A Roadmap for Achieving an AIDS-Free Generation

The announcement of a roadmap to achieve an AIDS-free generation is a fitting way to commemorate the 30th anniversary of the reporting of the first cases of AIDS in 1981.
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By Susan Blumenthal, M.D., and Melissa Shive

Tomorrow on World AIDS Day, President Obama will speak about beginning to end the AIDS epidemic in America and worldwide. Last month, Secretary of State Hillary Clinton announced the U.S. government's commitment to achieving an HIV-free generation by building upon the accomplishments of the President's Emergency Plan for AIDS Relief (PEPFAR) and the significant successes that U.S. and international investments in science and services have already achieved in the prevention and treatment of HIV/AIDS. The strategy involves combining traditional prevention methods, health systems improvements and social change with three particular action areas: eliminating mother-to-child transmission of HIV, expanding voluntary medical male circumcision and increasing access to treatment for people living with HIV/AIDS -- all aimed at significantly reducing the transmission and impact of the disease.

The announcement of a roadmap to achieve an AIDS-free generation is a fitting way to commemorate the 30th anniversary of the reporting of the first cases of AIDS in 1981. For the first time in the history of the epidemic, the possibility of an AIDS-free generation is in sight. Over the past three decades, groundbreaking research has produced lifesaving antiretroviral medications (ARVs) that have revolutionized HIV/AIDS treatment. This past summer, two landmark studies conducted in Africa revealed that a once-a-day pill combining two commonly-prescribed HIV medications can also prevent HIV infection by 60-70 percent. Recently, other research has demonstrated that oral pre-exposure prophylaxis, or a "prevention pill," is an effective prevention approach. Additionally, groundbreaking research released in May found that early treatment of an HIV-infected partner decreased transmission to the uninfected partner by a dramatic 96 percent, underscoring that treatment is also prevention. These advances can now be combined synergistically with other proven public health prevention measures, including education, safe-sex practices, voluntary male circumcision, syringe exchange programs and blood supply screening to save countless lives, reduce human suffering, decrease health care costs and prevent new HIV infections in the years to come.

As our global HIV/AIDS efforts expand internationally, we must do more to control the epidemic in the United States as well. In August, the Centers for Disease Control and Prevention (CDC) released a report stating that the number of new HIV infections has remained unchanged over the past decade -- 50,000 each year, and there are still more than 18,000 deaths annually from HIV-related causes. Alarmingly, rates of infection have actually increased among young men who have sex with men (MSM), who account for 61 percent of new cases in the United States. A subsequent CDC report released Nov. 29 stated that nearly three out of four Americans living with HIV do not have their infection under control. This is because one in five people with HIV do not realize they are infected and, of those who are aware, roughly one-half are not receiving appropriate medical care and treatment. And while there has been significant progress in decreasing the number of new infections and deaths from the disease in the developing world, an AIDS amnesia has occurred in America with many people -- especially youth unaware that the illness is a persistent health threat in the U.S.

The treatment and prevention technology to decrease rates of infection and stop the spread of AIDS in America and around the world exists today but must be effectively deployed in communities across countries worldwide. Our nation is at a momentous decision point. We can either make the commitment to end the AIDS epidemic or spend billions of dollars each year for generations to come. If there is to be a world without AIDS, governments, foundations, scientists, health care providers and NGOs must work together to strengthen efforts and commit the needed resources to achieve this goal, including increasing the president's Emergency Plan for AIDS Relief (PEPFAR) treatment goal, increasing funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria, and fully supporting implementation of the U.S. National HIV/AIDS Strategy released last year. Landmark new scientific findings must be put into practice now and current evidenced-based programs scaled up. The drivers of the epidemic -- poverty, stigma and discrimination -- must also be eliminated. If we follow this roadmap, there can be an AIDS-free generation in the years to come.

Rear Admiral Susan Blumenthal, M.D. (ret.) is the Public Health Editor of the Huffington Post. She serves as Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C., a Clinical Professor at Georgetown and Tufts University Schools of Medicine, Chair of the Global Health Program at the Meridian International Center, and as Senior Policy and Medical Advisor at amfAR, The Foundation for AIDS Research. Dr. Blumenthal served for more than 20 years in health leadership positions in the Federal government in the Administrations of four U.S. Presidents, including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, as a White House Advisor on Health, and as Chief of the Behavioral Medicine and Basic Prevention Research Branch at the National Institutes of Health. She has received numerous awards including honorary doctorates and has been decorated with the highest medals of the U.S. Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide and was the recipient of the 2009 Health Leader of the Year Award from the Commissioned Officers Association. Admiral Blumenthal has been named by the National Library of Medicine, The New York Times and the Medical Herald as one of the most influential women in medicine and as a Rock Star of Science by GQ magazine and the Geoffrey Beene Foundation.

Melissa Shive, a medical student at the University of California, San Francisco and a Masters in Public Health student at Harvard University, served as a Research Assistant at amfAR, The Foundation for AIDS Research.