October/November #175 : R.I.P. HIV - by Regan Hofmann

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Table of Contents
 

Features

R.I.P. HIV

From the Editor

Retiring the Ribbon

Feedback

Letters- October/November 2011

The POZ Q+A

High-Impact Prevention

What You Need to Know

Health Care Should Be a Human Right—for All

Too Few Pharma Companies in the Patent Pool

Legislation Proposed to End Criminal HIV Laws

AIDS Is Not an "Automatic Death Sentence"

Geckos Don’t Cure AIDS

We Hear You

The PrEP Debate

What Matters to You

Getting HIV Care Without Getting Deported

Treatment News

A Peek Into the Pipeline

Savvy Survival Strategy

Going Norvir-Free?

Cure Watch

Listen Up

Oh Baby!

Make Some Bones About It

Comfort Zone

Waiting to Inhale

POZ Heroes

Defying Gravity

   
Most Popular Lessons

The HIV Life Cycle

Shingles

Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV


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October / November 2011

R.I.P. HIV

by Regan Hofmann

Thirty years after people first started dying from a then-unknown virus, we face a thrilling tipping point in AIDS history. Leading scientists say the end of the pandemic is possible, maybe even in our lifetime. Now, the question is: How do we seize this moment? Here, we spell out our suggestions for what we need to lay HIV to rest.



Click here to read a digital edition of this article.

In September of 2010, Thomas Frieden, MD, MPH, director of the U.S. Centers for Disease Control and Prevention (CDC), named HIV one of “six winnable battles” the CDC will wage under his command. His claim that AIDS can be beaten may prove prescient.

Global health leaders agree that scientific breakthroughs indicate the end of AIDS could be in sight—possibly in the near future if we strategically apply our resources to capitalize on recent discoveries.

What’s different now? Primarily, new data from U.S.-funded research showing that antiretroviral treatment (ARVs) serves as prevention—in both people living with the virus and those who are not. A recent study known as “HPTN 052” offers evidence that treating people with HIV can lower the risk of viral transmission by a whopping 96 percent. When we put people with HIV on ARVs, we save their lives—and stop the spread of HIV. Several other studies show that when people at risk for HIV take treatment daily (a practice called “PrEP” for “pre-exposure prophylaxis”), or when they take ARVs after potential exposure (a practice known as “PEP” for post-exposure prophylaxis), their chance of contracting the virus is reduced.

The long-waged battle between the treatment and prevention camps is over—treatment is prevention. Bill Gates, one of the most generous funders in the fight against AIDS, has said, “We can’t treat our way out of this epidemic.” Indeed, ultimately, the answer is having a vaccine—and a cure. But while we develop them, it appears the tools already in our possession can begin to end AIDS. Perhaps we can at least partially treat our way out of AIDS after all.

Anthony Fauci, MD, head of the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, said recently in Science: “The fact that treatment of HIV-infected adults is also prevention gives us the wherewithal, even in the absence of an effective vaccine, to begin to control and ultimately end the AIDS pandemic.”

Putting a lot more people with HIV on ARVs is the equivalent of capping the well in a large oil spill. It doesn’t completely solve the problem, but it’s a first—and necessary—step to doing so. Treating people who are living with HIV stops the spread of disease, keeps the world safer and saves billions of American dollars—these facts provide new justification for the cost and effort required to achieve our goals of universal access to care for all who need it. The United Nations’ new goal for universal access is 15 million people by 2015. Currently, only 6 million of the 33.3 million people estimated to be living with HIV globally are on ARVs. Having so few on pills is like trying to clean up an oil spill while the well is still a geyser.

Once, the notion of universal access smacked of giving endless, expensive medications to an eternally growing pool of people who couldn’t afford them themselves and relied on the largesse of governments and pharmaceutical companies to save them. New data suggest that doing the right things today could enable us to get the upper hand on AIDS forever.

The critical question is no longer, “Can we end AIDS?” but “Will we end AIDS?” Will we garner the political and financial capital to do what science suggests we can?

