Thirty-one years after doctors saw their first cases of AIDS, scientists say they now have the knowledge to begin to end the epidemic.
The only questions, says AIDS researcher Diane Havlir, are "Do we have the will to do it?" and "Who is going to pay for it?"
Doctors can now prescribe drug cocktails that reduce the amount of AIDS virus in a patients' body to undetectable levels. Landmark research funded by the National Institutes of Health show that these patients are not only healthier but also virtually non-contagious.
Outside the controlled environment of the lab, however, fighting HIV is far more complicated.
Only about one in four Americans with HIV have their virus this well-controlled, according to the Centers for Disease Control and Prevention. The rest either aren't getting care, aren't getting consistent care or don't know they're infected.
"It's very easy to treat HIV, the virus itself," says John Lennox, chief of infectious diseases at Atlanta's Grady Memorial Hospital and a professor at the Emory School of Medicine. "It's very hard to get treatment to people with HIV."
More than 25,000 AIDS researchers, patients and activists will converge on Washington, D.C., next week for AIDS 2012, an international conference being held in the USA for the first time in 22 years. Though the location in the nation's capital will highlight the USA's scientific achievements and generosity in fighting AIDS around the world, the conference also will shine a spotlight on the country's uneven progress in treating the disease at home, activists say.
One in 30 adults in Washington are infected, including one in 16 black men. That's higher than the HIV infection rates in many African countries, including Ethiopia, Nigeria and Rwanda.
Though infection rates have fallen sharply from their peak in the late 1990s, about 50,000 Americans are newly infected each year, and nearly 1.2 million live with the disease.
"There are big gaps between what we have the potential to do in terms of prevention and what we're actually accomplishing," says Adaora Adimora, a professor at the University of North Carolina-Chapel Hill. "We need to be able to get treatment to more people who need it."
People on the margins
AIDS today disproportionately affects people who are on the margins of society, such as gays, minorities and the poor, Adimora says. Nearly half of all new HIV infections are in blacks, the CDC says.
The Affordable Care Act, which aims to provide health insurance to an additional 30 million Americans, could help get many HIV-positive patients into care, Adimora says. Some governors across the country, however, have pledged not to expand Medicaid.
Adimore says the health care law "would actually be a huge boon not only for HIV care but for HIV prevention, because it would allow us to implement some of this extraordinary scientific research," Adimora says. "How we deal with this problem in the next few years is going to help determine the fate of the AIDS epidemic in this country."
In communities with high infection rates, people can be at risk even without being promiscuous, simply because the virus is found at such high rates within their social network, says Justin Goforth, a registered nurse at Whitman Walker Health in Washington.
Young gay men -- who don't remember when AIDS was a universal death sentence -- are the only group in which the rate of new infections is increasing, largely because of an "alarming" growth in the disease among gay black young people. The infection rate climbed 48% among young gay black men from 2003 to 2009, the CDC says.
Phill Wilson, founder of the Black AIDS Institute, blames some of that increase on the failure of sex education, which he says has focused too much on abstinence. And Wilson says young gay men, who are often rejected by their families, "don't believe their lives are worth protecting."
The CDC launched a major campaign this week to encourage HIV testing. A CDC study to expand HIV testing helped diagnose 18,000 people, saving an estimated $2 for every $1 spent, partly by slowing the spread of the disease.
Unaware or in denial
Many young people are unaware or in denial of the dangers of unprotected sex, which HIV patient Kevin Swinton compares to "Russian roulette."
Other young people are fatalistic, he says. Convinced that they'll eventually contract HIV anyway, they decide to have fun while they can, says Swinton, 36, of Silver Spring, Md. By age 25, one in four black gay men have HIV, according to a report from the Black AIDS Institute, due out today.
Swinton tested positive for HIV in February. He had been unemployed and uninsured for more than a year and delayed getting care for four months.
"When people find out they have the disease, they're in shock, they think, 'I'm going to die,'" says Swinton, who also has type 1 diabetes. "They think: 'If I get treatment, then I'm facing the truth that I have the disease. I'd rather just live my life and see what happens.'"
Swinton agreed to see a doctor only because of Goforth's daily phone calls. Goforth even accompanied Swinton to his first doctor's visit.
"You can't just leave somebody with devastating news like that all on their own," says Swinton, now working and insured. "They don't have anything to fight with."
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