Will HIV/AIDS go down in history as the single largest pandemic of all time or will we effectively stop this killer before it tops the bubonic plague of the Middle Ages or the Great Influenza of 1918-1919? Early warnings suggested that HIV/AIDS deaths could reach 90 million, higher than the estimated 75 million that fell victim to the "black death" in the 14th century and the more than 50 million that died of the Spanish Flu as World War I ended. Now, thirty years into the crisis, AIDS has infected 60 million people and 27 million have died. How will history judge our response? And where do we go from here?
When AIDS first hit in the summer of 1981, doctors were baffled -- all they could do was help orchestrate a dignified death for their patients. Today, due to unprecedented investment and global collaboration, more than thirty drugs have been licensed to treat AIDS and more than 6 million HIV-infected people in the world's poorest countries are receiving lifesaving treatment. This is a modern miracle of science, medicine, and humanity.
Their effects are impressive, however, antiretroviral drugs are not a cure -- once infected, always infected.
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In the United States, approximately 1.2 million people are living with the virus although 20 percent are unaware of their status. New infections have stabilized from a high of 130,000 in the 1980s to approximately 50,000 annually. African-Americans have been particularly hard hit accounting for 44 percent of new infections while forming only 12 percent of the population. Unfortunately, as treatment options have expanded, complacency about the disease has set-in resulting in a continuing spread of the virus.
Antiretroviral therapy has allowed HIV-infected subjects in the United States and Europe to live longer with a greatly improved quality of life. These individuals are no longer dying of AIDS or related illnesses, but instead are succumbing to the same diseases of the heart, liver, kidney, brain and other organs that affect the general population. Disturbingly, these diseases are striking 10-20 years earlier in those infected with HIV despite effective antiviral treatment. Urgent efforts are now underway to understand why this "accelerated aging" is occurring and to devise ways to interrupt it.
While the tide was turning in the United States and other developed nations in the mid 1990's, Africa was dying of AIDS. Seven out of every ten new infections in the world occur within the sub-Saharan region. The 2000 International AIDS Conference held in Durban, South Africa helped galvanize the world into action. Highly successful programs like the President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria were launched and individuals from all walks of life came forward. These efforts are clearly paying off with twenty-two different African countries now reporting declining HIV infection rates. Storm clouds are on the horizon. The Global Fund recently announced that no new grants will be made until at least 2014 due to financial constraints. Our gains in the global HIV/AIDS epidemic are very fragile; the world desperately needs continued vigorous leadership by PEPFAR and the Global Fund.
Despite tremendous advances in treatment, prevention of HIV infection is the surest way to end the global threat of HIV/AIDS. Stunning advances have occurred on this front. Male circumcision has been shown to reduce HIV spread from infected women to men by about 60 percent; massive campaigns are now underway to circumcise adult men. A single antiretroviral pill taken once a day can prevent high-risk individuals from becoming infected and a new microbicide is at last providing women a safe means to partially protect themselves from HIV.
We continue the search for the "holy grail" of HIV prevention -- an effective vaccine. While the virus's ability to alter its form through mutation has thus far thwarted efforts, there is cause for hope. A recent HIV vaccine trial conducted in Thailand provided a hint of effectiveness for the first time.
Less heralded than advances on the treatment and prevention fronts, the HIV/AIDS crisis is spurring fundamental changes within African health systems that promise long-lasting and beneficial effects. A strong and self-sufficient Africa with health systems in place for delivering high-quality care to their populations and capable of confronting and containing the next epidemic, which is inevitable, is in the best interest of both Africa and the world.
One successful approach to building health capacity involves the creation of African-owned and African-led centers of excellence like Accordia Global Health Foundation's flagship program, the Infectious Diseases Institute (IDI), in Kampala, Uganda. Through its clinical, training, and research programs, IDI is helping change the health landscape of Uganda. IDI is also providing professional opportunities for talented African physicians and nurses who otherwise might have left for positions in the United States or Europe (Click here to read "Meet Dr. Sabrina"). The impact and reach of centers like the IDI are exceeding all expectations and provide a promising blueprint for building a healthier and stronger Africa.
There is much to be proud of in the history of HIV/AIDS, but our work is far from done. Today, President Obama and former President George W. Bush are commemorating this World AIDS Day in an address to George Washington University students, calling for the "beginning of the end of AIDS." This is a welcome reaffirmation of U.S. leadership in accelerating global efforts to end the HIV/AIDS epidemic. The impact of this commitment will be felt from Washington D.C. -- where infection rates rival that of many African countries -- to Kampala, Uganda.
In July 2012, Washington, D.C. will host the XIX International AIDS Conference themed Turning the Tide Together, reflecting the real opportunity to change the course of human history. HIV/AIDS can continue to be remembered as inflicting the "single greatest reversal in human development in modern history" or as our single greatest triumph as a global community.
How do you want to be remembered?