For years, we have tried various approaches to behavioral and non-biomedical prevention, with some success. But, since people continue, and likely always will, to have unprotected sex and share injection drug equipment, incidence of new infection rates is not declining and will never decline unless we stop HIV dead in its tracks. The best way to do that is to provide ARVs to the bulk of people living with HIV who need them. Modeling in several countries shows a direct correlation between increased access to care and decreased rates of new HIV infections.

There are many barriers to care. Drug prices alone are not keeping people from pills. In some nations, political unrest, lack of infrastructure and/or a shortage of medical workers mean that even if governments could afford the pills, the meds still wouldn’t get to the people. In the United States, impending federal budget cuts, inadequate state contributions to Medicaid and recent changes in eligibility requirements for Medicaid, lack of childcare and transportation, homelessness, substance addiction, mental health issues, comorbidities, health disparities, misperceptions and language barriers also present impediments to care.

And of course, fear of stigma, discrimination, homophobia,  criminalization, deportation, physical harm and death undermine HIV care efforts around the world.

While these challenges are daunting, it pays to overcome them. We need to greatly expand our testing efforts and do a much better job of linking people to and retaining them in care. If many more people become aware of their HIV status earlier, and if they access care and lower their viral load to an undetectable level, then they not only improve their own health but they contribute to better public health. Connecting people to medicines before they inadvertently pass along the virus will reduce community, and possibly global, viral loads. This is how the spread of AIDS begins to slow. This is how we cap the well.

Having 27.3 million people with HIV globally (about 1 million of them in America) remain untreated with existing drugs that can save their lives and prevent AIDS from spreading is a humanitarian crime of epic proportion. It’s also no way to stop the AIDS pandemic.

Expanded access to HIV treatment, while a lynchpin in any strategy to end AIDS, will not, by itself, solve the problem. We also need to develop and distribute biomedical prevention tools (like PrEP, PEP and microbicides), scale up male circumcision and continue to distribute more male and female condoms and clean syringes. The question is one of relative proportion. Current levels of resources applied in newly focused and optimally strategic ways to reflect the insight of recent medical breakthroughs will maximize their impact and hasten doomsday for AIDS.

We can make major headway by employing our complete arsenal of tools in a way that ensures we get the biggest bang for our buck. But we can’t get blood from a stone. If we are to end AIDS, we eventually will need more money. And it needs to come from fresh sources. No nation has applied more currency to the fight against AIDS than America. At its peak, the budget for the President’s Emergency Plan for AIDS Relief (PEPFAR) was $48 billion dollars. The United States spends about $19 billion a year to fight AIDS at home. But that’s about to change as our government now faces cutting $1.5 trillion from the federal budget. That’s not a budgeting haircut. That’s a buzz cut.

As budget cuts are made, all discretionary spending and entitlement programs (which comprise the bulk of domestic and global AIDS funding) are at risk. The community of people living with HIV/AIDS and our friends must convince political, economic and global health leaders not to slash AIDS funding. We are up against those fighting for support for other diseases, education, the military’s fight against terrorism, and the dollars needed to keep Social Security secure, to name a few causes. Our cry must be particularly pointed. If we fail to defend AIDS spending, tens of millions of people will perish needlessly in the next decade.

In his opening keynote speech at the International AIDS Conference in Rome, UNAIDS executive director Michel Sidibé called gaps in access to HIV treatment an affront to humanity that can and must be closed by innovations in developing, pricing and delivering treatments and commodities. “History will judge us not by our scientific breakthroughs,” he said, “but how we apply them.”

Ending AIDS won’t be easy, it won’t be cheap, and it won’t happen overnight. But if we develop a smart, sound, strategic plan—one that uses existing resources better and secures new funding from other nations—and if we sell it all the way up the political line to the president himself and across both sides of the Congressional aisle, it can be done.

