AIDS at 30

As we move into decade number four of the pandemic—what now?
by Larry Buhl

Anniversaries and birthdays can be a time for reflection. For people, the thirtieth year is an important turning point, when the dreams of youth are reevaluated, extinguished or revived with new vigor.

The “birthday” of a plague can be sobering. There is no cure. After three decades, the disease has claimed more than 30 million lives and orphaned approximately 16 million children. People throughout the world are still being infected—and disproportionately in some communities—and dying, again disproportionately. Today, there are still 1,000 babies born each day with HIV even though the treatment exists to virtually eliminate the chance that their mother will pass the virus to them. There are 33 million people today living with HIV/AIDS, and the cost would be more than $40 billion per year to treat all of them, if they could all be reached.

Just as birthdays are opportunities for redefinition, AIDS at 30 is seeing a revision of what constitutes a cure. In the past eight years there has been a dramatic increase in the number of people who have access to AIDS treatment and because of this the number of people dying from AIDS each year has declined nearly twenty percent since 2004. And, even though the number of babies born with HIV is unacceptably high, it has been on a rapid decline for the past several years. The global health community is committed to bringing this number to near zero by 2015, meaning there is the chance that a new generation, the first since 1981, will be free of this disease at birth.

On the immunological front, there are signs that the efforts of three decades of research are paying off in the fight to stop HIV/AIDS. There has been an acceleration of positive studies showing new approaches for fighting an old foe. In just the last few months, a vaginal microbicide gel showed promise in protecting women from HIV, and a large clinical trial of a pre-exposure prophylaxis reduced HIV transmission to partners by ninety-six percent.

This issue notes another anniversary: twenty years of A&U magazine. Several of the people featured on our covers have passed, including Liz Taylor and author E. Lynn Harris. Many of their hopes for eradicating the disease have not been realized. We revisited some of the featured activists, artists, and physicians featured over the years and asked them, what now? What is needed to provide treatment for the millions more who need it, to stop the growing infection rate, and continue to focus the brightest minds on putting an end to this crisis, not merely redefining the concept of “end.”

Sheryl Lee Ralph
Actor, singer

We need to address stigma, racism and gender issues. This disease continues to eat away at our humanity as we choose who we don’t care for and about. When it was Africans we didn’t care about the daily march of coffins to the graveyard. It wasn’t until the coffins became smaller and smaller did our shame of not caring kick in. When it was gay people we were publicly hateful with bibles in hand saying that God stood by our hatred and this is what Jesus would do. When it moved to women, we just didn’t care and we were so slow to action and when it became women of color we just were apathetic. The CDC said two years ago that one in four young women is already infected with an STD and nobody did anything! We need to do so much more because mortality and sterility are not options for our children’s future. When I feel like giving up I can hear my father say that it takes 100 years for change and since HIV/AIDS is now just 30 I guess we have come farther than we think.

Hillary Clinton
U.S. Secretary of State

Through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), we are making smart investments that will ultimately help bring us closer to a world free of HIV/AIDS. We work with dedicated organizations and individuals every day to make this goal a reality. The struggle is far from over, but the United States is committed to remaining a global leader in the fight against HIV/AIDS—today, tomorrow, and every day until the disease is eradicated. That is our obligation and our promise to the millions of souls around the planet living with HIV/AIDS.
[Editor’s note: Secretary Clinton submitted her response as a prepared statement.]

Gore Vidal
Author, playwright, essayist, screenwriter, political activist

I have little faith in the government’s ability to respond with the swiftness necessary. The government is effective when doling out money for bombs, but not at its best with a matter such as AIDS. There are many interested parties in the private sector doing good work raising money and awareness—they should be encouraged to continue doing so.

Margaret Cho
Actor, comedian

There still needs to be a cure and more information and education around prevention and living with the disease. Having grown up in the worst era of AIDS, the eighties in San Francisco, I have witnessed the devastation and suffering the disease is capable of. I hope to see a cure soon as well as more options for those living with the virus. I don’t think that much progress has been made. We need a cure, we need more funding for research and more information on how to prevent as well as live with the disease.

JL King
Author, publisher, HIV/STD activist

I’m very discouraged that people are no longer taking HIV/AIDS seriously. In personal ads the requirement of safer sex is no longer there. Gay clubs no longer give out free condoms. You don’t hear safer sex messages on urban radio anymore. The attitude now is that HIV is just a bump on the skin, a pimple that can go away. People need to be more afraid of it to stop the spread.

