HIV/AIDS, where are we at in the epidemic?

December 1st, 2014 was the 26th World AIDS Day. For a little background here, World AIDS Day (the first ever global health day) was first started in 1988 by the WHO  and it’s a worldwide day dedicated to the awareness of HIV/AIDS and for people to come together to get involved in the fight. But this post isn’t about World AIDS Day, persay, but is more about the current state of HIV/AIDS in the world and where we’re at with new treatments/cure possibilities.

In the US, the CDC says that more than 1.2 million people are infected with HIV and 14% (168,000!) of those people don’t know they’re infected. Around the world, there are 35 million people living with HIV/AIDS and 1.5 million people died from HIV/AIDS related issues in 2013. Since the beginning of the epidemic, 78 million people have been infected and 39 million people have died. These are large numbers but we must also think about the fact that many of those who’ve died from HIV/AIDS have died in the prime of their lives, leaving behind children and other family members. The fact that many of the dead died during their highest earning power years means that this disease, globally, has had a tremendous effect on the earning power of affected countries, by taking away their workers and taxpayers. But although we don’t have a quick fix for HIV just yet, I’d like to think we’re on the horizon.

For the first time ever, in 2014 there were more HIV positive people put on treatment than there were new infections identified. This is the TIPPING POINT people! Since we know that treatment is prevention, putting people on treatment to decrease their viral load lessens the likelihood that those folks can transmit HIV. Word on the street is that if we continue to increase the number of people put on ARVs (anti-retrovirals aka HIV drugs) and decreasing the number of people infected, we could end this epidemic in 15 years. While I’m hesitant to say this is for sure the beginning of the end, there is promise with the increased usage of ARVs and with the other HIV/AIDS related prevention/treatment products coming to market.

So one new product (well a reuse of a current product really) that many people may have begun hearing about is PrEP. PrEP stands for pre-exposure prophylaxis. This is an HIV drug (Truvada) already being used by those who are HIV positive, but now being put to use in those who are HIV negative as a once a day pill to prevent HIV. As you may imagine, there is a whole host of controversy around the use of PrEP. Basically that controversy centered around the use of PrEP allowing people to be more sexually irresponsible than if there was still the threat of contracting HIV. In my opinion, the people saying this remind me of when women’s birth control pill came about, because we all know that the pill just made women start having sex with everybody they ran into on the street since there was no longer any worry of pregnancy-see how utterly ridiculous their argument is? As my wonderful friend Sergio stated in a video about PrEP he did for MSNBC, if condoms worked so well and people always used them we wouldn’t have an HIV epidemic. PrEP is just another tool in the toolbox of HIV prevention, not every tool works for every person so let’s stop getting all judge-y and just applaud people who are at least doing something to prevent themselves from contracting HIV.

Another HIV prevention tool you may or may not have heard of is microbicides. Microbicides are compounds that can be applied in the vagina or rectum to prevent the transmission of HIV. The availability of microbicides allows women in societies where they cannot ask their partners to wear condoms (or condoms aren’t readily available) to take control of their sexual health by applying the microbicide before sex without their partner necessarily knowing. USAID and PEPFAR have shown that microbicides do work to prevent HIV.

Now no talk about HIV would be complete without the discussion of where we’re at with a vaccine. So far there has only been 1 HIV vaccine that has ever shown any sort of impact to prevent HIV, the Thai vaccine study aka the RV 144 vaccine. Scientists got to work reformulating the Thai vaccine since the original results at preventing HIV were barely statistically significant and the immunity provided to folks seemed to decrease with time (definitely not something you want for a vaccine). Now 5 years since the initial Thai vaccine study, scientists have tested the reformulated vaccine in South Africans. This attempt stimulated some immune response but not the exact type and strength that the researchers need for the vaccine to be effective. Because HIV is such a hypermutable (mutates A LOT) virus, getting an immune response that would work against all future mutations that HIV might make is extremely hard. But the good news is that with each attempt that doesn’t work out as hoped, researchers are learning a little bit more and are making improvements to the vaccine.

The future of HIV/AIDS around the world is not as bleak as it once was. While we still have a long way to go before we can say humanity has beaten HIV, we are getting to the point where I can realistically say that this win might happen in my lifetime.

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