US secretary of state Hillary Clinton pledged at first international Aids conference in America for two decades that the Obama administration would do whatever it takes to end the HIV epidemic.
"I'm here to make it absolutely clear that the US is committed and will remain committed to achieving an Aids-free generation. We will not back off and we will not back down. We will fight for the resources necessary to achieve this historic milestone," she told a packed plenary session of the 25,000 delegate-strong conference in Washington, DC.
Clinton said she had commissioned Dr Eric Goosby, America's global Aids co-ordinator, to produce a blueprint for the way ahead. Scientists and experts at the conference say that scaling up the rollout of Aids drugs to all the 15 million people who need them can not only keep people alive but reduce the chances they will infect others, slowing the spread of the virus.
Other prevention efforts – and maybe eventually a vaccine – could reduce transmission to the point where the epidemic is effectively at an end.
Clinton announced new money for several initiatives, including $40m for South Africa's plans to provide voluntary male circumcision for almost half a million young men and boys in the coming year. Studies have shown circumcision reduces men's chances of infection.
There will also be an investment of $80 million to support innovative approaches to ensure HIV positive pregnant women get the treatment they need, which will prevent their babies being born with the virus.
Clinton said she was particularly concerned to highlight the plight of women. "In sub-Saharan Africa, women account for 60% of those living with HIV, and they want access to adequate healthcare. We want to answer their call," she said.
These women – and all women – should have access to contraception so they can decide for themselves whether to have any or more children, said Clinton, applauding the recent family planning conference in London, which drew attention to their needs and raised $2.6bn to provide contraception for 120 million women and girls.
"Every woman should be able to decide when and whether to have children. This is true whether she is HIV-positive or not," she told the conference. "There should be no controversy about this. None at all."
But she also spoke of the need to help sex workers and people who use injecting drugs – groups who have not been allowed to have visas to enter the United States, triggering demonstrations and protests at the conference. Sex workers are holding their own conference in Kolkata instead, which has been given "hub" status by the International Aids Society, which organised the Washington event.
Clinton avoided any mention of their exclusion from America, but told the conference it was vital that their needs be addressed. Over the years she had experienced how difficult it can be to talk about a disease that is transmitted through sex and drugs, she said. "We can't afford to avoid sensitive conversations and we can't fail to reach those who are at highest risk," she said.
"When key groups are marginalised, the virus spreads rapidly within these groups and also into the lower-risk general population, We are seeing this happen right now in eastern Europe and south-east Asia. Humans might discriminate, but viruses do not," she said.
Clinton announced more money for three initiatives to help marginalised groups – $15m to identify the most effective interventions, a $20m challenge fund to support country-led initiatives and $2m to bolster the efforts of civil society groups to reach key populations.
While Clinton was enthusiastically received by most of her audience, she had at first to speak over noisy protesters, demonstrating against a US trade agreement with Pacific countries that they say will restrict the production and availability of cheap generic Aids drugs.
Médecins Sans Frontières later said in a statement that it applauded the US commitment to fighting Aids, "but we also need the US to pledge to do no harm with its trade policies".
The organisation of volunteer doctors also said more money is needed. "All donors need to reverse their flat funding for global HIV/Aids so we can speed up scale-up and reach the one in two people in urgent need to treatment that still do not have access."
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