Wednesday, December 1, 2010 marks the 22nd annual World AIDS Day. Started in 1988, many healthcare centers, universities, and advocacy groups hold events, charity auctions, and memorial services to bring awareness and attention to the HIV/AIDS epidemic, and to encourage the public to get tested and get involved in learning about what they can do to stop the spread of the disease.
In light of the day of awareness, it would be worthwhile to ask “Where do we stand?” regarding HIV/AIDS? Is medicine making progress towards a vaccine? Maybe a cure? Have the decades of education and prevention efforts worked?
The answers are simultaneously encouraging and frustrating.
Infection Rates
Currently in the United States, an estimated 1.1 million people are infected with HIV, the virus that causes AIDS. Worldwide, 33.4 million people are infected, with the greatest concentration of new infections happening in Sub-Saharan Africa, which is plagued with a staggering 71% of new infections. The Joint UN Programme on HIV/AIDS (UNAIDS) recently released the Report on the Global AIDS Epidemic 2010, which contains epidemiological data from all 182 countries in the world. Overall, the report presents a picture of HIV infection rates worldwide that would suggest that the education and prevention efforts are working. Director of UNAIDS, Michel Sidibé remarked, “"We are breaking the trajectory of the AIDS epidemic with bold actions and smart choices. Investments in the AIDS response are paying off, but gains are fragile – the challenge now is how we can all work to accelerate progress."
The numbers back up his comments. On the side of progress, the report showed that 2.6 million people became newly infected with HIV, which is a 20% decrease in the infection rate over the last decade when 3.1 million people were infected in 1999. Also showing progress was that in 2009, 1.8 million people died from AIDS related illnesses, which is another 20% decrease from 2004 when 2.1 million people died. Additionally, the report states that in 56 countries around the world, the infection rate has remained stable or decreased in some cases by as much as 25%, including 34 countries in Sub-Saharan Africa.
But even though the rate at which people are becoming infected with HIV is decreasing, the number of people who live with HIV is increasing. In 1999, it was estimated that 26.2 million people had the disease, 7 million fewer than today's 33.4 million. How could this be? The answer lies in mortality reduction. New drugs and treatment plans have allowed people with HIV to actually live longer.
Treatment and Prevention
The figures in the UNAIDS report that the number of people getting treatment for HIV infection has increased dramatically. In 2004, only an estimated 700,000 people had access to treatment, but that figure has multiplied seven and a half times in the five years since then. In 2009 over 5.2 million people were receiving life-saving treatment, no doubt a contributor in the increase in number of people living with the infection. And by this year, 2010, an additional 1.2 million people were added to the ranks of those getting treatment.
However, as promising as those figures are, it doesn't change the fact that there are an additional 10 million people who need the drugs aren't receiving treatment. And it's a problem that has an obvious, but difficult solution. Evidence shows that increasing treatment in high-prevalence areas directly leads to reductions in mortality. In 2009, $15.9 billion was available for international AIDS response...$10 billion short of what's needed in 2010. Funding is falling as well, as other diseases have taken funding away from AIDS research. “I think back in the early days of the epidemic there was a sense of urgency that somehow has been lost,” said Dr. Julio Montaner, the Director of the British Columbia Centre for Excellence in HIV/AIDS. He mentioned that as the disease no longer became a 'death sentence' in North America, attention turned from the western world to other causes, but the threat for the developing world is “devastating and killing.”
The Future
News was made recently when the New England Journal of Medicine published a study that showed a 44% reduction in HIV infection among men who have sex with men when they took an anti-retroviral drug called Truvada. Truvada is an established medication for treatment of HIV, but this was the first time it was shown to have a preventative effect. It also costs between $5,000 to $14,000 a year in the United States. However, in poorer countries where generic variations are available, the drug is only $140 per year, and could potentially help save lives of people who aren't able to use condoms, such as sex workers or rape victims.
Regardless, the same truths seem to still apply after 30 years of dealing with HIV and AIDS. Safety and education remain the best and most inexpensive ways to prevent and treat the disease. Consistent and correct condom use prevents infection. Period. And if you are sexually active, or have used needles at any point for drug use, get tested by a doctor at regular intervals.
