35 Years of HIV/AIDS

June 5, 2016 represented a solemn birthday as HIV/AIDS turned 35. On July 3, 1981, the New York Times published a groundbreaking article about a rare and often fatal cancer called Karposi’s Sarcoma, which was found in 41 cases of homosexual men in California and New York; eight of the sufferers died less than 24 months after the diagnosis was made. Due to the rarity of the cancer, it was believed at that time that earlier cases might not have been detected. An astounding 71 million infections later, and with over 34 million deaths, the HIV/AIDS epidemic is second in lethalness to the Bubonic Plague of the 14th century, which is estimated to have killed 75 to 200 million people. I began working in the field of HIV/AIDS in 1987, six years after its coming out party. During that time, an HIV diagnosis seemed akin to a death sentence. There was so much that we did know about HIV, and there was only one medication available to specifically treat HIV/AIDS. The medication, called AZT, was prescribed in such toxic doses that many felt more ill from the AZT treatments than they did from AIDS. People were so desperate for something to extend their lives that they would have taken almost anything. Needless to say, a fair number of individuals and "clinics" began to pop up with "cures" for AIDS. While a cure has continued to elude us to this day, we have dozens of medications that have extended the lives of millions of people throughout the world. The challenge now is to provide access to these life preserving medications for all who need them, and to ensure (or facilitate) people taking them. Several years ago I had an opportunity to meet with a group of female HIV activists from South Africa. When I informed them that not everyone in the US with HIV were taking anti-retrovirals, they were stunned. It was their understanding that HIV medication was widely available, and that everyone who needed them were taking them. I explained that health insurance plans in some states provided limited coverage for certain medications, and that some people (as many as 19%) living with HIV were unaware of their infection. While they understood this, they could not understand how so many who were aware of their diagnosis and had access to medications were not on medication. Various studies have shown that as few as 30% of people living with HIV in the US have suppressed viral loads, the gold standard for HIV care. While viral load suppression has risen in HIV+ individuals in care, there remains an alarming number of individuals not receiving consistent HIV disease management (ex. in and out of care, or not in care at all). While we cannot cure HIV, we have built a better toolbox that can help keep people alive for a long time, and there are even more tools in the pipeline. In spite of the tools at hand, however, issues of poverty, homelessness, substance abuse, and mental illness continue to disproportionately impact those most at risk for HIV. Thus, our goal at year 35 of the HIV/AIDS epidemic is to get people into care, and to help them stay there.