THE STORY of the AIDS pandemic has been grim for so long that optimism seems hardly possible. But as the 19th International AIDS conference opens in Washington on Sunday, there is hope for control of a disease that has killed nearly 35 million people over three decades and 1.7 million in the past year. Unfortunately, there is still no cure, nor a vaccine proven safe and effective. But a headline in the New England Journal of Medicine asks, “The Beginning of the End of AIDS?” This is not wishful thinking.
Much of the optimism comes from breakthroughs that have led to effective interventions for treatment and prevention of infection with HIV, the virus that causes AIDS. Antiretroviral drugs, used in combinations of three or more, have become more widely available and dramatically improve the health of those infected. A decade ago, 300,000 people in low- and moderate-income countries were receiving these drugs; by the end of 2010, the total had grown to 6.6 million.
Moreover, the concept of “treatment as prevention” has taken on new promise; a rigorous clinical trial showed significant protection for the sexual partners of a person taking a combination of antiretrovirals. The use of antiretrovirals to cut down on mother-to-child transmission also has been shown to work. Studies in Africa demonstrated that voluntary adult male circumcision reduced by half or more a man’s risk of acquiring HIV infection via heterosexual intercourse. Preliminary evidence suggests that an antiretroviral gel may bring down infections in women.
New HIV infections have declined by a fifth over the past decade, but there were still 2.5 million new infections last year and this drives the pandemic forward. The challenge that will be front and center at this week’s convention is how to spread the technology and prevention measures to more people, millions of them, surmounting obstacles that are political, logistical and financial. The scientific and medical breakthroughs that have been shown to work in trials must be scaled up globally. By one account, for every 1,000 people in sub-Saharan Africa who can be provided with the antiretrovirals, 228 deaths and the orphaning of 449 children could be avoided. Closer to home, the disease remains at epidemic levels in the District.
An expansion on all fronts will demand still more resources. The United Nations has called for an AIDS worldwide funding goal of $22 billion to $24 billion a year by 2015, up sharply from $16.6 billion last year. The United States continues to be the largest international donor, and this money remains essential to fighting the disease in sub- Saharan Africa, the region most affected by the pandemic. In the years ahead, everyone will have to pitch in still more to meet the U.N. goal. But some low- and middle-income nations are already funding most or all of their AIDS programs from domestic sources, meaning less dependency on global giving.
The most realistic chance yet to bring the pandemic under control ought to be an inspiration for redoubled commitment. The theme of the conference this week is “Turning the tide together.” It would have been hard to envision “turning the tide” 15 years ago. Now, it is at least in sight, if not yet in hand.