Ambassador-at-Large Deborah Birx serves as the U.S. Global AIDS Coordinator and U.S. special representative for Global Health Diplomacy. In a recent conversation with the George W. Bush Institute’s podcast, The Strategerist, she shared how U.S. dollars have helped save millions of lives in Africa through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Go Further partnership to end AIDS and cervical cancer.
In her conversation with Strategerist host Andrew Kaufmann and Bush Institute Executive Director Holly Kuzmich, which has been edited for length and clarity, she explains why the United States should keep its commitment to fighting and preventing HIV/AIDS.
Question: Where did your passion for eradicating HIV and AIDS start to form?
Birx: I got a call in 1982 about young soldiers dying at Walter Reed from a mysterious immune dysfunction. We didn’t know that it was HIV until 1985. From 1982 to 1985, I worked side by side with the infectious disease team. We tried to save these soldiers and couldn’t.
When you’re trained in medicine and you’ve got all this high-tech stuff, when you can’t make a diagnosis, when you don’t know what the problem is, and when you don’t know how to treat it, it’s devastating. It was incredibly humbling.
They died with such courage and such willingness to try different things, realizing it may not help them but it would help the person behind them. I just never saw that level of altruism in the midst of death and despair.
For the last 30-some years, I’ve been focused on saving lives but also changing the very course of the epidemic so the world could be imagined as AIDS-free.
Q: Let’s talk about PEPFAR and the progress made over the last 16 years.
Birx: It was like a moonshot. When President (George W.) Bush announced this program, it was this unbelievable translation of what America stands for. We will take our best and brightest, and everything that we know, and use that to change the future for others.
Being able to translate U.S. taxpayer dollars through this initiative has been the most extraordinary piece of work. And it was never about the money. It was about bringing the best science to the people who need it the most around the globe.
President Bush wanted results that have impact. The results had to be comprehensive, and they had to have the people that we were serving at the center (of our work). We’ve kept to those core values and that’s why we’ve made remarkable progress.
Q: What is that progress? How many lives have been saved?
Birx: It’s approaching 20 million. People see the lives saved, but so much government bureaucracy had to be cut through to make this program successful. This a great lesson to the rest of the government. You can make things different if there’s a motivation to make things different. Of course, when you’re saving lives, nothing could be more motivating than that.
Q: Why is it important that we still invest in PEPFAR?
Birx: We are in 54 countries. We always ask, why are some countries successful and others not as successful?
It’s very interesting, the African countries approaching middle-income status or which are firmly middle income are contributing about 50 percent to 60 percent of the response out of their own funds. The ministers of finance can see the business case of why investment is important.
And then there are countries that continue to have an epidemic — or an expanding one — that also have a youth bulge. When you see that we have more than twice as many 15- to 24-year olds as we did when the epidemic started 30 years ago, you realize you have to equally do prevention.
That’s been core to PEPFAR (since) the beginning — there was a large prevention intervention, and a treatment intervention and we’ve stayed very much to those values.
We can see the roadmap to success and we see the ever-increasing host country contribution in fiscal and human capacity and infrastructure.
We now have an evidence base in several (African) countries that we believe will have control of their pandemic by 2020.
That gives every country hope. If these countries can do it, any country can.
Q: Women who are HIV positive are four to five times more likely to get cervical cancer. Through PEPFAR a big investment in cervical cancer has been made in Sub-Saharan Africa. How is that work going?
Birx: That has been a really important piece of our work. We are working to ensure that every HIV-positive woman is screened (for cervical cancer). In the first year of the new partnership, we screened over half a million HIV-positive women for cervical cancer and treated thousands of women for pre-invasive cancerous legions.