HIV is a fierce opponent. Since its appearance three decades ago it has killed 35 million people, and in the process, decimated many countries’ most productive generations, further compromising efforts to stop it. Yet in recent years we have increasingly begun to win this fight by uniting policy and science.
For three years we have known with certainty that early treatment of HIV dramatically reduces transmission of the virus. This means that we are on the right track. If we continue to accelerate our fight against HIV, and do it better than ever before, we can win this fight.
But it is only one, vitally necessary step. The week before 40 U.S. legislators urged the president to double the number of people currently supported on treatment through PEPFAR. If he heeds that advice, science, united with policy, will continue to gain on HIV.
The development of the first antiretroviral drug in 1987 and continued improvement in treatment is one of the great accomplishments of the 21st century. More than 10,000,000 are already receiving treatment. But everyone with HIV infection needs treatment, and sooner rather than later. Today, an early diagnosis of HIV means taking just one pill a day, a pill that can provide a person with excellent health, a normal life span and a drastically reduced chance of transmitting the virus to someone else. By keeping people healthy and reducing new infections, early treatment of HIV proves to be a great investment. In some places-such as the South African province of Kwa-Zulu Natal-the increased availability of antiretroviral therapy has reduced the incidence of new infections quite dramatically, and almost certainly because infected people become less contagious. Treatment of HIV now (rather than later) saves health care costs by keeping people feeling healthy. And healthy people are more productive, which can have a positive effect on the economies of countries where HIV infection is common.
Remarkable progress in HIV research and care has led to the call for an AIDS-free generation. The cover of The Economist magazine speculated about “The End of AIDS.” But these are aspirations, not promises. History tells us that when we are making progress against an infectious disease, we must not relax. For HIV we must redouble our efforts in every regard: to get more people treated as quickly as possible, to make a vaccine, and to find a cure.
Cohen is the architect and principal investigator of the multinational HPTN 052 trial, which demonstrated that antiretroviral treatment prevents the sexual transmission of HIV, and was Science magazine’s 2011 “Breakthrough of the Year.” He is the associate vice chancellor for Global Health, the Yeargan-Bate Eminent Professor of Medicine, Microbiology, Immunology and Epidemiology at the University of North Carolina at Chapel Hill and a Scientific Advisory Committee member of the IDSA Center for Global Health Policy.