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Editorial: The Long, Uphill Battle Against AIDS




 

The international AIDS conference in Washington has already made two points clear. There is no prospect that scientists will any time soon find the ultimate solutions to the AIDS epidemic, namely a vaccine that would prevent infection with the AIDS virus or a “cure” for people already infected with the virus. Even so, health care leaders already have many tools that have been shown in rigorous trials to prevent transmission of the virus, making it feasible to talk of controlling the epidemic within the foreseeable future. The only question is whether the nations of the world are willing to put up enough money and make the effort to do it.

An estimated 34.2 million people around the world are currently infected with H.I.V., the virus that causes AIDS. According to the United Nations agency that tracks the disease, some 23.5 million of these live in sub-Saharan Africa and another 4.2 million in India and Southeast Asia. About 1.1 million live in the United States.

This conference is the first in more than two decades to be held in the United States. It became possible only when a benighted policy that prohibited entry visas for people suffering from AIDS or infected with H.I.V. was finally overturned in 2009. It was “a bad policy, based on faulty science, that ran contrary to America’s deepest values,” Kathleen Sebelius, the secretary of health and human services, told the conference.

There has been optimistic talk at the conference about accelerating the search for a “cure” that would allow people to eventually stop taking the drugs that have prolonged many lives for decades — and about developing a truly effective vaccine. But Dr. Anthony Fauci, the American government’s top AIDS expert, made clear just how difficult those tasks will be. He told the conference that a cure was “way upstream” and depends on future research breakthroughs, and he called the most successful vaccine trial to date “humbling” because it showed only a modest degree of efficacy.

Instead of waiting for these future possibilities, Dr. Fauci and other health leaders are proposing the broad adoption of other available tools to reduce the spread of the virus so as to produce an “AIDS-free generation,” a goal enunciated last year by Secretary of State Hillary Rodham Clinton. In her talk at the conference this week, Mrs. Clinton anticipated a time when virtually no child anywhere would be born with the virus, teenagers and young adults would have much less risk of becoming infected and those that do become infected would have access to treatments to prevent them from developing full-fledged AIDS or passing the virus on to others.

She cited the importance of condoms, counseling and testing; voluntary circumcision to protect males from becoming infected by a female partner; treating mothers to prevent transmission to their babies; and treating infected people with antiviral drugs as early as possible to enhance their own health and lessen the likelihood they will spread the virus to others. Studies also show that people at high risk of infection can protect themselves by taking an antiviral pill daily.

All that will take money. There is a widespread misconception that donors from well-heeled international organizations, rich countries and charitable foundations are the main source of money to combat the global epidemic. The share provided by international donors has, in fact, stagnated while the share provided by low- and middle-income countries to fight the epidemic on their own turf has been growing rapidly. Last year, the poorer countries invested $8.6 billion of their own money while international financing remained at $8.2 billion, the 2008 level, according to a report from the United Nations AIDS agency. Both groups will need to expand their contributions to meet ambitious treatment and prevention goals set for coming years.

Mrs. Clinton announced additional financing for AIDS programs, but perhaps her most important pledge was that the United States will issue a blueprint by Dec. 1 setting forth a road map for how to achieve an AIDS-free generation. To be effective, it will need to set priorities and define specific health outcomes and coverage targets and require detailed annual reports on the progress being made. It is unacceptable that millions of people sick enough to need treatment are not getting it.



 


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Information in this article was accurate in July 27, 2012. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.