Is An AIDS-Free Generation Within Reach?

Jul 3, 2012
Originally published on July 3, 2012 6:06 pm
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More now on the new era of AIDS. Joining us is Ambassador Eric Goosby. He's the head of PEPFAR, the President's Emergency Plan for AIDS Relief. That's the U.S.'s initiative to help HIV-AIDS patients around the globe. Ambassador Goosby, welcome to the program.

ERIC GOOSBY: Thank you.

SIEGEL: And first, is that rather encouraging story that Dick Knox just reported about Haiti, is it typical of what's happening in other developing countries? Is Haiti a successful outlier or around the medium? What would you say?

GOOSBY: I'd say that the HIV-AIDS response and the TB response that often runs concomitant with the HIV epidemic is typical. Haiti with its 135,000 HIV-positive people has about 38- to 40,000 who are on antiretroviral therapy at this time, and I would say that's pretty typical.

SIEGEL: And we would find the same numbers in sub-Saharan Africa, for example, you would think?

GOOSBY: You would find anywhere from 35 percent up to 95 percent in some of the countries like Rwanda and Botswana that have moved rapidly to really almost complete coverage of people below the 350 mark in their CD4 count, which is the trigger to initiate antiretroviral therapy.

SIEGEL: Dick Knox reported on the case of Mr. Francois St. Ker, who is surviving and evidently robust, thanks to his medication. He was at death's door a decade ago. Roughly, how much does it cost for a patient like that to be taking medication, say, for a year?

GOOSBY: The cost really started out at the beginning of PEPFAR in 2003, 2004 at about $1,100 per patient per year. That included drug costs with costs for a physician, a nurse, a patient information system. That total took that $1,100 down to $335 per patient per year, average.

SIEGEL: Well, explain to people who I think have the impression, at least, that an HIV-positive individual in the United States is racking up far higher costs than that. How is it that we can treat someone successfully for $350 a year in Haiti, but not so in this country, or can we?

GOOSBY: Well, it's a combination of lower costs because we went to 98 percent generic drugs. We also, in our sub-Saharan Africa and Haiti programs, bought in bulk, so the unit cost per drug dropped precipitously.

In the United States, you're in a situation where you have 27 different anti-retroviral drugs that can be put together in, you know, really a multiplicity of different combinations, all of which, if they are not generic but brand, are very costly. So the average cost in the United States per patient per year varies from $7,000 to $9,000.

SIEGEL: Isn't the challenge in trying to get people treated early on, early after they've contracted the infection? That, in that case, what you really require to find people who have flu-like symptoms, say, is a primary health care system and that may be a pretty tall order.

GOOSBY: It is a tall order. I think that the likelihood that we are going to be successful at bringing people in very early to infection is low. It's a strategy that we should engage with, but not one that we should depend on. I think that people, as they become more aware of the virus and as testing now is widely available, our ability to bring people in earlier and earlier will get better and better.

SIEGEL: Ambassador Goosby, on the occasion of World AIDS Day last December, President Obama called for an AIDS-free generation, but activists say the administration, in fact, lacks the will to do what it takes to end the epidemic. It's cutting PEPFAR funding, having trouble spending more than a billion dollars that's in the pipeline. Are the resources going to match the president's rhetoric here?

GOOSBY: Well, I would say that, in the time that President Obama's administration has taken over the helm of PEPFAR, we have gone from 1.7 million people on treatment to close to four million people on treatment. Our ability to identify, enter and retain these individuals in treatment programs is mapped out. We know where we're going. We know what groups we have to increase our testing and outreach efforts in, and I am confident we will meet all of the World AIDS Day goals with the current budget setting.

SIEGEL: Ambassador Goosby, thank you very much for talking with us today.

GOOSBY: It's a real pleasure.

SIEGEL: Ambassador Eric Goosby is the head of PEPFAR. That stands for the President's Emergency Plan for AIDS Relief. Transcript provided by NPR, Copyright NPR.