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Goosby is Documented@Davos Transcript Documented@Davos 2012 RANDI ZUCKERBERG: Thanks for joining us on documented@Davos from the World Economic Forum. My name is Randi Zuckerberg, and I'm very excited to be sitting here with Ambassador Eric Goosby, US Global AIDS Coordinator. Thank you so much for joining. ERIC GOOSBY: Pleasure. RANDI ZUCKERBERG: Now this is your first year here in Davos. What are you most excited about? ERIC GOOSBY: Well, I'm excited about being able to participate in dialogues that can help us support an intensification effort in preventing mother to child transmission of HIV. We're really focused on eliminating pediatric AIDS, and really see that within our reach within the next couple or three years. RANDI ZUCKERBERG: And especially as one of the core millennium development goals, it seems to be very top of mind for a lot of people here in Davos. What are some of the successes that we've seen in reducing mother to child transmission of HIV? ERIC GOOSBY: Well, interestingly, we have been in a position to understand the power of using antiretroviral drugs in preventing transmission since 1993. That was the first time studies showed that you would change the likelihood that a HIV positive pregnant woman would result in an HIV positive child. The ratio is about one to four. It's about a 27% chance in a HIV positive woman not antiretroviral drugs to have an HIV positive baby. The use of antiretroviral drugs drops it down from 27% down to less than 2%. So you pretty much eliminate it. So we've known how to do that. We've gotten very good at it and have really focused on the 22 countries on the planet that make up about 90% of your pediatric HIV. They're all in sub-Saharan Africa. And PEPFAR, the President's Emergency Plan For AIDS Relief, has focused on this for the last seven years. And we're so close now that we're trying to turn the volume up, bring in all the support we can get from both partner country governments, but also private sector, business, to try to get that last 390,000 kids per year born-- RANDI ZUCKERBERG: It is truly starting to feel like an achievable goal, to eliminate the transmission. Now you mentioned partnerships as being a huge reason of why you're here and what's needed for that final umph. It seems that Davos is really a

perfect place because its a gathering of public, private, government sector all coming together. ERIC GOOSBY: Well, that's our thinking too. And we hope that we'll be able to energize individuals who are involved in activities that would not feature a focus on preventing transmission to fetuses, babies. But the ability to identify, enter, and retain women in care over the duration of their pregnancy can be enhanced by people who know how to use market tools, how to use market tools to be repetitive to get repetitive behavior. And we're very excited about the partnership that we're creating with this. RANDI ZUCKERBERG: Now what do you think are some of the biggest challenges facing and reaching this goal? ERIC GOOSBY: Well, I think the biggest challenge is reaching women who are in rural areas who normally do not go for prenatal care. And when they deliver, do not deliver in a health facility, but deliver at home. Unfortunately, for the majority of the people we deal with in sub-Saharan Africa, that's the norm. It's the exception that women come into a medical delivery system in most of the countries we're in. Some countries they do. But the ability to identify that woman, test her for HIV, stage her for active disease versus latent disease, and decide if you are dealing with someone who has also another infection from, like tuberculosis. Treat that first, then start the antiretroviral drugs, and follow her over the gestation of the baby for the nine month period on the antiretroviral drugs. Once born, continue to follow them through breast feeding. If they're HIV positive, the mother's already HIV positive, she needs to be referred into care for the rest of her life, a setting that will continue to give her the antiretroviral drugs and monitor her. And if the baby's HIV positive, we need to do the same for them. So it's a chronic, progressive disease that requires a medical delivery system that can respond to the totality of those needs over the duration of their life. And that's a hard thing to do in countries where continuity care, outpatient care, is not the norm. In most of the countries we work in, the medical delivery systems are set up for acute care medicine. When you have a problem, you go to the doctor, you go to the emergency room, or you go to the clinic. But not for health care maintenance, kind of preventative work. And when you're feeling OK, and when you're not sick-- and pregnancy kind of falls into that category, where it's a normal function-- people don't use medical delivery systems. So it's been a tough lift to get the individual, identify them, and retain them in care.

RANDI ZUCKERBERG: Well, technology is on the minds of a lot of people here in Davos. Social media and technology, it seems to be quite a hot topic. What do you see the role of that in the initiatives you're doing? ERIC GOOSBY: Well, that was the carrot and the thought. Could we use cell phone media in particular, but also social networks, to enhance our ability to identify, enter, and retain the women in care and create a cadre of HIV positive pregnant women post-delivery who will continue to nurture and enhance their voice, to speak to government, to really demand and insist on services? Without that honest dialogue between those who use the services and the government, inevitably, you see governments get interested in other hot topics and move away from an area of need. That voice keeps governments focused on a continuous need. And HIV, unfortunately, will be a continuous need that they'll have to focus on for the rest of their life. So we're hopeful that the social network tools will really afford an opportunity for us to develop that cadre of natural leaders, let the information move. But also, kind of aggregate, concentrate, a voice that says, this isn't OK. Or this is OK, we want more of it. RANDI ZUCKERBERG: It definitely seems like social media amplifying this could help with that final push that's needed. ERIC GOOSBY: I think we're going to need it to do it. RANDI ZUCKERBERG: Well, thank you so much for joining us. You're doing amazing work. It's exciting to think that this could just be a few years away. So thank you for being here. Please follow the rest of our footage, scribd.com/documentedatdavos, or Twitter #davosdocs. Great. Thank you. It's really--