A Future Without AIDS? Global Health Leaders Point to Education, Prevention

Watch a replay of Ray Suarez at Columbia University moderating a panel of global health leaders as they discuss the future of combating AIDS.

If you’re old enough, you can remember when you first heard about a disease, or a group of diseases found among young men in New York and San Francisco. In those early years, understanding the biology of what became known as the human immunodeficiency virus, or HIV, and trying to stop its rapid spread became a worldwide crusade. The house was on fire, the danger real and the future uncertain.

Things now have changed enough to hold a conference with the audacious title, “A Future Without AIDS: Dream of Reality?” For this reporter, being invited to moderate a conversation of superstars in the global battle against AIDS was a chance to pick the brains of some of the most influential, and also the most experienced professionals in the struggle:

— Dr. Anthony Fauci of the National Institute of Allergy and Infectious Disease — Dr. Eric Goosby, US Global AIDS Coordinator at the State Department — Michel Sidibe, Executive Director of UNAIDS, the Joint UN Program on HIV/AIDS — and Dr. Wafaa El-Sadr, Director of ICAP at the Columbia Mailman School of Public Health.

I have covered AIDS as a reporter since the earliest days of the detection and diagnosis of the disease. At a hospice for infected infants I masked up and held dying infants in my arms. I’ve interviewed thin men with sunken eyes and lesions from Kaposi’s Sarcoma — one of the opportunistic diseases plaguing sufferers in advanced stages of AIDS — who talked of dying in their twenties. I’ve sat with exhausted clinic operators coming off yet another 15- or 16-hour day as they struggled to get their arms around a wildfire of disease. In short, I’ve been interviewing people who thought we would never reach the point where we could have a realistic conversation about the end of the AIDS epidemic.

The reports from the field are good: Sidibe talked of declining levels of new infections in the developing world and the suppression of the virus in the bloodstreams of millions of people who are getting anti-retroviral (ARV) treatment. Dr. El-Sadr said early research would indicate that people living in hard-hit communities do not return to risky personal behavior as their friends and neighbors stop dying of the disease. Dr. Goosby said that even while funds are being cut for the President’s Emergency Program for AIDS Research (PEPFAR), squeezing inefficiencies out of the delivery of care in poor countries has meant delivering care to even more people for less money. Dr. Fauci, one of the world’s most important veterans in the fight against AIDS, spoke of steady progress toward a vaccine, even though HIV has proven to be a daunting foe when compared with other viruses.

Public health executives and clinicians tend to be cautious men and women, unwilling to create false excitement or unwarranted optimism. They choose their words carefully. Sitting on that stage at Columbia University, some of that careful reserve fell away. So much progress has been made on so many fronts that they felt empowered to speculate about reaching that point where you can see the back of an epidemic being broken.

The reason for the excitement is summed up in three words: treatment as prevention. The current arsenal of ARVs has had such success in suppressing the disease in infected people that the risk of mother to child transmission in the womb is steadily dropping. As more people know their status, the chance of uninfected people having an encounter with a person who will infect them accidentally is also plunging, and those suppressed viral loads among patients who are on treatment infecting someone new is dropping even if the people on treatment engage in risky behavior.

In short, once a person is on treatment the danger of AIDS to their lives drops precipitously. If they are responsible sex partners their chances of infecting another is very small, and the chances of a new infection is lower and lower even when they don’t take precautions.

So this panel — representing the Big Powers in the war on AIDS, research universities, the U.S. government, and the U.N. — all having been on the front lines during the worse days of the epidemic’s spread, all say the world is inching closer to durable victories, and many more lives saved.

One caution came from Dr. Fauci, who reminded the audience at Columbia and via the live web stream that once that hoped-for day of widespread control of HIV arrives, the world would make a colossal mistake if it sat back, declared victory and relaxed. He reminded the audience of other defeated diseases, like polio, that come bouncing back when prevention is relaxed in the face of declining perception of threat.

Looking specifically at the U.S., Dr. Goosby and others talked of the ways the diseases profile differs from that of other places in the world: it is more concentrated among men who have sex with men, and more concentrated among specific minority groups like black men and black and Latino teens. He also talked about the lowered expectation of effective testing, detection and follow-up in rural communities in the South because of stigma, lack of access to care, and perceived gaps in privacy guarantees.

All in all, these important figures in the world effort to contain HIV spoke of their optimism for the coming years, Sidibe going as far as to insist that zero mother-to-child transmission as soon as 2015 was possible given the medical systems, education and prevention strategies already in place today. He has evangelized around the world for the goal of “zero-zero-zero”: zero new infections, zero discrimination against those already infected, and zero deaths from AIDS. He chuckled when he talked of being called naïve when he first expressed that hope, and said in the intervening years the world has come much closer to achieving all three.

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