AIDS at 30: Time to Act
07/12/2011
Dr. Bertozzi, Gates HIV director says crisis is "forcing us to become smarter, more efficient, and get more value for money"
The HIV/AIDS pandemic was 10-years-old in 1991 when I joined the University of California at San Francisco as a young medical resident. It was a humbling time to begin practicing medicine; almost all of our AIDS patients died within two years of diagnosis.
As the world marks the 30th anniversary of the CDC's first report about AIDS, I think back to those dark times - and of the resilience of the human spirit.
For those years also marked the dawn of disease-specific advocacy and civil disobedience, movements that helped change the world.
Few imagined that, by 1996, combination antiretroviral therapy would start turning HIV into a chronic condition. Fewer still imagined that these drugs, originally priced at $15,000 a year, would reach the world's poorest countries.
I cite this history because the pandemic is at another turning point. This time, the new research breakthroughs are in HIV prevention.
We are on the cusp of having a robust new set of HIV prevention tools. Male circumcision, pre-exposure prophylaxis (PrEP), vaginal microbicide gels, prevention of mother-to-child transmission, treatment as prevention - we now know that all of these tools can slow transmission of the virus. An HIV vaccine remains the best long-term hope, but we cannot allow the perfect to be the enemy of the good.
"Combination prevention" has a nice ring but where should the world invest scarce resources? Two measures stand out in terms of cost effectiveness.
First, we must accelerate the rollout of male circumcision in southern and eastern Africa. Second, we must offer treatment to infected pregnant women to protect their health and their babies from HIV infection. Both save more money than they cost and will save countless lives.
What about the recent flurry of excitement around "treatment as prevention" following the recent NIH-funded HPTN 052 trial?
It is wonderful to have proof that efficacious treatment is also efficacious prevention. We had strong evidence before, but it is now incontrovertible. However, let's not over-interpret those results. Two thirds of people with HIV in developing countries die for lack of access to treatment. We must focus on those who most need treatment for themselves - both for their own sake and because available evidence suggests that treating them will also have the greatest prevention benefit for others.
With today's limited resources, it would be a shame if we relaxed our efforts to increase treatment coverage among those most in need because we over-interpret the HPTN 052 results. It may be true that all treatment is beneficial because it all has prevention benefit, but some has a much lower cost and higher benefit than others. If collectively we don't focus our investments where they do the most good, people will become infected and die unnecessarily.
I know that these are difficult financial times, but I'm still optimistic. The crisis is forcing us to become smarter, more efficient, and get more value for money - and that will strengthen the response in the long-term. We are also finally seeing real success in the development of new prevention tools.
It has been a tough 30 years, but we've never had as many opportunities for action as we have today.
Dr. Stefano Bertozzi is director of HIV and Tuberculosis at the Bill & Melinda Gates Foundation.
E nough time we spend,now need good co-ordination among us,all of organization
&PPP;(Public-Private-Partnership) to achieve
our goal with training Programs& follow-up.
I agree with your way to do more work jointly
with good out come.
— Dr.Prakash Sanchetee on 2011-07-16
Thank you Dr. Bertozzi for the article which helps to affirm our commitment to prevention and creating access to services to the poor. There are many proven interventions as rightly stated in your articles. However, creating access to these services and products to the poor in Sub-Saharan Africa is still a huge challenge after 30 years of the AIDS epidemic. Only about one third of those who need ART are on treatment in my own country, Ethiopia. I was watching a news on local television in the country of my residence, Uganda, where treatment was interrupted due to short supply of the drugs in one of the corners of the country and patients walked/travelled hours and days to express their frustration and voice out their grief. We are still far behind reaching a universal access to treatment. It is good to take heed to capitalize on the accessible and cost effective prevention and care services such as MMC and PMTCT. With Best Regards
— shelemo Kachara on 2011-07-19
Inspiring writing, and we hope within few years remedial medicine for the infected and best preventive measure may be vaccine will available for the susceptibles and risks.
— Mahendra Shrestha on 2011-07-19
This writings gives the better picture of Nepal. In Nepal specially far western region is highly affected by HIV/AIDS. If we calculate the epidemicity of Nepal It is about 0.455 in total population and if we see the region wise it is about 1% in Farwest region. The total population of this region is about 3million and most of the people from here are seasonal migrants for India. Male seasonal migrants mostly the distination is Mumbay and the infecterd male are died due to HIV and their female spouse are still survived due to the use of ART (HAART). ART became the life of most survivors. In Nepal the use of ART for general people fro governemt side is about 8 years.
— Mahendra Shrestha on 2011-07-19
What a radical idea… treatment as.. err, you know, err, treatment.
Couldn’t agree more. No prevention revolution 2.0 getting to zero/breaking the trajectory contortions required.
— Tim France on 2011-07-20
30 years of HIV/AIDs.Let us put our focus on behaviour change and prevetion of mother to child transmission.Together we win!
— Nelly kanjele on 2011-07-20