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Why do we believe we can end the HIV/AIDS epidemic?

HIV science has undergone a renaissance in the past decade. Three powerful tools are leading the way:

Treatment as Prevention (TasP): We have compelling evidence that when a person living with HIV/AIDS is successfully treated and reaches an “undetectable” viral load, their risk of passing the virus on to someone else is negligible—essentially non-existent. In three large studies, HPTN 052, PARTNERS, and Opposites Attract, there were no cases of someone with an undetectable viral load transmitting HIV.[i][ii] Essentially, this means that if every single person living with HIV were diagnosed and treated immediately, we could end the epidemic tomorrow.  In addition, we know from research that people living with HIV have better health outcomes when they start treatment as soon as possible, which has also changed our approach to healthcare for people who are HIV positive.

Pre-Exposure Prophylaxis (PrEP): Simultaneously, we’ve seen the rise of PrEP, a daily pill an HIV-negative individual can take to reduce their risk of getting HIV via sexual exposure by up to 99%.[iii] In 2014, the CDC reported that at least 1.2 million Americans could benefit from PrEP.[iv] And although there is only one pill currently approved for prevention of HIV acquisition, other preventive technologies are being developed.

Post-Exposure Prophylaxis (PEP): PEP is an emergency 28-day course of antiretroviral drugs (ARVs) that should be started immediately after possible exposure to HIV—and no later than 72 hours later. Just like for PrEP, advocates are scaling up public knowledge and access to PEP for HIV-negative individuals who think they’ve been exposed to the virus. PEP has been available for many years, but in most places only healthcare workers and public servants (police, firefighters, etc.) have been properly educated and given access to it.

Simply having better tools does not mean there will be an end to the epidemic. The advent of effective treatment in 1996 did not mean that lifesaving medication was immediately available to all those who need it. Indeed, we continue to see millions of individuals dying of HIV worldwide each year; in 2014 nearly 7,000 deaths in the United States were attributed directly to HIV.[v]  If not for robust worldwide community-led advocacy, the outcomes would be even worse.

It is the new wave of HIV/AIDS advocacy spurred on by the advent of TasP and PrEP that gives us our greatest hope that the epidemic may end. Renewed mobilization around access to comprehensive treatment and prevention services has created new leadership, campaigns, and organizations. This passion, coupled with the promise of healthcare reform in the United States and an increasing awareness of key social justice barriers related to racism, transphobia, and homophobia provides real opportunities for progress, even within America’s currently volatile and dangerous political climate.

 

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[i] Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011 Aug 11;365(6):493-505. doi: 10.1056/NEJMoa1105243.

[ii] Rodger AJ, Cambiano V, Bruun T, et al; PARTNER Study Group. Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy. JAMA. 2016 Jul 12;316(2):171-181. doi: 10.1001/jama.2016.5148.

[iii] Anderson PL, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV, et al. Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Sci Transl Med. 2012 Sep 12;4(151):151ra125.

[iv]McCarthy M. HIV pre-exposure prophylaxis could help 1.2 million in US. BMJ. 2015 Nov 25;351:h6384. doi: 10.1136/bmj.h6384. 

[v] Kochanek M, Murphy S, Jiaquan X, et al. Deaths: Final Data for 2014. Natl Vital Stat Rep. 2016 Jun;65(4):1-122.