Next month, the International AIDS Conference returns to Washington, D.C., where it was last held in 1987. One of us (ASF) had the privilege of speaking at the 1987 conference, and will do so again this year. At the Washington conference 25 years ago, the mood was somber. The HIV/AIDS pandemic was expanding rapidly. Although some progress had been made with “safer sex” and other prevention efforts and in treating AIDS-associated opportunistic infections, just one drug against HIV was available. Unfortunately, AZT alone, which had been approved by the FDA about three months earlier, provided only modest and short-lived benefits. Absent better interventions, the sobering reality was that HIV infection in 1987 was essentially a death sentence for almost all patients.
We look to this year’s meeting from an entirely different perspective. Amid the sobering statistics concerning those who are still becoming ill and dying of HIV/AIDS, there are reasons to believe that we can significantly slow, and ultimately end, the onslaught of this modern-day plague. The conference theme, “Turning the Tide Together,” is apt, because if we work extremely hard to do so, we now can turn the tide.
First, we now have a robust armamentarium of approximately thirty antiretroviral drugs that are life-saving when given in combination, allowing people with access to these medications to live healthy and productive lives. In this regard, a growing number of HIV-infected people worldwide are accessing antiretroviral therapy (ART) — now about half of those who need it. At the upcoming conference, fresh insights will be shared into how we can efficiently provide these medicines to many more in need. Scaling up treatment will require novel ways to help people get tested for HIV, access the care they need if they are infected, and stay in care such that they derive the maximal benefit from medical and social services. In addition, there have been dramatic results with biologically based prevention modalities. For example, we will hear more about efforts to deliver voluntary medical male circumcision (VMMC) services to many more sexually active, uncircumcised men in countries with high rates of HIV infection. VMMC, a simple surgical procedure, is highly effective and durable in protecting heterosexual men from acquiring HIV infection. Used along with condoms and other prevention tools, VMMC holds great promise in reducing new HIV infections, especially in parts of Africa with high rates of HIV and low rates of male circumcision.
In addition to improving the health of HIV-infected people, ART can dramatically reduce their chances of transmitting the virus to their sexual partners, or, in the case of pregnant women, to their infants. Data presented at the Washington conference will underscore the potential to use ART for prevention as well as treatment. For example, clinical trials suggest that treating HIV-negative people at high risk of HIV infection with antiretroviral medications – either oral pills or as gels applied to genital mucosa – can help protect them from infection. A compelling message at the conference will be the importance of strict adherence to antiretroviral regimens, whether used for treatment or prevention. Lastly, the two great remaining scientific challenges in HIV research – finding an HIV vaccine and a cure – also will command much attention. On both fronts, promising data have emerged from laboratory, animal and human studies.
Taken together, these new developments provide a robust toolkit of prevention and treatment interventions. Our challenge is to work collectively to implement these proven interventions in order to make an AIDS-free generation truly possible. This will require increased financial resources, innovation, political will, an overall strengthening of health systems, fighting stigma, and greater ownership by all countries of HIV/AIDS efforts within their borders. At the International AIDS Conference, we will learn about the progress and the challenges that remain in “turning the tide” of HIV/AIDS. Let us hope it will help catalyze decisive and united action to put us squarely on the road to ending the pandemic.