We Haven’t Turned the Corner on AIDS

Next week I’ll be traveling to Durban, South Africa, to attend the International AIDS Conference. It’s an important opportunity for members of the AIDS community to discuss our ongoing efforts to fight the disease. I’ll be there to listen and learn. But I’ll also be delivering my own message.

The good news is that the fight against AIDS has seen many successes. The infection rate declined for several years and millions of people have been put on treatment, allowing them to live full, productive lives.

But we have not turned the corner. The infection rate has essentially stopped declining. That’s a particular problem in sub-Saharan Africa, which has a growing population of young people, who are most susceptible to the disease. If the infection rate stays the same while the at-risk population rises, then the number of people in sub-Saharan Africa who contract HIV each year could start going up instead of down.

One reason the infection rate has stagnated is that AIDS funding has stagnated. Another reason is that the current prevention tools have not had as much impact as any of us had hoped. Voluntary medical male circumcision is a very effective prevention approach, but the programs offering the procedure have not been scaled up sufficiently to reach all those who would benefit. The newest tool, using AIDS treatment as a way to prevent HIV infection among healthy people, has not been rolled out fast enough, and asking people to take a pill every day for prevention presents its own challenges.

There is the idea of “treatment as prevention”: Treating people who have HIV not only saves their life, it also makes them much less likely to pass the virus along to others. This is a promising approach and certainly we should treat as many people as possible so we can save their lives. But it is not yet clear to me that it is financially feasible to treat enough people to get a large prevention effect. I hope to learn more about this question at the conference next week.

For all these reasons, we need to invest more in both delivering the best prevention tools we have and developing new ones that are even more effective. For example, researchers are working on prevention and treatment tools that last for several months after a single dose, which would make it easier for people to stick to the regimes. I am also optimistic that within a decade we will have an AIDS vaccine that provides an acceptable level of protection.

In this video, I explain what it will take to make the most of these opportunities and ensure that AIDS cases keep going down: