By Sarah Gluckstern
When the earliest cases of AIDS appeared in 1981, nobody could have predicted the scope and reach the disease would have. Though we have seen many medical advances in the HIV/AIDS field, taking AIDS from being an untreatable condition to HIV becoming a chronic, manageable illness with the right medications, we are still facing an uncertain future, one in which there will be many more infections and deaths.
One particularly frustrating aspect of HIV has been the hunt for a vaccine. In 1984, the U.S. government predicted that a vaccine would be available by 1986, yet here we find ourselves today, still without one. Due to characteristics of the HIV virus, specifically that the virus mutates often and rapidly, it has been a challenge for researchers to find a vaccine that can protect against the multitude of strains that exist. However, the news is not all bad! Currently, two large-scale HIV vaccine clinical trials are ongoing in sub-Saharan Africa and much of the research is being conducted at sites where organizations such as the International AIDS Vaccine Initiative has cultivated trusting relationships among scientists, local governments, and local communities; a key component to any successful drug or vaccine trial.
Stigma, too, remains a major obstacle to ending this epidemic. Because HIV is associated with particular behaviors such as sex and drug use, those with the virus often fear being alienated from their communities, or being seen as bad people. Indeed, people in many parts of the world (including the U.S.) who are living with HIV are regularly cut off from their families, forced out of jobs and housing, and may receive subpar medical care. These circumstances can lead them to make choices for survival that are dangerous and may lead to even further spreading of the virus. Moreover, fear of stigmatization often leads individuals to avoid testing because they simply don’t want to know their status and risk the consequences.
On the upside, however, is the fact that we now know that early detection of the virus, if it leads to early treatment, can help curtail the current epidemic. Thanks to medical advances, there now exist a multitude of antiretroviral drugs on the market, and researchers have recently declared that Undetectable=Untransmittable, meaning that if an individual’s HIV viral count is undetectable in their blood, it is impossible for them to transmit the virus to partners. The hope is that if we can further increase testing rates such that the majority of people who have the virus KNOW that they have it, and continue to get newly diagnosed individuals into care, we can achieve viral suppression in a majority of people and thus significantly impact the rates of infection worldwide.
UNAIDS recently put forward an ambitious plan known as “90-90-90,” in which, by the year 2020, 90% of all people living with HIV will know their status, 90% of all people diagnosed with HIV infection will receive sustained antiretroviral treatment, and 90% of people receiving antiretroviral therapy will have viral suppression. We believe this is a realistic and promising goal.
37 years of an epidemic sounds like a long time, but the truth is that we have made many great strides in that time. Many more discoveries await, and we can do better together. By mobilizing scientists, academics, governments, industry, and advocates toward a shared goal of finding a vaccine and improving access to testing and care in the meantime, we may be able to bring about a sustained end to this epidemic.