AIDS Conference Ends With Hopes for Cure High, But Short of ‘Victory Lap’

July 27, 2012

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RAY SUAREZ: Well I am here at AIDS 2012 with Jon Cohen of Science magazine and John Donnelly of GlobalPost. And two Johns, let me put it to you, what is coming out of this meeting that is going to head out to the AIDS community in the rest of the world? John Donnelly, why don’t we start with you?

JOHN DONNELLY, GlobalPost: I think this meeting has been, in many ways, sort of a giant pep rally for getting people here excited, that there actually can be an AIDS-free generation. It may be a few generations from now, but that we’re moving toward an end of AIDS, because the scientific tools that are now available present a lot of hope for people that we can start reducing the infections very quickly.

RAY SUAREZ: Jon Cohen, same question.

JON COHEN, Science magazine: This meeting amplifies scientific advances that have happened over the past year or two. And I agree with John. The big message is we can do something now we couldn’t do before.

There was a breakthrough last year. There was a finding that treatment is indeed prevention. People who are treated fully and suppressed for viral levels don’t transmit the virus much at all.

So now the question is: can you really deliver on that promise? That’s the huge thing that this meeting doesn’t really want to focus on. But the reality is the aspirations and the reality on-the-ground have a huge gap between them.

RAY SUAREZ: What do you mean by that, that this meeting doesn’t want to focus on it?

JON COHEN: Well, you don’t see people at the big plenary getting up and saying, ‘We’ve got a huge mountain to climb here.’ Because right now in the United States, we have 1.2 million infected people. Of those, only 28 percent are fully suppressed, on treatment. If you really want to slow the spread with treatment, you are going to have to do a whole lot better than 28 percent.

RAY SUAREZ: So, John Donnelly, it sounds like it’s way too early to take a victory lap?

JOHN DONNELLY: It is way too early and a lot of what’s being said here really has an eye towards getting more funding in the future to fight AIDS. And I think it is — this administration has been hard-pressed to actually put any details to how they are going to move ahead globally, and also domestically.

Hillary Clinton made this big call about getting a blueprint for future actions, but she is still waiting another five months. So it’s moving — the whole conference is moving ahead with great hope, but without much meat behind it.

JON COHEN: The epidemic keeps changing shape. And in the United States, the epidemic has moved from it being in big cities, and often white, gay men who are economically stable, into young, black, gay men in the South. That is the epicenter now. And that is a huge shift, which requires an entirely different response. And this country is wrestling with that.

And we’re also seeing the aging of HIV-infected people. By 2020 in this country, half the people who are infected are going to be over 50. That’s a very different demographic and it raises all sorts of different problems. So, this isn’t the same issue we were dealing with even five years ago.

RAY SUAREZ: But doesn’t that come from a good place? I mean, the reason the affected people are aging is because they are living so long on ARVs.

JON COHEN: Absolutely, the aging component is a positive thing. But think about this: people are having trouble taking their medication. What happens when you get to be 50, 60, 70, and you start adding pills for all sorts of things? It makes it even harder to take your antiretroviral medications.

Plus, believe it or not, people over 50 still have sex.  And what if you’re infected and over 50? Are they as likely to use condoms, to do the preventative things we know? Studies show they aren’t. So we have some issues we’re going to be facing in the next few years that I think are going to be very surprising to a lot of people.  

RAY SUAREZ: Why, Jon Cohen, is a meeting like this still even held at a time, when a lot of the information that comes out of this meeting could be transmitted to the furthest, tiniest hamlet on the planet where people need to know, without anybody having to get on a plane anywhere?

JON COHEN: This is a family. The people involved here have been working together for decades. You talk to your family on the phone. You email each other. You still get together for a dinner and find out all sorts of things you didn’t know.

And that’s what it’s about. It’s about mingling, spending time together, looking at the same information together, going out to dinner together, waking up tired together. It’s a lot more yeasty than can happen with just something being transmitted electronically.

JOHN DONNELLY: And I think, also — that’s a great analogy, but I think also, the family has changed. I think now, for instance, the amount of African experts on HIV/AIDS, both in science and delivery, has grown exponentially. So the head of the Global Fund, for instance, made a very important point. He said the knowledge, the base knowledge on HIV/AIDS used to be in Imperial College in London, but now it’s really in Africa, in Latin America, that the majority of people who are experts on AIDS are not here anymore. They’re there, in Africa.

RAY SUAREZ: Has there been a tremendous tone shift? When I look at what came out of earlier meetings in this series, where the numbers were gruesome and the news was bad, is there something quite different about what the international conference is saying to the rest of the world?

JON COHEN: Oh absolutely. When I first started attending these in 1990, people were dying who were at the meetings, and holding protests, running up to the stage saying, ‘Do something for me. I’m dying. Everyone I love is dying.’ You are not seeing that now. The drugs work. There’s been a tremendous scientific achievement here. The problem now is all the low hanging fruit has been picked scientifically. So the scientific challenges today are about curing HIV or about finding a vaccine, which would be the ultimate way to prevent transmission. And those are really big asks. That’s a really, really horrific scientific challenge because it’s been going on for 31 years and there aren’t answers for those questions.

RAY SUAREZ: So how do you temper the message? High fives, chest bumps when you need them, because there are tremendous bits of progress being made, but at the same time telling the rest of the world, no, no. This disease is still dangerous and we haven’t gotten over some of the big humps to having that AIDS-free generation.

JOHN DONNELLY: I think it’s a huge challenge, actually, to keep enthusiasm for the fight against AIDS, because it’s been around, the fight’s been going on for 30 years now. And the message from here is: we’re some success. So I think a lot of people who go around the U.S., the impression, even in newsrooms in America – the impression is that we’ve done AIDS. We’ve had a success, that victory. Why do we need to continue to pour all this money into efforts for it?

So, the answer to that is that as we have seen in Anacostia, just a few miles from here, that people still don’t know enough about AIDS. People need to be educated, especially in the U.S. So there needs to be an emphasis at getting better at finding whose infected and getting them into treatment, and to do it broadly in the U.S. and around the world.

RAY SUAREZ: John Donnelly of GlobalPost and Jon Cohen of Science magazine. Gentleman, thank you both.


JON COHEN: Thank you very much.


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