This Congress and this president have the chance to kill one of the world’s worst killers and in the process save tens of millions of people and billions of dollars. If we rapidly increase access to care, and if infection rates and deaths decline, then the resources needed to fight global AIDS could shrink in as few as five years. And, significantly expanding access to care will make the pharmaceutical companies who make the drugs even richer. I know, I know. But the answer to bankrolling the end of AIDS is not as simple as dropping drug prices. The prices set by for-profit companies are only likely to go down if the volume of drugs sold goes up. And for that to happen, we need to find more guaranteed payers. This is why the rest of the world needs to help come up with the cash to expand access to care for people with HIV.

We have a rare opportunity to rewrite the ending of one of the world’s worst tragedies. We didn’t give up when we didn’t have the answers for what can end AIDS—we certainly shouldn’t now that we do.

The bottom line? If the HIV community can encourage the world to up the antes of international financial and political will, if global advocacy efforts are bolstered and expanded, if we correctly position the arguments for why the world should spend the money to stop AIDS, if we put AIDS back in the spotlight and take it out of its silo, if we utilize existing health care and faith-based infrastructure to deliver care, if we make health care a human right that is equally offered to all, if we protect the human rights of people with HIV, if we put our money where we know it works best, and if these things result in more people getting educated, protected, tested, treated and linked to care, HIV’s days could be  clearly numbered.

With that in mind, POZ outlines seven key areas where we need to focus global efforts if we are to end AIDS, and we suggest specific tactics within each of those areas.

Pages: 1 | 2 | 3 | 4

Search: Washington DC, Thomas Frieden, U.S. Centers for Disease Control and Prevention, CDC, HPTN 052, PEP, PrEP, pre-exposure prophylaxis, post-exposure prophylaxis, Bill Gates, Anthony Fauci, National Institutes of Health, National Institute of Allergy and Infectious Diseases, United Nations, Medicaid, Medicare, stigma, discrimination, homophobia, criminalization, deportation, President?s Emergency Plan for AIDS Relief, PEPFAR, Barack Obama, Office of National AIDS Policy, President's Advisory Council on HIV/AIDS, PACHA, Michelle Obama, Global Health Initiative, GHI, UNAIDS, Affordable Care Act, AIDS Drug Assistance Program, ADAP, Ryan White CARE Act


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  comments 1 - 15 (of 31 total)     next > >>

bettyforacure, , 2012-03-25 15:37:13
Please keep your negative comments to yourself!! I understand for some of you it has been a long and difficult battle, but there are genuine efforts being made by the scientific communities to find at least a 'functional cure' of some sort for those individuals that can access it. We must not give in to self-pity and defeat!! Instead let us pray and uplift the scientific community for moving forward with a possible resolution to this dreadful disease. I refuse to give up or in to this disease!

David McCombs, Toronto, 2012-01-25 23:52:27
Interesting article, but I was diagnosed in 1985 and have seen lots of hope that never happens. The ARVs are not always the gift we are told they are (I am dealing with liver failure right now because of Darunavir). Friends of mine back in the 80s always believed that if a vaccine ever came out, they would leave us Poz folk to just die off. I'm not sure that is not true. It is a nice dream, but I'm sure that I won't be here to see it. Thanks for the article though

legolas613, Nashville TN, 2011-12-02 03:36:18
It sure is a wonderful ambition. However, the reality is it will never happen with a heavy reliance on ARV's. A preventitive and currative vaccine is the only way to a true victory. The ARVs route is too dependent on behaviors & there are always going to be HIV+ persons who will (a) not know their own status, (b) lie to others about their status, (c) many with a barebacking fetish (like me) (d) will become "lost to follow-up" with their Dr. or (e) choose not take take or adhere to ARVs (like me)

jane, Everywhere, world, 2011-12-01 11:08:37
MM-1 created in 1988... today is 12-01-2011. side effect fever or 102 to 103. Tylenol side effect liver failure and which leads to hospitalization and lots of cases death. truvada issentress, novorir, etc side effects, diarea, vomiting, rashes, severe head achs, some allergic reactions etc, and the lost of control for you own life. As long as there is no cure you are out of control.

