World AIDS Day has become a time to reflect on the daunting challenges we face in the battle against this tenacious killer. Although huge strides have been made over the past two decades, we are, in many respects, continuing to lose ground as new infections outpace our ability to deliver treatment. Of 33 million people in the world who are HIV positive, only about 4 million are on treatment. Last week, UNAIDS and WHO released statistics which imply that the global epidemic may be slowing, but in hard-hit countries, that statistical aberration is not felt at all. However, on the 21st annual World Aids Day, there is reason to be hopeful.
When President Obama took office, he identified international development as a key area for strengthening global security. Since that time, we have, tantalizingly, begun to see movement forward in the area of global health. The days of placing ideology over science may be over, as USAID bureaucrats once again put family planning, maternal health, child health, and rational preventive programs for stanching AIDS on the front burner. The outrageous promotion of religiously-inspired abstinence-training programs appears to be exiting rapidly and in another hopeful sign, HIV-positive foreigners are once again free to enter the country.
That's not all: with the mid-November announcement that the former Gates Foundation superstar Dr. Raj Shah would be nominated to head USAID, real leadership and movement forward on global public health may now be possible. Dr. Shah is expected to be confirmed, and with the removal underway of ideological roadblocks to sane and effective prevention strategies, he should consider the following.
There are two key areas where effective developments continue to elude researchers: a cure for HIV/AIDS and an effective vaccine to prevent it. The development of a vaccine has become the holy grail of drug researchers, and this September's announcement that an experimental vaccine appeared to cut the risk of becoming infected with HIV by more than 31 percent made headlines globally. Unfortunately, analysis of the trial's results suggests that the results may have been distorted by the data and that the vaccine may be statistically ineffective.
That's a blow to those of us who work in public health with a concentration on fighting HIV/AIDS, but we must move forward as quickly as possible. An effective vaccine should be pursued aggressively, but it is not the only way to achieve the results we need.
Although today's drug regimens can bring viral levels to scarcely detectable levels and can dramatically expand a person's life expectancy, it's still a dream to find a way to completely wipe out the virus. Both these scientific goals must be top priorities in the years to come, because it's clear that even the most effective prevention and treatment programs leave the global health system with an enormous burden for years to come.
That said, there's much more that can be done today to fight the pandemic. It's a painful truth about human behavior that the pandemic could theoretically be shut down today if every HIV positive person were to consistently use condoms. That's right - condoms are virtually 100% effective in preventing the spread of the virus yet their utilization levels remain appallingly low. That's in part the result of the failure of aid programs to emphasize them during the past decade. With a modest outlay of financial resources for accelerated education and distribution programs, however, we could start to see some real traction. Such a move proposed during the last administration would be unheard of but we now have a chance to position them as the first line prophylaxis.
The effectiveness of such programs in the developed world has been proven, and every piece of evidence we have shows that, of existing preventatives, condoms have no equal. However, they have heretofore been ignored in favor of the unrealistic abstinence programs which, may have encouraged the spread of HIV. It's a catch-22 situation; we have been getting better at distributing and delivering anti-retrovirals, while at the same time, we have been getting worse at protecting people from infection.
Despite nearly a quarter of a century of treatment and research, nearly two million die from AIDS every year. The pandemic only gains momentum: nearly three million new cases of the disease occurred this year, and only a small percentage of these patients will receive treatment before they die. In June 2008, a joint WHO/UNAIDS report showed that nearly three million people were receiving anti-retroviral drugs in the developing world, less than a third of the 9.7 million people who needed them at that time. That's a polite way of saying that 6.7 million were dying for lack of drugs.
This must change. When someone is drowning, you don't ask that person's beliefs, you save her. Ideology can't have a place in lifesaving programs on any scale, whether its one person or three million. As our next USAID Administrator considers his opening moves in his war against HIV/AIDS, I'd suggest that if we are to make some dent in the vast number of new HIV cases that appear annually, we will have to use our most effective tools.
