New optimism about stemming spread of AIDS
More than 20,000 HIV researchers and activists will gather in Washington, D.C., for the International AIDS Conference later this month to discuss, among other things, the possibility of dramatically reducing the number of people worldwide infected with HIV/AIDS.
The Associated Press
WASHINGTON — An AIDS-free generation: It seems an audacious goal, considering how the HIV epidemic still is raging around the world.
Yet more than 20,000 international HIV researchers and activists will gather in the nation's capital later this month with a sense of optimism not seen in many years — hope that it finally may be possible to dramatically stem the spread of the AIDS virus.
"We want to make sure we don't overpromise," Dr. Anthony Fauci, the National Institutes of Health's infectious disease chief, told The Associated Press. But, he said, "I think we are at a turning point."
The big new focus is on trying to get more people with HIV treated early, when they're first infected, instead of waiting until they're weakened or sick, as the world largely has done until now. Staying healthier also makes them less likely to infect others.
That's a tall order. But studies over the past two years have shown what Fauci calls "striking, sometimes breathtaking results," in preventing people at high risk of HIV from getting it in some of the hardest-hit countries, using this treatment-as-prevention and some other protections.
Now, as the International AIDS Conference returns to the U.S. for the first time in 22 years, the question is whether the world will come up with the money and the know-how to put the best combinations of protections into practice, for AIDS-ravaged poor countries and hot spots in developed nations as well.
"We have the tools to make it happen," said Dr. Elly Katabira, president of the International AIDS Society, which organizes the world's largest HIV conference, set for July 22-27. He points to strides already in Botswana and Rwanda in increasing access to AIDS drugs.
But Fauci cautioned that moving those tools into everyday life is "a daunting challenge," given the costs of medications and the difficulty in getting people to take them for years despite poverty and other competing health and social problems.
In the U.S., part of that challenge is complacency. Despite 50,000 new HIV infections here every year, an AP-GfK poll finds that very few people in the United States worry about getting the virus.
Also, HIV increasingly is an epidemic of the poor, minorities and urban areas such as the District of Columbia, where the rate of infection rivals some developing countries.
The conference will spotlight this city's aggressive steps to fight back. These include a massive effort to find the undiagnosed, with routine testing in some hospitals, testing vans that roam the streets, and even free tests at a Department of Motor Vehicles office. Rapidly getting those patients into care is the next step.
"These are the true champions," Dr. Mohammed Akhter, director of the city's health department, said of patients who faithfully take their medication. "They're also protecting their community."
Combination of risk factors
About 34 million people worldwide have HIV, including almost 1.2 million Americans. It's a very different epidemic from the last time the International AIDS Conference came to the United States, in 1990. Lifesaving drugs emerged a few years later, turning HIV from a death sentence into a manageable chronic disease for people and countries that can afford the medications.
Yet for all the improvements in HIV treatment, the rate of new infections in the U.S. has held steady for about a decade. About 1 in 5 Americans with HIV don't know they have it, more than 200,000 people who unwittingly can spread the virus.
Government figures show most new U.S. infections are among gay and bisexual men, followed by heterosexual black women. Of particular concern, African Americans account for about 14 percent of the population but 44 percent of new HIV infections.
ZIP codes play a role in risk, too. Twelve cities account for more than 40 percent of the nation's AIDS cases: New York, Los Angeles, Washington, Chicago, Atlanta, Miami, Philadelphia, Houston, San Francisco, Baltimore, Dallas and San Juan, Puerto Rico. Many are concentrated in specific parts of those cities.
"Maps tell the story," said Brown University assistant professor Amy Nunn, who is beginning a campaign that will bring a testing van door-to-door in the hardest-hit Philadelphia ZIP code.
"It's not just what you do, it's also where you live. There's just a higher chance that you will come into contact with the virus," she explained.
Potential for prevention
Prospects for a vaccine are so far elusive and health disparities are widening, so why the optimism as expressed by the Obama administration's goal of getting to an AIDS-free generation?
Consider the potential strategies, to add to tried-and-true steps such as condom use and treating HIV-infected pregnant women to protect their unborn babies:
• Studies found treatment-as-prevention could lower an HIV patient's chance of spreading the virus to an uninfected sexual partner by 96 percent. In the U.S., new guidelines recommend starting treatment early rather than waiting until the immune system has weakened. Abroad, the United Nations hopes to more than double the number of patients being treated in poor countries to 15 million by 2015.
• Other studies show a longtime AIDS medication called Truvada can prevent infection, too, if taken daily by healthy people who are at risk from their infected sexual partners. The U.S. Food and Drug Administration is expected to decide by fall whether to formally approve sale of Truvada as an HIV preventive.
• A study from South Africa found a vaginal gel containing anti-AIDS medication helped protect women when their infected partners wouldn't use a condom, generating more interest in developing women-controlled protection.
• Globally, experts also stress male circumcision, to lower men's risk of heterosexually acquired HIV.
In the U.S., the government is targeting the hardest-hit communities as part of a plan to reduce HIV infections by 25 percent by 2015, said Assistant Secretary of Health Howard Koh. Work is under way to learn the best steps to get people treated early, including in cities such as Washington, where 2.7 percent of residents have HIV, roughly four times the national rate.