As we prepare to commemorate 30 years since the first AIDS case was diagnosed in America, we now have the tools that could end the HIV pandemic.
Last week
the National Institute of Allergy and infectious diseases (NIAID) at the
National Institute of Health (NIH) released the results of a historic study
demonstrating the efficacy of treating HIV patients with antiretroviral drugs
as a method of HIV prevention.
The study
involved 1,763 couples in which one partner was HIV negative (not infected with
HIV); the other partner was HIV positive (infected with HIV). All of the HIV positive participants
had a T-cell count—a measure of their immune system's strength—of between 350
and 550. The participants were
randomly divided into two groups. One group started on antiretroviral treatment right away, while
researchers delayed treatment for the other group until the HIV-positive
partner exhibited symptoms of an AIDS-related illness or his or her T-cells
fell to 250 (the recommended time to start antiretroviral therapy for most of
the world at the time the study began). All participants were given condoms and provided HIV- and STI-prevention
services.
During
the study's 6-year duration, 28 infections were genetically linked to the
HIV-positive partner. Of those, 27
occurred in the group whose treatment was delayed; only one took place in the
group where treatment had been started right away. This suggests that if a person with HIV takes antiretroviral
(ARV) treatment they are 96 percent less likely to pass on the virus than
someone who is HIV-negative and not taking preventive ARVs.
These
findings definitively end the previous debate about whether to invest in
prevention or treatment. There is
no longer a “prevention strategy”; there is no longer a “treatment
strategy.” From now on there
should only be a coordinated “end the AIDS epidemic strategy”; for if the
results of this study are confirmed, treatment is prevention!
These
results come on the heels of promising clinical trial findings about the
efficacy of vaginal microbicides for women and pre-exposure prophylaxis for men
who have sex with men.
We have
reached a deciding moment: HIV is 100 percent preventable, 100 percent
diagnosable and in many cases treatable. Our prevention toolbox is now exploding with options. We now have the tools to end the AIDS
epidemic!
But, the
question remains whether we have the political will to invest in using these
tools strategically, effectively, and compassionately.
It’s time
to call on Congress, the Obama Administration, and federal and state agencies
to do three things:
1. Invest in expanded access to
testing and linkages to care.
2. Increase access to care for
vulnerable communities including the ADAP waiting lists.
3. Raise HIV science and treatment
literacy in vulnerable communities.
People
need to know their HIV status, and those who are HIV positive need to be linked
to appropriate care immediately.
Federal and
state governments must address the ongoing funding crisis facing the AIDS Drug
Assistance Program (ADAP), which provides HIV-related prescription drugs to
those who are underinsured or without insurance. Over 30 percent of all people diagnosed with AIDS are
enrolled in ADAP. Over 60 percent
are uninsured, and 55 percent are Black or Hispanic.
Nationally
nearly 8000 people remain on ADAP waiting lists. Fourteen states have reduced the number and types of drugs
they will pay for. A number of
states have stiffened financial eligibility requirements, capped enrollment or
removed some people who were already enrolled. Other states are considering
doing the same.
This
approach is outrageous. Not only
are such cuts immoral and financially shortsighted, as these recent data prove,
starving ADAP programs creates a public health threat.
We also
need to finally invest in HIV treatment education in vulnerable
communities. HIV health
disparities are growing in the U.S., and Black people are disproportionately impacted.
Black Americans become infected at a younger age and at higher rates, are
diagnosed at a later point in their disease, and die faster than any other
racial ethnic group. Our lack of
scientific understanding about how the virus behaves in the body and what
options exist to treat it is one of the biggest barriers to efforts to confront
HIV in our communities.
Lacking
this knowledge too many of us in the Black community become distracted by myths
and misinformation. When we don’t
understand the science of HIV/AIDS, we are unable to protect ourselves, we put
off getting tested, delay starting treatment, fail to adhere to the treatment
regimens, and are reluctant to own the disease and/or our responsibility for
ending it.
If we
don’t raise HIV-related science literacy, capacity and infrastructure in Black
communities, Black people will continue to be left behind, and we won’t succeed
in ending the disparities, despite the biomedical advances we’re making.
As the
saying goes, “An ounce of prevention is worth a pound of cure.” We may have reached a time where
we can get both a pound of prevention and a pound of cure/treatment on the same
dime—if only we’re willing to spend the dime.
Phill
Wilson, President and CEO of the Black AIDS Institute.