Jane, , 2011-12-01 11:01:13
They have been writing promising articals for almost a decade now. We want to see a cure not a change. How long does it take to break through plastic. 20yrs? 30yrs maybe? They can and will always offer only some brief artical about how that "may", be a cure insight. Who's sight is the question. Your not born yet children? Or is it their children? What about MM-1? How long has the government supressed this? I know the answer. They will give you radiation for cancer but no a cure for AIDS. SCINCE

Ce, Orlando, 2011-11-30 10:57:47
I will agree witht he rest. Big Pharma is making too much money which means that the elected officials are making just as much. Lets bring stem cell reasearch into the USA and I am betting we can cure manythigns. Yeah they do not want that cause they all go broke. It is capitalism at its best and worse depends on which end of the money your at. Me it is at it's worse . Folks wake up this is all going to as one person said go away whena new money making drug needs ot be to treat another virus!

michael, san francisco, 2011-11-30 10:10:41
Great article, lots of misguided hope. Sadly, it won't happen. Why? Because Pharma holds key patents required to identify and produce a cure for HIV. Further, Pharma is not interested in killing off their global cash cow. It's too profitable for them. If you really want to eraticate HIV you'll have to find a way to take the profit out of it for Pharma. The obvious solution is to kill off (which Congress, Medicare and ADAP Programs are now doing) those infected with HIV. Sorry to burst it.

Elizabeth, Marlborough, 2011-11-30 09:19:42
As soon as the pharmaceutical companies find a more profitable disease, they may drop the cost of drug for HIV/AIDS, they will move their business elsewhere. However, it's a disappointment that so many live and research has been done with not a positive outcome for a cure. At least, they have found some cure certain cancer. I wonder if the pharmaceutical companies have put themselves on our shoes I am positive that the cure be available right away.

Cate, Peterborough ,canada, 2011-11-29 06:57:45
As long as pharmaceutical companies make money from HIV + AIDS there will be know cure. AIDS is a big business. I have been positive for 20 years and have taken all HIV drugs but one. I have laid in the hospital near death a few times. There are no silver bullets here. These statements of control and cure are not those of people living with this disease.

David, New York, 2011-11-27 10:20:15
Re Bone marrow transplant as a cure... Not a realistic option! The procedure kills 1 in 3 patients within the first 100 days, and another 1 in 3 die of long term chronic side effects within 5 years. Would you gamble for a 33 percent chance of total cure vs. 66 percent death?

Rick, West palm beach, 2011-11-10 09:33:58
A great article. Thank You! There are so many institutions which help our cause. I have limited funds, but I want to contribute to finding a cure and a vaccine. To which of these institutions should concentrate my contributions? Does Poz.com have a list of recommended organizations to donate to?

josue, dallas Tx, 2011-11-08 21:08:39
Iam dont like this but until they get tired of make money inventing hundreds of pills maybe wee all get lucky and finale wee ear the CURE is ready because for all those politicians is more important make WAR with every country they decide to keep the business ongoing than make a real effort and end AIDS after 30 years dealing with it

AlexMerida, Merida, 2011-11-02 12:54:39
I totally agree with Rob Careman, but the question is how, wich proyect is closer to a real cure. We can give money to speed up the research....

AlexMerida, Merida, 2011-11-01 13:08:07
Please, we go to do something researcher are doing their part, We have to leave the confort are where many people are (including me) and think that all of us Can meke the cure of HIV possible and soon, please. In Tunez, Egypt, NY, Spain social networks have made history

Jonathan, New Haven, 2011-10-30 20:35:45
we need to fund ADAP and get the 9000 people in the USA off the ARV waiting list. I agree, the battle will not be easy nor cheap, but it is necessary. I am 30, gay and recently HIV pos. We need policy change-sex education, availability of condoms, and education in general. However, I do not agree about increasing male circumcision. I am VERY against this. I am cut and will always be missing a vital part of my natural body that with proper hygiene, does NOT aid in transmitting HIV

comments 1 - 15 (of 31 total)     next > >>

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