President Obama marks World AIDS Day

Paul A. Volberding , MD

World AIDS Day reminds us to consider where we stand in hopes of ending the epidemic while recalling all those still being lost worldwide. This year has been a very positive one, culminating in AIDS 2012 in Washington, D.C., marking the return of the largest AIDS conference back to the United States; the first since 1990, thanks to the lifting of the travel ban on HIV-infected persons. While we look at the advances in transmission prevention through the use of antiviral drugs, the world remains in desperate need of an effective HIV vaccine. Great progress, but still many challenges.

Kevin Fenton, MD, PhD

As we reflect on the devastating global impact of HIV on World AIDS Day, we must not forget that our fight against HIV at home is far from over.  More than 1.1 million people in the United States are living with HIV, and nearly one in five of those don’t know they are infected. In the United States, gay and bisexual men, African Americans and Latinos are particularly affected by HIV. The new Vital Signs report released this week also underscores the significant impact that HIV has on our nation’s youth. Too many young people are becoming infected with HIV, are not aware of their status and are not getting tested.

Achieving both the vision of the National HIV/AIDS Strategy and an AIDS-free generation will require that we address significant challenges. Too many people with HIV don’t know they are infected, and many of those with HIV do not receive ongoing treatment and care. Education and awareness about HIV remain critical. Additionally, disparities in HIV rates are fueled by social and economic conditions, which we must address if we are to defeat this epidemic. But what can we do about this? Expanding the impact of HIV prevention is key to ending the US epidemic. Fighting HIV requires action from all of us, and physicians play a critical role in helping to increase access to HIV testing and care. We must make HIV prevention a top priority. We must raise awareness about the impact of HIV and needed solutions, as well as fight the stigma that continues to fuel the epidemic’s spread. Finally, as individuals, we must get tested for HIV, and protect ourselves and our partners from this devastating disease.

W. David Hardy, MD

World AIDS Day was established by the International AIDS Society in 1998. Since its first observance, the primary purpose has been to raise and maintain awareness of the global AIDS pandemic. Historically, the day became one of remembrance for the people who have died from AIDS.

The emphasis on World AIDS Day today has become more about the hope of creating an AIDS-free generation, globally, using the science that our world has created in terms of offering life-saving treatment to people who are infected with HIV. Recognizing the tremendous scientific progress made since the disease was first discovered in 1981, we must celebrate how quickly we have applied our new discoveries to the development of a new arena of anti-viral treatment. We have transformed a disease that was once almost 100% fatal into one that is chronically manageable, though not yet curable.

To succeed in creating an AIDS-free generation, there are several areas we need to address. First, we need to decrease the social stigma associated with the disease, as it destroys as progress as much as the virus itself. Second, we must increase HIV testing and screening of all U.S. citizens aged 13-65 years, including it as we do for other common medical conditions like hypertension and diabetes. The U.S. Preventive Services Task Force recently issued a recommendation in support of routine HIV testing for adults and adolescents.  Third, we must recommend initiation of highly effective combination ART for people with HIV infection. There have been significant advances in treatment: we now have three one-pill, once-daily regimens. While we have not yet cured HIV, we certainly have created treatment regimens that are very effective, well-tolerated and easy to take.

Fourth, on a larger scale, we must prevent transmission of HIV by using treatment as prevention. We have learned that treatment is not only good for the person who has HIV, but it is also good for stopping the transmission to others in the community. In many areas of the world, mother-to-child transmission remains a major source of HIV infections. By treating the mother, we can prevent transmission to her children, which prevents transmission into the next generation.

The prevention of new HIV infections stopping HIV transmission to babies and preventing death due to AIDS are the biggest challenges to creating an AIDS-free generation. This achievable goal has been recognized by many global organizations, including WHO, PEPFAR, NIH, HIVMA and the Center for Global Health Policy. The science on which this goal is based is well supported by research largely organized and funded by the NIH, which has had a tremendous role in creating ART treatments and in demonstrating that treatment is a form of prevention. Professional organizations like HIVMA and others continue to play a significant role in advocacy to use these tools that have been developed by the scientific community.