October/November #175 : R.I.P. HIV - by Regan Hofmann

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Table of Contents



From the Editor

Retiring the Ribbon


Letters- October/November 2011


High-Impact Prevention

What You Need to Know

Health Care Should Be a Human Right—for All

Too Few Pharma Companies in the Patent Pool

Legislation Proposed to End Criminal HIV Laws

AIDS Is Not an "Automatic Death Sentence"

Geckos Don’t Cure AIDS

We Hear You

The PrEP Debate

What Matters to You

Getting HIV Care Without Getting Deported

Treatment News

A Peek Into the Pipeline

Savvy Survival Strategy

Going Norvir-Free?

Cure Watch

Listen Up

Oh Baby!

Make Some Bones About It

Comfort Zone

Waiting to Inhale

POZ Heroes

Defying Gravity

Most Popular Lessons

The HIV Life Cycle


Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV

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October / November 2011


by Regan Hofmann

Thirty years after people first started dying from a then-unknown virus, we face a thrilling tipping point in AIDS history. Leading scientists say the end of the pandemic is possible, maybe even in our lifetime. Now, the question is: How do we seize this moment? Here, we spell out our suggestions for what we need to lay HIV to rest.

Click here to read a digital edition of this article.

In September of 2010, Thomas Frieden, MD, MPH, director of the U.S. Centers for Disease Control and Prevention (CDC), named HIV one of “six winnable battles” the CDC will wage under his command. His claim that AIDS can be beaten may prove prescient.

Global health leaders agree that scientific breakthroughs indicate the end of AIDS could be in sight—possibly in the near future if we strategically apply our resources to capitalize on recent discoveries.

What’s different now? Primarily, new data from U.S.-funded research showing that antiretroviral treatment (ARVs) serves as prevention—in both people living with the virus and those who are not. A recent study known as “HPTN 052” offers evidence that treating people with HIV can lower the risk of viral transmission by a whopping 96 percent. When we put people with HIV on ARVs, we save their lives—and stop the spread of HIV. Several other studies show that when people at risk for HIV take treatment daily (a practice called “PrEP” for “pre-exposure prophylaxis”), or when they take ARVs after potential exposure (a practice known as “PEP” for post-exposure prophylaxis), their chance of contracting the virus is reduced.

The long-waged battle between the treatment and prevention camps is over—treatment is prevention. Bill Gates, one of the most generous funders in the fight against AIDS, has said, “We can’t treat our way out of this epidemic.” Indeed, ultimately, the answer is having a vaccine—and a cure. But while we develop them, it appears the tools already in our possession can begin to end AIDS. Perhaps we can at least partially treat our way out of AIDS after all.

Anthony Fauci, MD, head of the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, said recently in Science: “The fact that treatment of HIV-infected adults is also prevention gives us the wherewithal, even in the absence of an effective vaccine, to begin to control and ultimately end the AIDS pandemic.”

Putting a lot more people with HIV on ARVs is the equivalent of capping the well in a large oil spill. It doesn’t completely solve the problem, but it’s a first—and necessary—step to doing so. Treating people who are living with HIV stops the spread of disease, keeps the world safer and saves billions of American dollars—these facts provide new justification for the cost and effort required to achieve our goals of universal access to care for all who need it. The United Nations’ new goal for universal access is 15 million people by 2015. Currently, only 6 million of the 33.3 million people estimated to be living with HIV globally are on ARVs. Having so few on pills is like trying to clean up an oil spill while the well is still a geyser.

Once, the notion of universal access smacked of giving endless, expensive medications to an eternally growing pool of people who couldn’t afford them themselves and relied on the largesse of governments and pharmaceutical companies to save them. New data suggest that doing the right things today could enable us to get the upper hand on AIDS forever.

The critical question is no longer, “Can we end AIDS?” but “Will we end AIDS?” Will we garner the political and financial capital to do what science suggests we can?

For years, we have tried various approaches to behavioral and non-biomedical prevention, with some success. But, since people continue, and likely always will, to have unprotected sex and share injection drug equipment, incidence of new infection rates is not declining and will never decline unless we stop HIV dead in its tracks. The best way to do that is to provide ARVs to the bulk of people living with HIV who need them. Modeling in several countries shows a direct correlation between increased access to care and decreased rates of new HIV infections.

There are many barriers to care. Drug prices alone are not keeping people from pills. In some nations, political unrest, lack of infrastructure and/or a shortage of medical workers mean that even if governments could afford the pills, the meds still wouldn’t get to the people. In the United States, impending federal budget cuts, inadequate state contributions to Medicaid and recent changes in eligibility requirements for Medicaid, lack of childcare and transportation, homelessness, substance addiction, mental health issues, comorbidities, health disparities, misperceptions and language barriers also present impediments to care.

And of course, fear of stigma, discrimination, homophobia,  criminalization, deportation, physical harm and death undermine HIV care efforts around the world.

