At last month's International AIDS Conference, the big topic was “The End of AIDS.” But is the end of AIDS a close reality, or wishful thinking?
The last time that the AIDS Conference happened on American soil was 22 years ago, at the height of the epidemic. In the early 1990s, an HIV diagnosis was a death sentence.
When HIV/AIDS exploded into an epidemic, it spread rapidly and there were few treatments. In 1990, when the conference was held in San Francisco, there were almost 19,000 deaths from AIDS.
Now the picture is much different. Antiretroviral therapy (ART), introduced in the mid-90s, has made it possible for people diagnosed with HIV to lead a long and relatively healthy life.
Research and awareness about HIV and AIDS has come a long way. Scientists and doctors have made huge strides improving care and outreach, and working towards a vaccine and cure.
But there is still a big gap between the progress that's been made and people around the world who have been infected or are at risk of being infected with AIDS. In the US alone, there are 50,000 new infections each year.
Today, an estimated 34 million people are living with HIV. The epicenter of the epidemic has shifted to Sub-Saharan Africa, where 69 percent of new infections occur.
In a report titled “Together We Will End AIDS,” the international organization UNAIDS announced that deaths from AIDS are have dropped from 1.8 million in 2010 to 1.7 million in 2011.
The UNAIDS report was released in advance of the International AIDS Conference. At the conference, high-profile attendees expressed optimism and hope that AIDS will soon go the way of smallpox.
But what will it take to rid the world of AIDS?
“Turning The Tide Together”
This was the theme of the 19th annual International AIDS Conference. It was back in the US since President Barack Obama lifted long-standing restrictions on HIV-positive visitors entering the country.
Nearly 20,000 delegates attended, from healthcare workers to political stars to celebrities like Elton John.
Hilary Clinton, the US Secretary of State, spoke early in the conference about the goal of creating an “AIDS-free generation.” She defined it in her speech: “It is a time when, first of all, virtually no child anywhere will be born with the virus. Secondly, as children and teenagers become adults, they will be at significantly lower risk of ever becoming infected than they would be today no matter where they are living.”
“And third, if someone does acquire HIV, they will have access to treatment that helps prevent them from developing AIDS and passing the virus on to others.”
Secretary Clinton announced that the US will contribute tens of millions of dollars to this goal. "We will not back off; we will not back down. We will fight for the resources to achieve this historic milestone,” she said.
Another high-profile speaker was Michael Sidibe, the executive director of UNAIDS. He said that so much progress has been made towards creating effective treatments and increasing access, but that's not enough.
"Today we should not just say, 'okay, let us have treatment.' We should say, 'why not a cure? Why not a vaccine?' That is the area where we need to put our energy, and that will bring us certainly to the end of this epidemic," he said.
Discussing the end of the conference on PBS Newshour, reporter John Donnelly of GlobalPost said that the meeting felt like “sort of a giant pep rally” for the end of AIDS. He said that scientific advancements have created a lot of hope.
John Cohen of Science magazine, also speaking on Newshour, worried that there's now a huge expectation to meet.
“So now the question is: can you really deliver on that promise? .... But the reality is the aspirations and the reality on-the-ground have a huge gap between them,” he said.
Over a million people in the US are living with HIV, and it's estimated that 1 out of every 5 HIV-positive individuals do not know that they are infected.
The group that does not know their positive status are inadvertently responsible for transmitting the virus through their communities. Outreach programs to increase HIV testing in high-risk communities, and provide follow-up treatment and support, have aimed to reduce the numbers of infections.
Increasing access to antiretroviral therapy (ART) – HIV-fighting medicines – have also done their part to reduce infection. When people are on ART, the virus is less likely to infect someone else.
That's because the virus is more likely to be suppressed, or at very low levels in their bodies. That's good news for sexual partners, as well as the newborn children of HIV-positive mothers.
But still, access to these life-prolonging medications does not mean that every patient has their virus under control. In fact, the Centers for Disease Control and Prevention reported that only 28 percent of HIV-infected Americans have suppressed HIV.
An emerging issue is drug-resistant HIV, which has appeared partially as a result of patients going on and off their medications, then transmitting a strain of the virus that does not respond to the first line of treatment.
Meanwhile, people are still dying of AIDS – in the US, the number is 16,000 each year.
Progress Towards a Vaccine and a Cure
The term “AIDS-free generation” recognizes that HIV and AIDS will be with us for many decades, as those who have been infected age and continue to require treatment.
But the holy grail for researchers is a vaccine that will prevent entire generations from being infected. It's proven to be a challenging quest, one that has already taken thirty years.
There have been a number of trials and research “breakthroughs.” The most successful trial only protected against 30 percent of infections.
Breakthroughs remain on the basic research level. Scientists are learning more about the structure and behavior of HIV, in order to identify weaknesses that vaccines may be able to target.
Meanwhile, plenty of attention this year has gone to the first patient to be “cured” of HIV, called the “Berlin patient.” This man had a bone marrow transplant for another health condition, and the donor had a genetic resistance against HIV.
There's an active debate about whether the man is fully cured, but tests have shown either extremely low levels of HIV or no HIV in his system at all. He no longer takes medication for HIV.
The treatment he went through is far too expensive and difficult to scale up. But it does give hope that, someday, HIV can disappear from infected bodies.
Your Role in Ending AIDS
Bringing about the “end of AIDS” requires an international collaboration, along with research, money and time. But there are steps that individuals can take to help and support the cause.
First, get tested. Easy and quick HIV tests are available for free in most areas, often with results delivered within the hour.
It's also possible to volunteer your time working with local HIV/AIDS organizations. Another option is to donate money to support programs and outreach, on the local, national or international level.