Turning the Tide on HIV through the Effective Use of Treatment, July 23rd's Plenary Session
July 25, 2012
Senior Associate, Global Health Policy Center, CSIS
In Monday’s celebrity-filled AIDS 2012 plenary session, entitled “Ending the Epidemic: Turning the Tide Together,” much of the technical information came in Dr. Anthony Fauci’s presentation of the epidemiologic and research data that are the basis for the optimistic projections of an “AIDS-free generation” to come.
In his comprehensive presentation, Dr. Fauci began by noting appropriately that, to achieve an AIDS-free generation, recent scientific progress in this field will have to be matched by future progress in all aspects of program implementation, e.g., early identification of HIV-infected people; their successful referral to anti-retroviral treatment (ART) programs; long term retention of those patients in ART programs; high levels of adherence to recommended ART regimens; laboratory evidence that treated patients’ viral loads (HIV concentration in blood) remain suppressed; careful evaluations of program outcome and impact. He mentioned the slow progress in finding a true cure for HIV and in developing an effective HIV vaccine while noting the nearly 8 million people globally who have already been begun ART and the 840,000 deaths averted in 2011 among that group. He cited Rwanda as an example of progress by ART programs in achieving a 92% patient retention rate at two years after program entry. Dr. Fauci also introduced the topic of domestic U.S. HIV/AIDS challenges by raising the issue of Washington, DC’s exceedingly high HIV prevalence and some of the recent efforts to begin reducing that burden.
Following Dr. Fauci, Mr. Phill Wilson returned to the domestic HIV/AIDS issue, noting our national position of having the largest HIV burden of all industrialized countries and that 20% of all HIV-infected in this country are unaware of their infection. He also spoke about the persistent failure to link HIV-infected people with treatment programs and the high lost-to-followp rates among Americans started on ART. (See the most recent national and state-specific U.S. HIV/AIDS data here.)
However, the most reassuring aspect of the entire plenary session was Secretary of State Hillary Clinton’s three part definition of an AIDS-free generation: (1) “virtually no child anywhere will be born with HIV infection”; (2) “…as children and adolescents become adults, they will be at significantly lower risk of ever becoming infected [with HIV]”; and (3) if someone does acquire HIV, they will have access to treatment that helps prevent them from developing AIDS and passing the virus on to others.” Secretary Clinton went on to acknowledge that although HIV will be with us for a while longer, AIDS doesn’t necessarily have to be with us during that time. Transcript of Secretary Clinton’s remarks are available here.
Much to my relief, it seemed clear from these presentations that, although achieving an AIDS-free generation globally as well as in the United States will not be easy or simple, it may be a realistic – and not purely aspirational - goal. It remains to be seen whether upcoming resource allocations and program implementation and evaluation activities will be equal to the task.