Until we have an HIV vaccine or a cure for AIDS, we must focus on optimizing HIV treatment and prevention with antiretroviral medication to slow, and control, the AIDS epidemic. Last year, about 2 million people became infected with HIV around the World. About 150,000 of them were children under the age of 15. As is the case in the United States, HIV rates are rising in several populations disproportionately, young gay men and transgender women, young women in sub-Saharan Africa, and people who inject drugs in eastern Europe and Central Asia.
Although some approaches to HIV prevention are simple in theory, such as consistent condom use for sex and access to sterile needles for people who inject drugs, the reality is more complex. Condoms may not be an option when there is interest in having children, or when monogamy is presumed, or when a partner refuses to use them. In some cases, those most vulnerable to HIV infection are persecuted by their governments for engaging in behaviors that may put them at risk for HIV. Nigeria, Russia, India, Uganda, and The Gambia have each criminalized same-sex behavior to varying degrees in recent years, making it all but impossible to implement appropriate HIV prevention programs. Persistent and insidious gender inequality in some parts of the world has the same effect, impeding efforts to reduce rates of HIV infection among women.
The community of scientists and researchers working to end HIV have responded to these obstacles in innovative ways by leveraging social networks and developing digital technologies to share information. In India, for example, HIV prevention information is delivered via text to male sex workers participating in a pilot randomized control. And in Lima, Peru, transgender women participating in a pilot study are being coached on the effectiveness of PrEP (pre-exposure prophylaxis) in preventing HIV and sharing that information with their social networks in order to scale efforts at education and outreach.
These strategies can act as a bridge until we get where we need to be to end the spread of HIV, which is full human rights for all populations across the globe. Getting there will also require holding governments responsible for the implementation of evidence-based, public health programs of HIV prevention. The World Health Organization and major private foundations must insist on and incentivize the delivery of safe, effective healthcare to men who have sex with men, transgender women, people who inject drugs, and women living under repressive levels of gender inequality.
The work that needs to take place to ultimately end this epidemic is daunting to contemplate: implementation of routine HIV testing, access to medication and treatment, prevention services tailored to those most at risk. But we only need to look back at where we were to see that we will eventually get to where we need to be. Today, infection with HIV is no longer a death sentence―it's a chronic manageable infection. The advances in treatment―and highly effective behavioral interventions―have been extraordinary.
The 21st International AIDS Conference that is taking place in Durban, South Africa, will showcase the numerous creative, innovative, effective ways in which HIV treatment and prevention are being expanded. The days, weeks, and months following the July conference, however, must be filled with equally creative work to make these models of care, treatment, and prevention mainstream in every community around the world. In doing so, we will take control of the epidemic.