Losing the War on AIDS

Last Thursday was World AIDS Day. It is held every year on December 1st, and commemorates those who have died since HIV/AIDS was first recognized as a public health threat in 1981.

In the three decades since the HIV/AIDS epidemic began, over 26 million people around the world have died. That is almost 20 times the number of people believed to have died from the plague in Medieval Europe. The number of people killed by HIV/AIDS also recently surpassed the number of people who died during the Influenza Pandemic of 1918, long considered the most devastating epidemic in history.

Another 35 million people across the globe are currently living with HIV/AIDS. Many do not know they are infected. Most live in the developing world where, until recently, access to treatment and care for HIV/AIDS was unavailable, unattainable, or simply too expensive to buy. The average cost of treatment in the US can run almost $20,000 a year, which is out of reach for those in countries where the average person lives on less than a dollar a day.

That has begun to change. Starting in the early part of this millennium, through the efforts of international programs like the Global Fund to Fight AIDS, Tuberculosis and Malaria, and US-based programs like the President’s Emergency Plan for AIDS Relief (also known as PEPFAR), millions of HIV-infected people around the world now have access to generic versions of antiviral drugs at little or no cost.

As you may have learned from recent internet and television ads starring such celebrities as Hugh Jackman and U2 frontman Bono, lifesaving treatment for those living with HIV/AIDS in Africa and Asia can now be provided for about 40 cents a day. That is a good thing. Not only do these drugs extend the lives of those living with HIV/AIDS, but widespread treatment also reduces the likelihood that these individuals will transmit the virus to others.

When a HIV-infected person is on effective treatment, the amount of the virus in their blood and other bodily fluids drops to near zero. If there is little to no virus, then there is little to no chance that they will infect others. We in the HIV field call this the “Treatment as Prevention” paradigm. Because of this paradigm, it is estimated that the rate of HIV transmission around the world has dropped markedly since the Global Fund and PEPFAR began to offer widespread treatment to those in the developing world.

Unfortunately, the success of “Treatment as Prevention” is threatened. As a result of the ongoing economic crisis, governments and philanthropic organizations around the world have reduced their donations to the Global Fund. Just last week, the Fund announced that contributions had dropped far below the $15 billion needed to prevent and treat HIV/AIDS on a global scale. As a result, the Global Fund has been forced to scale back on new treatment initiatives in some of the hardest hit countries in Africa.

Here in the US, the situation is no less dire. The Centers for Disease Control and Prevention estimate that less than a third of HIV-infected Americans are currently on treatment. Many have never been tested for HIV, either because they do not believe they are at risk or because they are afraid of the stigma and discrimination associated with a positive diagnosis.

Even if they know they are infected, they may lack access to treatment. They may be one of the 50 million Americans who do not have health insurance. And while government-sponsored projects like the AIDS Drug Assistance Program exist to provide antiviral drugs to those who can’t afford them, funding for these projects are likely to be slashed as Congress continues its partisan deficit battle.

The truth of the matter is this: for less than the cost of one month of fighting in Iraq and Afghanistan, a year’s worth of lifesaving treatment could be provided to every person in the world who is currently living with HIV/AIDS. The impact of doing this would be immeasurable. Economic productivity would improve as those who were formerly too sick to work regain their health. Long-projected health care savings would be realized as future HIV infections are averted. And America’s badly tarnished global reputation would be bolstered.

Regrettably, I doubt that this will happen. Our political leaders are simply too shortsighted. But that doesn’t mean that we, as individuals, cannot do something to help stem the rising tide of HIV/AIDS around the world.

The easiest thing to do is getting tested for HIV. Think of it as an early Christmas gift to yourself and your family. If you are HIV negative, learn about ways to further protect yourself and your loved ones from infection. If you are HIV positive, seek treatment and take action to prevent passing the virus on to others.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on December 8, 2011. It is also available on the WAMC website.]


About Sean Philpott-Jones

A public health researcher and ethicist by training, Sean holds advanced degrees in microbiology, medical anthropology, and bioethics. He is currently Chair of the Bioethics Department at Clarkson University's Capital Region Campus and Director of the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai, and Director of two Fogarty-funded programs to provide research ethics education in Eastern Europe and in the Caribbean Basin. Until his term expired in August 2012, he served as Chair of the US Environmental Protection Agency’s Human Studies Review Board, an advisory panel that reviews the scientific and ethical aspects of research involving human participants submitted to the EPA for regulatory purposes.
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One Response to Losing the War on AIDS

  1. Pingback: Today is World AIDS day « europeancitizen.org

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