Turning the tide against HIV/AIDS

This year, research supported by the NIH confirmed that HIV treatment is not only lifesaving for those already infected but also prevents the spread of infection to others. This large, randomized clinical trial found that people who were infected with HIV and treated with antiretroviral therapy were 96 percent less likely to transmit HIV to their uninfected sexual partners than those whose treatment was delayed. 

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These findings make it clear we now have the tools to alter dramatically the trajectory of the pandemic. But to effect this change, we must commit resources to communities around the world where delivery of HIV care, services and treatment are needed, including domestically. 

The toll wrought by HIV/AIDS remains staggering, as does the unmet need for care. In the U.S., more than 50,000 new infections occur annually, and almost one-fourth of people with HIV disease are not aware they are infected.

Many who are diagnosed start treatment far later than recommended, after their immune systems are severely compromised and they have unknowingly been capable of transmitting HIV for many years. Nationwide, it is estimated that half of those infected are in care, and less than one-fifth are diagnosed, engaged in care and on treatment that effectively suppresses their virus — conditions necessary to prevent transmission. 

Globally, nearly 3 million people are infected with HIV each year, yet only a third of those in poor countries who need treatment have access to it. According to a 2010 United Nations report, fewer than 40 percent of those needing lifesaving treatment in sub-Saharan Africa, the epicenter of the pandemic, have access to antiretroviral therapy. 

The recent findings on the effectiveness of treatment as prevention chart the course for ending this pandemic. We must ensure access to HIV care and treatment for all people living with HIV, both here and abroad. In combination with other prevention tools, this could ultimately end the pandemic.

Unfortunately, growing demand for HIV care continues to exceed funding for clinics providing this care to those without insurance, with many clinics struggling to stay open. As of November, nearly 6,500 low-income individuals in 12 states were on waiting lists for HIV medications through the AIDS Drug Assistance Program. Sustaining our investment in the highly effective Ryan White Program and expanding access to quality care through full implementation of healthcare reform are vital to realizing an AIDS-free generation here at home. 

Sadly, funding for global HIV treatment through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria is declining just as the science has shown that treatment prevents transmission. Despite these difficult times, we must recognize the power of our investment in HIV treatment and prevention, not only to extend life and restore health and productivity to millions of people living with HIV, but also to bring the pandemic to an end.

In July 2012, the world’s largest AIDS conference will return to the U.S. for the first time in more than 20 years. The conference theme, “Turning the tide together,” could not be more timely. “While the finish line is not yet in sight,” Clinton said at the NIH, “we know we can get there, because now we know the route we need to take.” 

For the first time in 30 years, we can realistically envision the end of the greatest pandemic of our time. For this vision to be realized, we must fully commit our leadership and resources to the battle against HIV/AIDS.  

Aberg is chairwoman of the HIV Medicine Association (HIVMA) and director of the Division of Infectious Diseases and Immunology in the Department of Medicine at New York University School of Medicine. Gallant is a professor of medicine and epidemiology in the Division of Infectious Diseases at Johns Hopkins University School of Medicine in Baltimore.