No Silver Bullet: HIV & AIDS Challenges and Solutions

Dr Nelly Mugo, AIDS 2012

XIX International AIDS Conference (AIDS 2012) Washington, DC. Dr. Nelly Mugo, Kenya © IAS/Steve Shapiro -Commercialimage.net

Tuesday’s (July 24) session at the XIX International AIDS Conference kicked off with a plenary session on HIV & AIDS “Challenges and Solutions”.

The first three presenters, Javier Martinez-Picado (Spain) from the AIDS Research Institute IrsiCaixa and ICREA; Dr. Nelly Mugo (Kenya) of the University of Nairobi and Kenyatta National Hospital; and Dr. Bernhard Schwartländer, (Switzerland) the Director for Evidence, Innovation and Policy at UNAIDS, each spoke about the possibilities for ending AIDS. Dr. Howard Koh, Assistant Secretary for Health for the US Department of Health and Human Services described US efforts to end AIDS.

A cure or eradication is necessary

Dr. Martinez-Picado launched the session with a list of reminders why a cure or eradication is necessary: (1) The HIV virus is suppressed with antiretroviral therapy (ART), and (2) the vast majority of patients who adhere to treatment will live long, healthy lives. However, (3) mortality and morbidity from chronic diseases such as heart disease and cancer is still higher in populations of HIV-positive patients in treatment than in the general population. In addition, (4) stigma and discrimination against people living with HIV continues to plague nearly every community. And (5) the cost of treatment is projected at $22 billion per year for universal access. For all of these reasons, a cure or eradication is preferable to lifelong treatment.

This cure or eradication will require, “a prolonged period of research,” said Martinez-Picado. But he urged the audience not to let that deter our efforts. He presented a series of scientific studies that are showing varying signs of promise for progress toward a cure. Though none of them is a silver bullet, it is clear that progress is being made in HIV science.

Science, Not the Only Answer

Science isn’t the only answer — though an important one — Dr. Nelly Mugo reminded us in her presentation. According to Dr. Mugo, 44 percent of new HIV infections in Kenya are among married or cohabitating couples, and 50 percent of HIV-positive couples are serodiscordant. Often a couple’s desire for children will overshadow their fear of transmitting the virus to their partner, thus preexposure prophylaxis and treatment as prevention are important strategies for keeping partners of people living with HIV free of the disease.

However, adherence to treatment and linking patients with care after testing are still major problems — not only in Kenya, but worldwide. The solution to these problems is not more advances in science, but rather community-based efforts to make sure both HIV-positive clients and their partners understand the necessity of accessing treatment and adhering to it for life. After all, treatment as prevention cannot work if treatment is not accessed.

Another $7 Billion

Neither science, nor social programming is free. And without increased funding, the number of new HIV infections per year will stagnate, said Dr. Bernhard Schwartländer. Though he believes we must “learn how to do more with what we have,” Dr. Schwartländer also urged countries to take ownership of their health and increase domestic funding for health, including HIV services. Though he believes another $7 billion is needed by 2015 in order to halve the rate of new HIV infections, he says that if low- and middle-income countries continue to fund health services at the same rate they are currently funding them, the gap will be closed as these nations emerge from low-income to middle- and high-income status over the next decade.

“None of this will be achieved without a strong activist voice,” Dr. Schwartländer reminded the crowd, and urged us to challenge our governments to rise to the challenge. “The world overall is getting richer,” he said, “We have to make it fairer.”

Dr. Howard Koh presented achievements made during the first two years of implementation of the United States’ HIV and AIDS strategy. He praised the FDA’s recent approval of Truvada for pre-exposure prophylaxis and the provisions the Affordable Care Act will make for HIV care — including ending insurance companies’ ability to cap lifetime care limits and preexisting condition exclusions. The US plans to decrease the number of new infections within our borders by 25 percent by 2015 through cutting-edge research on vaccines and microbicides and increasing the number of people who know their status through innovative programs, such as free HIV testing at the department of motor vehicles.

It is clear from this session that we will not end AIDS tomorrow. But with the vision of our leaders, the voices of our activists, and the hard work of those on the front lines living and working with people living with HIV a future free of HIV is within our reach.

Mary Burket is communications manager in MSH’s Center for Health Services.