation on Africa and much of the developing world. Facing the stark reality of death and despair faced by those in the wake of this disease citizens around the world had to make a choice—the same choice faced by countless individuals and communities before us—to either rally or be overwhelmed.
History of the Epidemic & Response
Celebrating success and a call to action

3. Where we were before PEPFAR…
1991 – 2001:
Peak
of the
Pandemic
2001: Nearly 10,000 new HIV infections daily
2002: 50,000 on treatment in sub-Saharan Africa
Health systems overwhelmed by the epidemic
Life expectancy declines of over 20 years in some countries
Loss of working age population – reversing decades of development progress

4. Delivering an AIDS-Free Generation
Unwavering Leadership from Congress Demonstrated Commitment to Ending the AIDS Pandemic
2003
US Leadership Against AIDS, TB, & Malaria Act
2008
Hyde-Lantos Reauthorization of PEPFAR
2013
PEPFAR Stewardship & Accountability Act
Delivering an AIDS-Free Generation
Accountability
Transparency
Impact

5. Trends in New HIV Infections, 1990-2013
PEPFAR Has Saved Millions of Lives New Infections Halved since Peak of Epidemic
Trends in New HIV Infections,
But we can’t become complacent now. The road ahead to an AIDS-free generation remains long….. and complicated. And all of you know that because you’re paving the road!

6. 2
Leaving no one behind
Women face disproportionally high burden of HIV/AIDS

7. Key Populations Face a Significantly Higher Risk of Acquiring HIV/AIDS
Young women
Sex work
People who inject drugs
Men who have sex with men
Transgender
Migrants
Prisoners
Displaced
Pregnant women
50+
Disabled
African American women
Intimate partners
Young women in Sub-Saharan Africa are by far the largest group with a disparately high risk of acquiring HIV
Source: UNAIDS, 2014

8. New HIV Infections in Sub-Saharan Africa by Age & Sex, 2013
Disparately High HIV Prevalence among Young Women Compared to Young Men
New HIV Infections in Sub-Saharan Africa by Age & Sex, 2013
Source: UNAIDS 2014

9. HIV Leading Cause of Death among Adolescent Girls in SSA
In Eastern and Southern Africa, HIV is the leading cause of death in girls aged 15-19
16.9
Source: Global Burden of Disease 2010

10. PEPFAR: Improving Outcomes for Women & Girls3
PEPFAR: Improving Outcomes for Women & Girls

11. Women & Girls on Lifesaving Treatment

12. ACT: Accelerating Children’s HIV/AIDS Treatment
PEPFAR & CIFF
(the Children’s Investment Fund Foundation)
launched a
public-private partnership
to keep
Children & Adolescents
alive and healthy
This $200 million initiative aims to double the number of children on treatment in at least 10 countries in sub-Saharan Africa
With this initiative, we could avert an additional 250,000 HIV-related deaths of children under the age of five
Additional HIV-related deaths will be averted in the 5-15 year old age group.

13. 800 mothers die attributable to HIV Maternal Deaths & HIV 18%
Maternal mortality ratio, 2010
Every day
800 mothers die
due to pregnancy & childbirth
WHO estimates that
18%
of all maternal deaths are
attributable to HIV
People Living with HIV by Region, 2011
Source: WHO, 2011/2012

14. PMTCT: HIV Testing for Pregnant Women
Over half of HIV+ pregnant women in the world are tested and identified with PEPFAR support
6.9%

15. PMTCT: Getting Lifesaving ART to HIV+ Pregnant Women to Protect Maternal & Infant Health
In 2013, 56% of women received lifelong ART, up from 23% in 2011.

16. Saving Mothers Giving Life An Innovative Public-Private Partnership
SMGL is bringing together key partners…
To address the 3 delays that contribute to maternal mortality:
Delay in decision to seek care
Delay in reaching care
Delay in receiving quality health care
Approximately half of all women in sub-Saharan Africa deliver at home without skilled care and timely access to emergency services; this puts them and their newborns at increased risk of dying from pregnancy-related complications should they arise.
Saving Mothers, Giving Life focuses on reducing maternal deaths when these emergencies occur, by addressing the three delays:
-Delays in deciding to seek appropriate care
-Delays in reaching care
-Delays in receiving timely, quality care at the facility
The partnership works to address these issues in a number of ways:
--Raising awareness and mobilizing communities to encourage more women to seek facility births.
--Facilitating access to facilities, through enhanced communications, transportation and referral networks.
--Improving quality of care through supporting the training of health providers, community midwives and other health workers, by improving facility infrastructure, and by procuring needed supplies.

17. SMGL Outcomes Evaluation January 9, 2014
SMGL Phase 1 Results: Institutional Maternal Mortality Declined in both Uganda & Zambia
- 35%
- 35%
- 36%
- 35%
Percentage declines noted are statistically significant

18. significantly higher risk
Pink Ribbon Red Ribbon Public-Private Partnership to Combat HIV & Cervical and Breast Cancers in Africa
HIV-infected women
have a
significantly higher risk
of acquiring
cervical cancer
Cervical cancer – one of most common cancers among women in developing world
275,000 deaths each year
>85% global burden in developing countries
$85 million over 5 years currently committed
Zambia and Botswana are initial PRRR countries
Major expansion of “screen and treat” programs
Pilot programs for HPV vaccination
Training for breast cancer awareness and CBE
Founding PRRR members include:
PEPFAR
The George W. Bush Institute
Susan G. Komen for the Cure
UNAIDS
Multiple private sector partners

19. PEPFAR Gender Strategy
in the past four years, PEPFAR reached over 114,000 survivors of sexual violence with post-exposure prophylaxis to prevent HIV
Increasing gender equity in HIV/AIDS programs and services, including reproductive health services
Preventing and responding to gender-based violence
Engaging men and boys to address norms and behaviors around masculinity and sexuality
Increasing gender-related policies and laws that increase legal protection
Increasing gender equitable access to income and productive resources, including education

20. Mitigation as Prevention: OVC Programs
Impacts of social protection on girls’ past-year incidence of transactional sex

21. Together for Girls A Unique Public-Private Partnership
Daniela starts here

22. Our work is not done. This week alone…
Over 3600 children died this week from HIV
Over 25,000 adults died this week from HIV
Over 4,600 babies were infected with HIV
Over 36,500 adults were infected of which more than 7000 were young women

23. As I reflect on my new role as Global AIDS Coordinator, I am humbled to play my small part in the worldwide effort to bring and end to AIDS as we know it.
I cannot emphasize enough that we are all in this together. That’s why coordination and collaboration is so important. Each and every one of us is doing our part in delivering an AIDS-free generation through impact, transparency and accountability.
And each and every one of us is making a difference in the lives of others. That’s a pretty remarkable feat. A feat, which should make us all proud. …….
Again, thank you for all of your hard work and thank you for your continued commitment to PEPFAR’s promise. The next few days will give us an opportunity for open dialogue about how we move forward together—the interagency, donors, multilateral organizations, civil society, people living with and affected by HIV, indigenous organizations, and host-country governments. We all have a critical role to play. The responsibility and success of PEPFAR is dependent on all of us.
I look forward to answering your questions.