2010- a Year of Promise

For so many years, the news about efforts to combat HIV/AIDS has been, in a word, depressing. It seemed that with every positive development would come news of escalating infection rates, or that some promising vaccine or therapy was less promising than we had hoped. But 2010 will be remembered as one of the first years where there seems to be almost universal optimism that real progress is being made in this war.

Perhaps the most optimistic front has been in the area of science. During this year, we have been uplifted with promising results of studies raging from the possible efficacy of microbicides, to the potential of gene therapy. At the International AIDS Conference, one of the major themes throughout the event was that effective HIV treatment IS prevention i.e., that reducing viral load may be an effective tool in reducing infection rates. Moreover, for many years, the idea of a pill that could prevent HIV infection was almost universally derided. Yet with the recent announcement of the National Institutes for Health study of pre –exposure prophylaxis in MSM, we now may have another tool to reduce infection rates in individuals at greatest risk.

Not all of the positive news has just been in the field of science. Thanks to President Barack Obama, the United States has its first National HIV/AIDS Strategy with an extra 30 million dollars added for HIV prevention (and 25 million for the struggling ADAP program). Moreover, with the reopening of the National AIDS Policy Office, the approval of needle exchange, the elimination of the travel ban for people with HIV and most importantly, the passing of the Affordable Care Act, the United States has finally taken a broad, visible leadership role in fighting this epidemic.

So while there is undoubtedly good news, there also remain challenges. Less than half of the individuals needing HAART are receiving it. Moreover, the global recession has caused historic belt tightening throughout the world. In the United States, many states and cities are either reducing or considering reduction in HIV/AIDS services. Even staunch HIV advocates are reflecting on the monumental task (not to mention the expense) of keeping tens of millions of HIV+ individuals alive with HAART indefinitely, a lifetime cost that a Cornell University study estimated at $600,000 per person.

So where do we go from here? Perhaps the greatest optimism during 2010 has been the belief from many HIV researchers that a cure may be on the horizon. There are several very promising areas of “cure” research with promising results. However, in this case, the ‘devil is not in the details,’ but in the dollars. In order to find a cure, whether a functional one that allows people to maintain an undetectable viral load without medication or an eradication cure, it will take a lot more money then is being expensed now. For example, the cost of researching and developing a single drug has been estimated at 500 million to 2 billion dollars.

The hundred dollar question is: will we demonstrate the commitment, through the economic resources and the will to revamp the infrastructure to facilitate cure and vaccine research, or will we keep looking around and hoping for some lucky, miraculous (and cheap) breakthrough? A wise man once coined the phrase to me that the history of AIDS is still being written. Let’s make this next chapter, 2011, the year where WE gave the bully a bloody nose.