Is it too soon to imagine an end to AIDS?
Maybe not. Three decades into the AIDS pandemic, health officials say they have the medicines and other tools to stop the spread of HIV, the AIDS virus. But one of the biggest barriers is complacency.
"We are no longer in crisis mode after 30 years of HIV," says Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, part of the Centers for Disease Control and Prevention. "Certainly in the United States, the sense of crisis has waned. But the reality is that people are still becoming infected and people are still dying of this disease."
The Kaiser Family Foundation, in a survey released in June, found a "declining sense of national urgency and visibility of HIV/AIDS." It ranked seventh among national health concerns, after cancer, obesity, the uninsured, heart disease, health care costs and diabetes.
Yet for the first time, the goal of eradicating the disease is possible. Research reported recently by the National Institutes of Health found that people infected with HIV are much less likely to pass it to others if they're being treated with antiretroviral drugs in combination with using safer behaviors.
New research shows "treating people with HIV (is) 96% effective in reducing transmission," says Joel Gallant of Johns Hopkins University, vice chairman of the HIV Medicine Association. "Nothing has been that effective -- not condoms, not abstinence. That should be a call to action."
The new research "brings home that treatment is prevention," says CDC director Thomas Frieden, who on Tuesday announced new funding for state and local health departments to boost HIV testing and treatment. "We have the tools to stop HIV spread in individual patients and the tools to greatly reduce its spread in communities."
But the CDC says that of 1.2 million Americans with HIV, only 28% are being treated effectively, so the level of virus in their bodies is low enough for them to be healthy and unlikely to pass the virus to others. Almost 20% of those who are infected don't know it; of those who do, only 51% are getting ongoing treatment. Among those receiving treatment, 77% have suppressed levels of HIV.
Yet, Gallant says, funding for clinics may be in jeopardy, and because of strapped state budgets, thousands are on waiting lists to get medicines.
"People are getting on treatment much later and, during that time, are potentially creating more HIV cases. It's not a moral way to go."
The HIV Medicine Association is concerned that health care reform may make matters worse by cutting or eliminating funding for the federal Ryan White CARE (Comprehensive AIDS Resources Emergency) Act, which provides grants for AIDS clinics and other services, and transferring HIV coverage to Medicaid.
If the clinics lose funding, the infrastructure that supports the services patients need will disappear, and they will be more likely to get spotty or inadequate care, Gallant says.
"It's critical that we keep patients in treatment, because if they stop, it can create resistance to the drugs," he says. "Helping people to stay in care is not just beneficial to them, but also to society."
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