While these challenges are daunting, it pays to overcome them. We need to greatly expand our testing efforts and do a much better job of linking people to and retaining them in care. If many more people become aware of their HIV status earlier, and if they access care and lower their viral load to an undetectable level, then they not only improve their own health but they contribute to better public health. Connecting people to medicines before they inadvertently pass along the virus will reduce community, and possibly global, viral loads. This is how the spread of AIDS begins to slow. This is how we cap the well.

Having 27.3 million people with HIV globally (about 1 million of them in America) remain untreated with existing drugs that can save their lives and prevent AIDS from spreading is a humanitarian crime of epic proportion. It’s also no way to stop the AIDS pandemic.

Expanded access to HIV treatment, while a lynchpin in any strategy to end AIDS, will not, by itself, solve the problem. We also need to develop and distribute biomedical prevention tools (like PrEP, PEP and microbicides), scale up male circumcision and continue to distribute more male and female condoms and clean syringes. The question is one of relative proportion. Current levels of resources applied in newly focused and optimally strategic ways to reflect the insight of recent medical breakthroughs will maximize their impact and hasten doomsday for AIDS.

We can make major headway by employing our complete arsenal of tools in a way that ensures we get the biggest bang for our buck. But we can’t get blood from a stone. If we are to end AIDS, we eventually will need more money. And it needs to come from fresh sources. No nation has applied more currency to the fight against AIDS than America. At its peak, the budget for the President’s Emergency Plan for AIDS Relief (PEPFAR) was $48 billion dollars. The United States spends about $19 billion a year to fight AIDS at home. But that’s about to change as our government now faces cutting $1.5 trillion from the federal budget. That’s not a budgeting haircut. That’s a buzz cut.

As budget cuts are made, all discretionary spending and entitlement programs (which comprise the bulk of domestic and global AIDS funding) are at risk. The community of people living with HIV/AIDS and our friends must convince political, economic and global health leaders not to slash AIDS funding. We are up against those fighting for support for other diseases, education, the military’s fight against terrorism, and the dollars needed to keep Social Security secure, to name a few causes. Our cry must be particularly pointed. If we fail to defend AIDS spending, tens of millions of people will perish needlessly in the next decade.

In his opening keynote speech at the International AIDS Conference in Rome, UNAIDS executive director Michel Sidibé called gaps in access to HIV treatment an affront to humanity that can and must be closed by innovations in developing, pricing and delivering treatments and commodities. “History will judge us not by our scientific breakthroughs,” he said, “but how we apply them.”

Ending AIDS won’t be easy, it won’t be cheap, and it won’t happen overnight. But if we develop a smart, sound, strategic plan—one that uses existing resources better and secures new funding from other nations—and if we sell it all the way up the political line to the president himself and across both sides of the Congressional aisle, it can be done.

This Congress and this president have the chance to kill one of the world’s worst killers and in the process save tens of millions of people and billions of dollars. If we rapidly increase access to care, and if infection rates and deaths decline, then the resources needed to fight global AIDS could shrink in as few as five years. And, significantly expanding access to care will make the pharmaceutical companies who make the drugs even richer. I know, I know. But the answer to bankrolling the end of AIDS is not as simple as dropping drug prices. The prices set by for-profit companies are only likely to go down if the volume of drugs sold goes up. And for that to happen, we need to find more guaranteed payers. This is why the rest of the world needs to help come up with the cash to expand access to care for people with HIV.

We have a rare opportunity to rewrite the ending of one of the world’s worst tragedies. We didn’t give up when we didn’t have the answers for what can end AIDS—we certainly shouldn’t now that we do.

The bottom line? If the HIV community can encourage the world to up the antes of international financial and political will, if global advocacy efforts are bolstered and expanded, if we correctly position the arguments for why the world should spend the money to stop AIDS, if we put AIDS back in the spotlight and take it out of its silo, if we utilize existing health care and faith-based infrastructure to deliver care, if we make health care a human right that is equally offered to all, if we protect the human rights of people with HIV, if we put our money where we know it works best, and if these things result in more people getting educated, protected, tested, treated and linked to care, HIV’s days could be  clearly numbered.

With that in mind, POZ outlines seven key areas where we need to focus global efforts if we are to end AIDS, and we suggest specific tactics within each of those areas.

Pages: 1 | 2 | 3 | 4

Search: Washington DC, Thomas Frieden, U.S. Centers for Disease Control and Prevention, CDC, HPTN 052, PEP, PrEP, pre-exposure prophylaxis, post-exposure prophylaxis, Bill Gates, Anthony Fauci, National Institutes of Health, National Institute of Allergy and Infectious Diseases, United Nations, Medicaid, Medicare, stigma, discrimination, homophobia, criminalization, deportation, President?s Emergency Plan for AIDS Relief, PEPFAR, Barack Obama, Office of National AIDS Policy, President's Advisory Council on HIV/AIDS, PACHA, Michelle Obama, Global Health Initiative, GHI, UNAIDS, Affordable Care Act, AIDS Drug Assistance Program, ADAP, Ryan White CARE Act

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