已阅读5页,还剩3页未读, 继续免费阅读
版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
July19,2010PreparedRemarksbyBillGates,Co-chairandTrusteeWatchavideoofthespeechThankyou,Vuyiseka,forthatkindintroduction.IalsowanttothankPresidentClintonfortheinspiringmessagehedeliveredthismorning.Itsanhonortospeakwithallofyoutoday.Asyousawinthevideo,theworldhasmadeamazingprogressinthefightagainstHIV.Yetwealsohavetorecognizethatthesearetoughtimesforallofuswhoarepassionateaboutthiscause.Economicturbulencehasdrivenupgovernmentdeficits,andsomecountrieshaverespondedbyfreezingorevenreducingtheirinvestmentsinglobalhealth.Thisisachallengeweallface.Butitdoesnotneedtodefineourtime.Iamheretodaybecause,whenitcomestothefightagainstAIDS,Iamstillanoptimist.Thepast10yearsareatimeofremarkableprogress.Todaymorethan5millionpeoplearereceivingantiretroviraltreatment,upfromfewerthanhalfamillionjustsixyearsago.Since2001,therateofnewHIVinfectionshasfallen17percent.Thoseofyouinthisroomhelpedmakethisprogresspossible.Thescientistsmadeprogressonnewtoolstofightthedisease.Thecommunityworkersandcliniciansdrovepreventioncampaigns.Theadvocatesarguedformorefundingandtheworldrespondedbyaddingmoneyforthiscausefasterthananyotherhealthprobleminhistory.TheGlobalFundhasbeenafantasticvehicleformakingsurethisfundinghelpsthepeoplewhohavethegreatestneed.Allofyoucametogethertoovercomehugeobstacles.Twodecadesago,theskepticssaid:“Wecantmakedrugstotreatavirus.”Butyoupersistedandnowtheycan.Thentheskepticssaid:“Wecanmakethedrugs,butwecantmakethemcheapenough.”Butyoukeptpushingandnowtheydo.Thentheskepticssaid:“Wecanmakethedrugscheaply,butwedontknowwhetherpeoplewillsticktotheregimen.”Butyouinsistedandnowtheyknow.Todaytheskepticslookatthestrugglingeconomyandsay:“WecantbeatAIDSunlesswecantreatmorepeople.Andwecanttreatmorepeoplewithoutmoremoney.Soifwedontraisemoremoneyfortreatment,welllosethefightagainstAIDS.Itshopeless.”Theskepticshaveapoint.Thisisatougheconomicenvironment.Rightnowthereisntenoughmoneytosimplytreatourwayoutofthisepidemic.Ifwekeepspendingourresourcesinexactlythesamewaywedotoday,wewillfallfurtherbehindinourabilitytotreateveryone.ThatswhyIwanttomakethecasetodaythat,evenasweadvocateformorefunding,wecandomoretogetthemostbenefitfromeachdollaroffundingandeveryounceofeffort.Ifyoupushforanewfocusonefficiencyintreatmentandpreventionandalsopushtocreatenewpreventiontools,wecandrivedownthenumberofnewinfectionsdramaticallyandstartwritingthestoryoftheendofAIDS.ScalingupexistingtoolsMalecircumcisionOurfirsttaskistoscaleupthepreventioneffortsthatarecheap,effective,andeasytoapply.Someoftheseespeciallymalecircumcisionandpreventingmother-to-childtransmissionaresocheap,andsoeffective,thatinendemiccountriesitismoreexpensivenottopursuethem.Inasinglemonthlastyear,36,000meninKenyawerecircumcised,atatotalcosttothegovernmentof$1.4million.Ifthesemenhadnotbeencircumcised,andeventuallybecameinfectedwithHIVattheprevailingrateforuncircumcisedmalesinKenya,treatingthemwouldhavecostthegovernmentnearly10timesasmuch.Thatsanastonishingfinancialreturnbutitsnotjustsavingmoney;itssavinglives.Ihavetoadmit:Whenitcomestocircumcision,Iusedtobeoneoftheskeptics.Ithought:“Sure,itreducestransmissionbynearly60percent.Buttheresnowaythatlargenumbersofmenwillsignupforit.”Imgladtosay:Iwaswrong.Whereverthereareclinicsavailable,menarevolunteeringtobecircumcisedinfargreaternumbersthanIeverexpected.Iwouldliketoshowyouashortvideoaboutoneofthem,ayoungmanfromSwaziland.LastDecember,IwenttoSouthAfricatoseeformyselfhowenthusiasticallymenareembracingcircumcision.IvisitedaclinicinthetownshipofOrangeFarmthatservesmorethan750meneverymonth.Imetafewofthem,andtheywereallthrilledaboutgettingcircumcised.Theoneswhohadalreadyundergonetheproceduresaiditmadeiteasierforthemtouseacondom.IalsometasurgeonatirelessyoungwomannamedJosephineOtchere-Darko.Shetoldmeshehadperformed67circumcisionsthatday.Iaskedher,“Whendoyoustop?”Shesaid:“Whenwearedone.”RightinterventionfortherightpopulationMalecircumcisionisanamazingadvanceinprevention.Ifwehadavaccinethatwasaseffective,wewoulddoeverythinginourpowertodeliverittoeverypersonwhocouldbenefitfromit.Anditisreachingmanymenbutnotnearlyenoughofthem.Inthefouryearssincewelearnedaboutitsbenefits,only150,000meninsub-SaharanAfricahavebeencircumcisedoutof41millionwhoneedit.Thatsinexcusable.Countriesneedtomakethisapriorityintheirpoliciesandintheirfunding.Wehavetodoafarbetterjobofscalingupinterventionsthatareproventowork,assoonastheyareproventowork.Wehaveseensimilargapswithotherpreventionefforts,includingcounselingsexworkersandofferingdrugtreatmentandneedleexchangesfordrugusers.Therearemanyreasonsforthesefailures.Forinstance,moreaidfromdonorcountriesneedstoreachthepeopleitsintendedtohelp.Butthereisonereasonthatespeciallydeservesourattention:Manypreventioneffortsarenottargetingthecommunitieswheretransmissionisthehighest.AccordingtotheKnowYourEpidemicreportpublishedthisyearbyUNAIDS,10percentofHIVinfectionsinKenyaareduetosexbetweenmen.Insomecoastalregions,itcouldbeashighas20percent.YetmostdistrictsinKenyahavenopreventionprogramsforthesemen.InRussia,theepidemicisconcentratedamonginjectingdrugusers.Inareaswheretheyreceivedcleanneedles,testing,andotherservices,theinfectionraterose15percentoverfiveyears.Wheretheydidnt,itskyrocketed105percent.Clearly,theseserviceswork.YetRussiahasguttedthemcutthebudgettozeroandshiftedthemoneyintoprogramsforthegeneralpopulation.Why?Theproblemisnotalackofdata.UNAIDScanhelpanyendemiccountryanalyzeinformationtounderstandwhichpopulationsareatthegreatestrisk.Theproblemisthatmanycountriesarenotusingthisdatatomaketheirfundingdecisions.Instead,politiciansaremakingthembasedonfearandstigma.Theydontwanttoassociatethemselveswithpeoplewhoengageinbehaviorthatmakesthemuncomfortable.AsPresidentClintonsaidthismorning,everydollarwastedputsalifeatrisk.Ifyoureafraidtomatchyourpreventioneffortstotherightpopulations,thenyourewastingmoneyandthatcostslives.TreatmentaspreventionThereisoneotherpreventiontechniquewheregreaterefficiencywillmakeabigimpact:antiretroviral(ARV)treatment.WenowknowthatputtingpeopleonARVsmakesthemfarlesslikelytopassthevirusontoothers.Treatmentisprevention.Butthisraisesacrucialquestion:Howcanwegetthemostpreventionbenefitfromthetreatmentwereproviding?WhenyouhaveahigherCD4countandyourviralloadislow,youfeelhealthyandaremoresexuallyactive.AsyourCD4countdrops,yourviralloadspikes,andyoubecomelessactive,butyoumaybemoreinfectious.Whenshouldyoustarttreatment?ArecentstudyinvolvingsevenAfricancountriesfoundanintriguinganswer:PeoplewithCD4countsbelow200weresixtimesmorelikelythanhealthierpeopletotransmitthevirus.Thiswastrueevenafteraccountingforthefactthattheywerelesssexuallyactive.Sowhetheryourgoalistomaximizethepreventivebenefitsoftreatmentortosaveasmanylivesaspossible,youshouldfocusfirstontreatingeveryonewithaCD4countbelow200.ThisgivesusvitalinformationforthefightagainstHIV.Ithelpsusseewhereourtreatmenteffortscanbetargetedsotheymakethebiggestimpactforprevention.Atthesametime,wehavetofaceaharshtruth:Becauseofthevirusslonglatencyperiod,expandingourpreventioneffortswontdrivedownthenumberofdeathsforadecadeormore.Evenasweactnowtopreventfutureinfections,theonlywaytosavemorelivesimmediatelyistoexpandthenumberofpeoplereceivingtreatment.Unfortunately,thecurrenthighcostoftreatmentmeanswecannottreateveryonewhoneedsit.IfyouhaveAIDS,andyougotoahealthclinic,youshouldneverhavetohearsomeonesay:“Imsorry.Youcanthavethedrugsthatwouldsaveyourlife.Wedonthavethemoney.”Whenfundingislimited,therearetwowaystostopturningpeopleawayandstartexpandingtreatment:Youcanreducethecostofthedrugs;oryoucanreducethecostofdeliveringthemtopatients.Thecheapestfirst-linedrugsnowcostlessthan$100peryear.Weneedtokeepworkingtoreducethecostoftheseandothertreatmentdrugs,especiallythemoreeffectiveregimesthatcontaintenofovir.Butunfortunately,noneofthedrugsarelikelytogetalotcheaperinthenextfewyears.Thatleavesoneoptionforexpandingtreatmentnow:drivingdownthecostofdelivery.Weareseeingexcitingevidencethatthisispossible.In2006,PEPFARstudiedanumberofitssitesinBotswanaandreporteddeliverycostsofnearly$1,000perpatientperyear.Twoyearslater,thecostwasdownto$245.InNigeria,itdroppedfrom$2,000to$280areductionofnearly90percent.Someofthesesavingscomefromminimizingpersonnelcosts.Asasiteseesmorepatients,thestaffneedslesstraining.Sometaskscanbeshiftedfromdoctorstonurses,orfromnursestoassistants.Someclinicsalsocutcostsbysimplifyingtheirtestingregimes.TheymayrunfewerCD4countsorchecklessoftenfortoxicity.Todrivedownthecostofdeliveringtreatment,weneedtodoboth:minimizepersonnelcostsandsimplifythetestingregimes.Butthebestpracticesarentbeingmeasuredorshared.Isthereamore-expensivedrugthatactuallysavesmoney,becauseitrequireslessmonitoringorcanbedeliveredbylower-paidstaff?Wedontknow.Weneedtoidentifythemostefficientmodelsandthenmakesureeveryclinicfollowsthem.Ifwecouldlimitthedeliveryandadministrativecoststonomorethantwicethecostofthedrugsthemselves,thenthetotalcostoftreatmentwouldbeabout$300perpatientperyear.Forthesameamountofmoneywespendtoday,wecouldtreatmorethantwiceasmanypeople.ARVtreatmentandmalecircumcisionaretwopowerful,proventoolsforprevention,andweshouldscalethemupasquicklyaspossible.Anothersetofinterventionsthosedesignedtopersuadepeopletochangeriskybehaviorhavehadsuccessincertainregionswithcertainpopulations.Forinstance,ourfoundationsupportseffortsinIndiatoencouragesexworkersandtheirclientstousecondoms,andtheresultshavebeenimpressive.Now,aswescaleupvariousmethodsofbehaviorchangeinAfrica,weneedtomeasuretheirimpactsoweknowwhichonesmakethebiggestdifference.Thepayoffofscalingupexistingtoolscouldbehuge.Ifweidentifythemosteffectivepreventionefforts,andthenexpandaccesstothem,wecanpreventmillionsofdeaths.Thisisgoodnewsbutitisnotgoodenough.Evenifwedideverythingpossiblewiththetoolswehavetoday,themostoptimisticpredictionssuggestthattheywouldonlyreducenewinfectionsbyhalf.Millionsofpeoplewouldcontinuetotransmitthevirus,andwewouldneverhaveenoughmoneytotreateveryonewhoneededit.DevelopingnewtoolsFortunately,thereisnoreasontoassumethatinthefuturewewillbelimitedtofightingHIVwiththetoolswehavetoday.Wecandobetter.Innovationsinbasicscience,diagnostics,computermodeling,andourunderstandingofthevirusitselfwillmakeitpossibletocreatenewweaponsforthefightagainstAIDS,preventevenmoreinfections,andsaveevenmorelives.LetmedescribesomeoftheworkthatImespeciallyexcitedabout.ARV-basedpreventionOnepromisingareaisARV-basedprevention:pills,injections,andgelsthatcontainthedrugsnowusedfortreatment.Fouryearsago,whenMelindaandIspokeattheInternationalAIDSConferenceinToronto,wecalledARV-basedmicrobicides“thenextbigadvanceinthefightagainstHIV.”TheearlytrialresultsofgelsthatdidnotcontainARVingredientsfailed.Butwearestillveryoptimisticaboutthelong-termpotentialofmicrobicidesandotherformsofARV-basedprevention.ThenewgenerationofmicrobicidescurrentlybeingtestedismorelikelytosucceedbecausetheycontainARVs.Theresultsfromthefirstofthesetrials,CAPRISA,willbeannouncedtomorrow.Researchersarealsobuildingonimportantlessonsfromtheearlymicrobicidetrials.Theynowunderstandthatweneedawiderangeofproducts,becausepeoplehaveawiderangeofneeds.Forinstance,somewomencantorwontuseageleveryday.Soresearchersarestudyinglong-actingproductsthatcanbedeliveredbyvaginalringsthatstayinplaceforamonthormore.Efficacytrialsononeringarescheduledtobeginnextyear.Ifitworks,itcouldhelpovercomesomeoftheadherenceproblemsweveseeninearlymicrobicidetrials.Anotherpromisingareaofresearchispre-exposureprophylaxis,orPrEPadailypilloralong-lastinginjection.Thiswouldputthepowerofpreventionintothehandsofwomenwhocantusemicrobicides,andpeopleathighrisk,suchasinjectingdrugusersandmenwhohavesexwithmen.Laterthisyear,researchersinLondonwillbeginanewstudyoftheoraltreatmentdrugrilpivirine,toseeifitcanbeusedasalong-lastinginjectionforPrEP.Whenwegetresultsfromthesestudies,weshouldbereadytoactrightaway.Butrightnow,werenotready.SupposewegotpositiveresultsonanARV-basedpreventiontooltoday.Betweengainingregulatoryapprovals,raisingmoney,trainingthestaff,andotheractivities,usingthenormalapproachwouldlikelytakeatleastsixyearstoscaleitup.Thatisunacceptable.Whentherearepositiveresults,weneedtobereadytolaunchalargecommunitytrialalmostimmediately.Wemadethismistakewithmalecircumcision.IhopewewontmakeitagainwithARV-basedprevention.VaccinesEffectiveARV-basedpreventionwouldbeabigadvance,buttheultimatepreventiontoolwouldbeavaccine.Foryears,somequestionedwhetheritwasevenpossibletopreventacquisitionofHIVwithavaccine.TheresultsfromthetrialinThailandlastyeargaveustheanswer:Itispossible.Weveneverhadthiskindofevidencebefore.ResearchersarenowstudyingtheThaisamplestolookforacorrelateofprotection.Iftheyfoundone,itwouldbeamajorbreakthrough,becauseitwouldhelpusselectthemostpromisingcandidatesforfuturetrials.Thereareotherexcitingdevelopments.Inthepastyear,boththeNIHVaccineResearchCenterandtheInternationalAIDSVaccineInitiativehaveisolatedverypotentantibodiesthatcanneutralizealmosteverystrainofthevirus.Thisisthefirststepinmakingavaccinethatcanstimulatethebodytoproducetheseantibodies.Thesearepromisingideas.Butrightnow,ittakesmuchtoolongtoturnideasintoproducts.Sofar,onlythreevaccineconceptshaveundergoneclinicalefficacytesting.Thefirstwasin2003.ThemostrecentwastheThaitrial,in2009.Inthatspanoftime,nearly17millionpeoplewereinfectedwithHIV.Thatswhyweneedtospeedupthedevelopmentprocessforallnewtools,withoutcompromisingsafetyorthepotentialtogetproductslicensed.Researcherscanhelpbydesigningtrialsthatrequirefewerparticipants,involveearlierreviewsofthedata,andtargetthepopulationswiththehighestincidence.Atthesametime,theagenciesthatregulatetrialscanbemorereceptivetotheseideas,andpharmaceuticalcompaniescandomoretoallowdirectcomparisonsoftheirproducts.SeeingtheImpactVaccines,newdiagnostics,andARV-basedpreventionaresomeofthenewtoolsImexcitedabout.Ofcourse,itsimpossibletoknowwhichofthesemightbreakthrough.Butifwegotjustafewofthem,theimpactwouldbephenomenal.Tounderstandtheimpact,ourfoundationworkedwithresearchersatImperialCollegeinLondon.TheyrancomputermodelsfortwopartsofAfricawheretheepidemiclooksverydifferent.Inbothcases,wefoundthatnewtoolscouldleadtodramaticresults.RuralZimbabweThefirstisruralZimbabwe,wheretheepidemicisgeneralizedacrossalargepartofthepopulation.Wellstartwiththestatusquowhatcouldhappenifwedontdoanymorethanwedotoday.NowIlladdalinetoshowwhatcouldhappenifwescaleupsomeexistinginterventionsthatworkinageneralizedepidemicsuchasmalecircumcision,ARVtreatment,andpreventingmother-to-childtransmission.Asyoucansee,annualnewinfectionscouldbereducedby38percentin2031.Nowletslookatsomenewtools.FirstIlladdARV-basedPrEPandmicrobicides.Thesecouldbringannualnewinfectionsdownbyatotalof53percent.Ifwealsogotapartiallyeffectivevaccineanddeliveredittomostofthepopulation,itcouldcutannualnewinfectionsby90percent.Thesefiguressuggestthatwecouldstopnearly400,000infectionsbetweennowand2031,justinruralZimbabwe.Thatwouldbefantastic.Butthewaywefightageneralizedepidemicisverydifferentfromthewaywefightonethatsconcentratedinaparticularpopulation.Theepidemicisdifferent,soyouneedtoapplythetoolsindifferentways.Thisraisesaquestion:Canwemakeasmuchprogressinplaceswheretheepidemicisconcentrated?UrbanBeninTofindout,letslookaturbanBenin,wheretheepidemicisconcentratedamongsexworkersandtheirclients.AgainIllstartwithwhatcouldhappenifwedontdoanythingnew.NextIlladdafewexistingtoolsthataretargetedforthispopulation,suchaspromotingcondomsamongsexworkers.Scalingtheseupcouldcutannualnewinfectionsby46percentin2031.NowletsseewhathappensifweaddPrEPandmicrobicidesdeliveredtomostsexworkersinthearea.Thatcouldcutannualnewtransmissionsbyatotalof64percent.Finally,letsaddapartiallyeffectivevaccinethatsdeliveredtoa
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 2024年江西省赣州市南康区小升初总复习语文测试卷含答案
- 2024年河北省邯郸市开发区爆台寺实验小学小升初总复习语文测试卷含答案
- 2024年朔州市平鲁区六年级下学期小升初招生语文试卷含答案
- 专利许可合同8篇
- 待岗协议书7篇 待岗协议书7篇怎么写
- 离婚协议满意度双方对协议满意程度
- 离婚协议书填写技巧和范例
- 离婚协议履行协议的履行过程
- 离婚协议的法律保障
- 2024年公共事业技能鉴定考试-商品营业员笔试参考题库含答案
- 乳化沥青(乳化沥青常规项目检测)
- 动力电池充电系统设计
- 《工程流体力学基础教程》课后参考答案 王雁冰
- 二氧化碳气瓶内残液处理操作规程
- 传统体育养生
- 规范的公司治理结构-董事会领导下的总经理负责制
- 蔬菜配送服务标书
- 数据挖掘基础及其应用PPT全套完整教学课件
- 室间质评不合格原因分析及纠正措施表
- 跟我学礼仪(黑龙江农业工程职业学院)【智慧树知到】章节答案
- 新时代创业思维知到章节答案智慧树2023年东北大学秦皇岛分校
评论
0/150
提交评论