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.
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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
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