Lainie Kazan
Actor, singer

Scientifically we have made extraordinary progress. But the youth have become blasé and are having unsafe sex. Younger generations don’t realize what we’ve been through. AIDS groups that promote and talk about AIDS should be all over the media. We need to revamp the effort to promote safer behaviors.

Bobby Shriver
Activist, attorney, politican

Obviously, a cure and a vaccine are the end goal, but until then we have to drastically ramp up access to treatment and increase prevention measures. Treatment becomes prevention. Another important piece to the puzzle is the empowerment of women through education and employment. Lack of education, economic opportunity and equality put women and girls at heightened risk for HIV infection. We need to invest in programs that give women and girls the information and the confidence to make smart choices when it comes to protection and family planning.

Emanuel Xavier
Poet, spoken word artist

Now that AIDS has become something sustainable, now people have become too easygoing and less concerned about protecting themselves. Too many young people coming of age think that the crisis is passed and it won’t affect them. AIDS needs to be talked about within all communities and people need to be reminded it’s still a crisis.

Larry Kramer
Author, AIDS activist

There’s still no cure. There’s still precious little research for a cure. The numbers of infected are still increasing rapidly around the world. People who should know better are still seroconverting and infecting others because they are willing to have sex with strangers without condoms. People still aren’t able to afford the drugs to keep them alive. Ryan White funding is disappearing. Bureaucrats say the right things but they don’t do them. Someone needs to be in charge to find cures for plagues like this, and it’s not Obama. I have as much faith in him as I do in the tooth fairy.

Bill Gates
Founder, Microsoft; Chairman of Bill and Melinda Gates Foundation

The best tool would be a vaccine for HIV. The scientific progress on this has gone well. The positive results of the trial in Thailand were a turning point for the field, and blood samples from the volunteers are being studied in depth for lessons about why that vaccine worked but only to a limited degree. There has also been an explosion in the discovery of antibodies that block HIV infection. Scientists don’t yet know how to make a vaccine that will cause patients to generate lots of these antibodies, but there are several approaches that look promising and will be ready to go to trials in the next few years. In order to get a fully effective HIV vaccine we will almost certainly need several rounds of trials where we learn and improve the candidate vaccines. So to get a vaccine as soon as possible we need to minimize the length of the trials and the time between trials. So far each cycle has taken over five years. The field needs to look into how to shorten this so that progress matches the urgency of the problem.
[Editor’s note: Bill Gates submitted his response as a prepared statement.]

Michael Weinstein
President, AIDS Healthcare Foundation

There are many people in the world who aren’t being treated, either because they don’t know they are infected or there are no resources available. The test and treat model has been a success and it should be scaled up to get the job done. This not only helps the infected but slows down the rate of newly infected. And we need to reinvent primary prevention for the new era where HIV is a manageable illness, and not the death sentence it was in the eighties and nineties. For that to work, change must come from the ground up. It can’t be government, academia, or drug companies telling them what they must do.

Dr. Sharon Lee
HIVMA Board Member, Executive Director of Family Health Care at University of Kansas Medical Center

There are not enough doctors going into HIV as a specialized field. This is partly the profession’s fault. There is no good plan to identify and cultivate those who would be good HIV doctors, and not enough medical students and new doctors are interested because the pay is not good at all. We also need to have stronger prevention messages. It’s a preventable disease. Doctors must be more comfortable talking about topics like sexual history and safer sex. And if we can get HIV-positive people diagnosed and into treatment earlier, [then] that in itself is a prevention strategy.

Dr. Anthony Fauci
Director, NIAID, NIH

We’ve made tremendous progress in some areas. Prior to the development of drugs for HIV, the median survival was measured in months. Now HIV-infected people can live an additional fifty years. We have seen some very successful trials and a modestly effective vaccine from the Thailand trial. But there are still 56,000 new infections per year in the U.S., and it’s not going down. More people need to be identified and tested and put on HIV treatment earlier. A vaccine, when it comes, will play one role but will not be the only thing. We will still use multiple modalities for prevention that we know are successful.

Larry Buhl is a freelance journalist and screenwriter living in Los Angeles.

June 2011