"Undetectable" HIV: A New Goal for the Global AIDS Response?

AIDS exists as the continuing crisis it is today because of malicious inaction by governments and power holders. But AIDS activists have also shown that overcoming political cowardice is possible.
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As the International AIDS conference got under way in Melbourne Australia this week, following the tragic loss of leading HIV treatment activists and scientists on the downed Malaysian flight, AIDS activists issued a call for a new model for the AIDS response that would not have been thinkable just a few years ago. Leading groups from the AIDS movement throughout the world demanded a bold new focus on enabling every person with HIV to achieve an 'undetectable' viral load and challenged political leaders to set national and global targets to deliver on the means to achieve that goal by 2020. The statement is worth reading.

The idea of an 'undetectable' viral load has become important as new and effective HIV treatments let patients start earlier and actually control the HIV virus without many of the major side effects of older drugs. Recent science has shown doing so not only keeps people living with HIV alive and healthy, it also is among the most effective methods of preventing HIV infection available. Networks of people living with AIDS, including the Nobel-nominated Treatment Action Campaign of South Africa have begun mobilizing to demand access not just to AIDS treatment but to quality treatment, with good drugs, and well funded support programs to actually enable people to proclaim themselves 'undetectable.'

"Currently, reaching and maintaining an 'undetectable viral load' is the closest thing we have to a cure for HIV," read the statement from activists. Indeed, discussion of how to actually end the AIDS crisis are gaining real traction--both in the U.S. and around the world. Enabling people living with HIV to suppress the virus is an essential component to making that possible--which means they have to know their status and have access to high quality HIV treatment programs. Viral load testing has been available only in wealthy countries until quite recently--meaning most people living with HIV around the world have no idea whether they are, in fact, suppressing the HIV virus with treatment programs. But in recent years rolling out viral load in low- and middle-income countries has become a major priority--with tests as cheap as $10.

Meanwhile, there's an important additional message the activists delivered in Melbourne: ending AIDS and allowing all people living with HIV the opportunity to achieve an 'undetectable' viral load is possible--but it means redoubling efforts and refocusing on the politics of the AIDS response.

Currently, flat or declining budgets from donors are hobbling the AIDS response. Indeed, the Senate recently voted not to restore critical global AIDS funding cut from the PEPFAR program in recent years, funding the House of Representatives did include in their version of this year's budget. Meanwhile, the affordability of the new AIDS treatment is uncertain--attacks on India for producing generic versions of medicines and increasing patent barriers in middle-income countries mean new medications may not be available to millions of people around the world. The hypocrisy of Northern governments is increasingly evident as they pull back on promised support while demanding intellectual property rules that undercut access to medicines. And protection of human rights is also a concern. On the one had it is essential that the move to 'end AIDS' doesn't result in forced or coerced treatment--a tempting strategy for over-zealous public health authorities. In addition, this strategy of undetectable will only work if some of the most marginalized groups in societies actually get access--and often sex workers, men who have sex with men, people who use drugs and others are the last to receive access to healthcare.

There are few better examples in the world of politics and science blending to both create and to attack health challenges than in the global AIDS pandemic. AIDS exists as the continuing crisis it is today because of malicious inaction by governments and power holders. But AIDS activists have also shown that overcoming political cowardice is possible--and the next step is going to have to be tackling the tough challenges that would make it possible for every person living with HIV to have access to an 'undetectable' viral load. Stay tuned.

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