The Battle to End AIDS

It has been 38 years and a month since the first case of HIV infection was detected in 1981, according to Anthony Fauci, Director of the US National Institute of Allergy and Infectious Diseases (NIAID), who told a recent conference in Mexico City that life expectancy for a 20-year old newly diagnosed with HIV, only one to two years in the 1980s, has now increased to an average 53 years if that patient is on anti-retroviral therapy.

The world now has the knowledge, expertise and evidence-based tools to prevent transmission of HIV, according to Juergen Rockstroh, a professor of Medicine at the University of Bonn, who attended the conference. So far, although 193 governments have promised to end AIDS by 2030, a reality check shows there is a long way ahead to end the scourge, one of the most deadly killers in human history.

Ending the AIDS epidemic, Rockstroh said, is more than a historic obligation to the 39 million people who have died of the disease. It also represents a momentous opportunity to lay the foundation for a healthier, more just and equitable world for future generations.

Just 17 months to bridge the gap

Yet, despite all this, as per the latest UNAIDS report, launched in Washington, DC on July 19, 37.9 million people today are living with HIV (PLHIV) out of which 14.6 million are still not able to access antiretroviral therapy (ART). In 2018 there were 1.8 million new infections (5,000 new HIV infections each day) - which was just 100,000 fewer than 2017. Thus global reduction in new HIV infections has fallen off the so-called 90-90-90 targets for 2020. [90-90-90 refers to a situation in which 90 percent of those living with HIV know their status, 90 percent are provided with anti-retroviral drugs and 90 percent of HIV positive patients are virally suppressed.]

The infection rate must be brought down to 500,000 million by 2020 in order to achieve the UNAIDS targets. In fact, there is a gap of 7.7 million to reach all the three 90s of these targets. The world has just 17 months to bridge this gap.

"It is high time to set our eyes, not on just the 2020 targets but on the targets to end AIDS by 2030, which are 100 percent of people living with HIV must know their status, 100 percent of people living with HIV must get ART, and 100 percent of HIV positive people must be virally suppressed and new HIV transmission rate must be zero," said Dr Ishwar Gilada, a governing council member of International AIDS Society (IAS) and President of the AIDS Society of India.

While conceding that some places including Thailand, Malawi, New South Wales, London and San Francisco have dramatically reduced HIV incidence and mortality, Dr Adeeba Kamarulzaman, President-elect of IAS and Dean of the Faculty of Medicine, University of Malaya, Malaysia, said that there are many countries where uptake and scale-up of prevention and treatment programs have been slow.

She cited HIV-associated stigma, criminalization of sex work and of men who have sex with men, lack of sustainable funding and political inertia, as the biggest barriers in implementing evidence-based interventions to prevent and treat HIV.

Echoing similar sentiments, Dr N Kumarasamy, Director of Infectious Diseases Medical Centre at VHS Hospital in Chennai said the required science and biomedical tools are available to achieve this target, but challenges around linkages and retention should be addressed.

Seize this opportunity that we have now

In the words of Dr Quarraisha Abdool Karim, Associate Scientific Director, CAPRISA, South Africa and UNAIDS Special Ambassador for Adolescents and HIV: ‘We have the evidence to achieve HIV control, an important first step. But we need to do much more to realize this goal.”

The medical profession, he said, “needs to sustain and expand current achievements in treatment and enhance prevention efforts; we need to reach those we have been unable to reach; we need local, national and international political commitment. We need partnerships with communities and the private sector; we need innovations to improve current treatment and prevention modalities, and for a vaccine and a cure; and we need an appreciation that investments today will be more cost-effective with massive human capital gains compared to finances that will be needed in the future if current trajectories remain unchanged. We need to seize this opportunity that we have now.”

And as has been said, it is not simple anywhere but possible everywhere. We are aiming to reach there and we will get there, provided policy makers know the cost of inaction and prevent the epidemic of bad policies from blocking the path that leads to an AIDS free world.

Shobha Shukla is editor of Citizen News Service