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A 'generation without AIDS'? Prevention strategy faces massive challenges

“Treatment is Prevention.” It is a simple slogan that has dominated this year’s International AIDS Conference, springing from a 2011 study that showed when HIV patients receive proper drug treatment, they not only remain healthy, but are also virtually incapable of infecting others. 

The solution to AIDS -- the terrible plague that has killed 64,000 Americans and 35 million people worldwide over the past 31 years -- does not require waiting for a vaccine, which remains at least a decade away, or exploring research avenues towards a “cure,” something achieved in one man with a dangerous, terribly expensive and complex bone marrow transplant. All that needs to be done is to find all who are infected, get them treatment and the virus will die out. That would lead us to a future “generation without AIDS,” another refrain heard often at the conference.

Jacquelyn Martin / AP

The world's largest AIDS conference returns to the United States for the first time since 1990.

As America’s leading AIDS physician, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases puts it: “Now we have the tools that we know work and that if we implement them, we know they will ultimately be effective."

But Fauci and most other experts are well aware that it is not so simple.

In the United States there are 1.2 million people living with HIV infection, the virus that causes AIDS. About 20 percent of them don't know they are infected.

“Between 60-70 percent of all new infections come from an individual who's infected, does not know that he or she is infected and infects someone else,” Fauci says. “So if you just imagine if you can get into the community, penetrate the community to the higher risk people, get them voluntarily tested and linked to this continuum of care, you would have a major impact that would be almost immediate.”

But there are massive problems facing this strategy, according to numerous sessions at the AIDS conferences. There are reports of people losing their homes, their friends, their jobs and their family connections when others learn they are HIV positive. The stigma of AIDS may be less than it once was, but it is far from gone. 

No wonder many people do not volunteer for the test, even though screening now only involves a cheek swab and a wait of 20 minutes. All too often men have sex with men and yet do not want to admit it to themselves it has happened, let alone to the community in which they live.

And just testing is hardly enough. People have to get medical treatment and then stick with it. For example, physicians have long known that many well-off heart patients with access to good health care fail to properly take their medicines after they have had a heart attack, putting themselves at greater risk for another. Take that general problem and put it into heavily AIDS-infected populations that have long lacked access to adequate medical care, such as African-Americans and Hispanic men and women, and one can see that “a continuum of care” is often difficult to achieve. Efforts to cut expenditures on medical care for poor people will make the challenges even greater.

But success stories can also be heard at the conference sessions. Washington, D.C. has brought down its huge HIV rate by offering testing in many places, including the Department of Motor Vehicles, drug stores and mobile vans. The nation’s capital has also made great efforts to reduce the stigma and get people into proper treatment. Rwanda, the east African country that was the scene of one of the most brutal massacres of modern times, has managed to bring down its huge infection rate through testing and treatment. 

However, those positive stories do remain rare, existing only when there is a huge commitment from the top levels of society, a source of funds and a political will to support the programs. Sadly, in many parts of the United States and much of the world, both are still lacking.

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