AIDS: The Next 30 Years

This week the world has been looking back at 30 years of AIDS. Three decades have taken us from five young gay men in Los Angeles to 34 million men, women and children around the world living with HIV. But what about the next thirty years? Could we see an end to AIDS?

A year ago -- or even a month ago -- thinking about an end to this epidemic in our lifetimes might have seemed no more than a pipe dream. But landmark data from the HPTN 052 trial released a few weeks ago gave us, for the first time in the 30 years of the HIV epidemic, conclusive evidence that earlier initiation of highly active combination antiretroviral therapy (ART) is also a highly powerful tool for preventing HIV transmission to sexual partners.

We can now say that treatment is prevention. And that changes everything.

The HPTN 052 result is the latest in a string of HIV prevention research successes. We have proof that an AIDS vaccine is possible. With good science that is backed by sustained political and financial will -- and some good luck -- researchers will one day crack the code and find a safe and effective vaccine that can be implemented.

We also have recent proof of concept for two antiretroviral-based prevention options for HIV-uninfected people -- a topical microbicide gel and oral pre-exposure prophylaxis, or PrEP. We've known for many years how to prevent vertical transmission of HIV and infections caused by needle sharing. We are now well on the way to having all of the tools that we need to effectively prevent all modes of HIV transmission.

The last fifteen years have brought more than 30 drugs to treat HIV, and in the last decade we've seen complicated drug cocktails reduced to as little as a pill a day. Better yet, we've proven that with sustained community mobilization, strategic financial investments and a little ingenuity, HIV treatment programs can be rolled out anywhere and everywhere.

Getting to this point hasn't been easy. Science is difficult, and successes have been hard won and often seem to have taken far too long. Implementing successful programs for treatment and prevention is challenging, but time and again the global community of advocates, scientists and policy makers has risen to the challenge.

Making sure we have the money and the political will to end this epidemic should be the easy part. But it isn't, especially when promising scientific advances come at the same time as enormous economic challenge.

Policy and funding for AIDS has consistently fallen short. We've made great strides in rolling out treatment programs in developing countries, but millions of HIV-positive people are still in need of drugs that can save their own lives and help break the cycle of new infections. We know that people who are marginalized from society are often at greatest risk of HIV infection, yet it is impossible in many communities and countries for gay men, transgendered people, injecting drug users, sex workers, and others at high risk for HIV infection to access existing treatment and prevention programs.

This week a diverse group of international researchers and activists came together to release a declaration -- We CAN End the AIDS Epidemic -- that points the way to the paradigm shift that is needed in the AIDS response. This declaration embraces the principles outlined in the new investment framework from UNAIDS published last week in the journal the Lancet -- principles that point to a targeted and strategic approach to investment in the prevention AND treatment response that will yield long-term dividends.

At the same time, world leaders gather at the United Nations this week for the third time in a decade to assess the state of our collective response to the epidemic and to make new commitments -- and they have an opportunity to do something bold.

They can act on scientific evidence that points the way to ending this epidemic and saving millions of lives and provide the political will and sustained funding to make it happen.

Governments have a real opportunity to save lives now AND save money in the long run by funding evidence-based strategies with combination ART as a cornerstone of a set of proven strategies to prevent and treat HIV. These include male and female condoms; male circumcision; prevention of vertical transmission; behavior change programs that target social norms as well as individual risk; activities addressing key populations including sex workers, gay men and other men who have sex with men and transgender people; harm reduction programs for injecting drug users; and sustained investment in research and innovation.

The evidence is in. The path forward is clear. We know the way to end AIDS for all time. Now is the time to invest and act accordingly.

Visit We CAN End the AIDS Epidemic and add your name to this critical call for action.