Chris Collins, a vice president of the AIDS research foundation amfAR, said the blueprint “changes the conversation from hopefulness to the practical next steps we have to take.”
There’s been a big push in the past decade to bring antiretroviral therapy to HIV-infected people in the developing world. There are now about 8 million on treatment, which is slightly more than half the people who need it.
The trend has accelerated in recent years, with a 63 percent increase in treated patients between 2009 and 2011. That, along with other methods of prevention, has led to a 50 percent or greater drop in new infections in 25 countries over the past decade. Nevertheless, in many places the epidemic continues to grow, albeit more slowly than it once did.
The blueprint depends on prevention methods whose effects have been measured.
The most important is antiretroviral therapy itself. A study last year showed that treating an infected person reduces his or her chance of transmitting the virus through sexual contact by 96 percent. When HIV-positive pregnant women take antiretroviral drugs, fewer than 5 percent of their babies become infected. Circumcision reduces a man’s chances of acquiring HIV sexually by about 60 percent.
“We see a kind of a synergy with all of them together that we don’t see with any of them alone,” said Eric P. Goosby, a physician who heads PEPFAR.
The document shows how the incidence of AIDS will change in four countries — Cambodia, Kenya, Uganda and Zambia — under three scenarios.
One is the current trend of treatment and prevention. The second is increasing treatment coverage to 80 percent in people with relatively advanced infection, as defined by a CD4-cell count of 350 or less. The third scenario is bringing that same treatment coverage to people in an earlier stage of infection (CD4-cell count below 550), which is the standard in high-income countries.
The graphs in the blueprint show a downward trend in incidence with the second and third scenarios — and more steeply with the third.