February 28, 2014

Progress in Prevention on World AIDS Day

This World AIDS Day comes at a time of remarkable progress in biomedical HIV prevention. In late November, researchers announced that in a Phase III trial, a daily dose of an antiretroviral (ARV) treatment taken as prophylaxis reduced HIV infection in men at high risk by 44%. Earlier, a vaginal microbicide gel reduced HIV infection in women in a trial in South Africa by 39%, an AIDS vaccine candidate showed modest (31%) efficacy, and researchers discovered powerful new antibodies to many variants of HIV, thus providing researchers important clues about how to design AIDS vaccines to elicit such antibodies.

New epidemiological data released by UNAIDS show that rates of both new HIV infections and AIDS deaths are slowly falling. Still, the burden of AIDS is unacceptably high.  Each day, 7,100 people become infected with HIV, 1,000 of them children. Two people are infected with HIV for each one who starts antiretroviral treatment.

Since HIV was discovered to be the cause of AIDS in 1983, there has been one great scientific advance in suppressing the virus: a revolution in treating HIV. Largely because AIDS activists demanded expedited research and approval, there are now more drugs licensed to treat HIV than there are for all other viruses put together. Generous donors and innovative pricing mechanisms have made those antiretroviral drugs available to a third of those in the developing world who need them to stay alive and healthy. Increasingly however, both donor and recipient governments are struggling to continue to make the necessary resources available to sustain and expand access to these drugs for those who need them.

The time has come now for a second AIDS revolution—a revolution in HIV prevention. The goal of this revolution is to end the devastation of AIDS once and for all.  As the recent scientific advances indicate, this is an achievable goal. Rates of HIV transmission can be reduced by using all the currently available evidence-based methods of prevention—condoms, male circumcision and clean needles. Access to ARV treatment for all HIV-positive people who need it saves their lives and reduces the likelihood that they can transmit HIV to others. According to some projections, adding microbicides and ARVs as prophylaxis to the available HIV prevention menu could cut the global HIV infection rate in half. A broadly effective vaccine, on top of that, could eventually end the AIDS pandemic altogether.

While the science for these new tools is promising, further progress is threatened by limited funds. Funding for research on new HIV prevention methods is flat, yet advancing new findings through the product-development process will require expanded funds. While sustaining commitments to HIV treatment and care and to current prevention efforts, governments should make significant investments in new prevention methods as well. AIDS activists can play their part, too, demanding the development of new HIV prevention tools as passionately as they have demanded universal access to HIV treatment. The struggle to end AIDS cannot be won with half measures.