Have we cured AIDS?

Vox reader Burak Ova asks: What is HIV and AIDS? How is it transmitted? What are the prevention methods? Is there a cure?

Human immunodeficiency virus (HIV) killed millions of in humans every year In the early 2000s During the height of the AIDS epidemic. Now, nearly two decades later, scientific advances and public health interventions have transformed a deadly disease into something manageable, with regular doses of Medicines almost stop its spread All in all

So you wonder if we’ve squashed AIDS, at least to the point where people don’t have to worry about it.

HIV is a particularly complex virus. When it infects a person, the virus infects and kills that particular person Type A blood cell (called a T cell) that fights infection. It weakens the immune system and prevents the immune system from killing HIV. If left untreated, HIV infection can lead to a serious condition called acquired immunodeficiency syndrome (AIDS) At that point, the virus has completely destroyed the immune system—making people more susceptible to widespread infection with little protection.

HIV is spread through contaminated bodily fluids, usually during sex or when people share needles. Scientists now believe that HIV first spread to humans From an infected chimpanzee in Cameroon, Central Africa. The virus spread slowly and sporadically among people, locating in modern-day Kinshasa, the bustling capital city of the Democratic Republic of the Congo. From there, the virus spread worldwide, and in 1981, the Centers for Disease Control and Prevention first registered In some cases what would be known as HIV.

Since that fateful day, approx 90 million People around the world are infected with HIV and more than 40 million people have died from the disease. At one point, almost 5 million People are infected with HIV every year, and some 2 million people die a year from it

Today, the results are much better. In 2023, About 600,000 People died from HIV, while just over 1 million people were newly infected with the disease. Scientists and public health officials have developed several drugs and interventions to prevent infection or contain the virus so that HIV-positive people have no symptoms and can live full, healthy lives. Ending AIDS actually seems possible.

But, despite such incredible progress, HIV remains strong in many parts of the world. These tools were not enough and will not be enough to end the epidemic once and for all – alone. While further medical interventions, such as a true cure for HIV or a vaccine for the disease (which are probably still years, if not decades away), would help, this is no longer really a science problem. Ending the HIV epidemic by trying to solve seemingly insurmountable problems of equity and inequality.

In some places, esp African countriesHIV – and its complications – is one of the leading causes of death. Certain populations — gay men, adolescent girls and young women, sex workers, those who use IV drugs, and people in prison — are at disproportionately high risk not only of contracting HIV but also of not receiving adequate treatment.

“If it was just about developing products, about research and development, this epidemic would be over,” said Mitchell WarrenInternational Nonprofit Executive Director AVAC. “This is not unique to HIV, but HIV is perhaps the most glaring example. HIV is an epidemic that is obviously about a virus, but it spreads because of inequality, because of stigma, because of discrimination, because of criminal behavior.”

However, American and European support for the fight against HIV is waning. Governments are reducing and even considering critical funding eliminated Core HIV programs eg PEPFARor the US President’s Emergency Plan for AIDS Relief. But now there is a risk of a resurgence of abandoned diseases that could threaten not only human lives, but also economic and political stability, just as it did when the pandemic first emerged.

How far have we come to end HIV – or haven’t we?

Warren began his career in HIV in 1993. He stayed in South Africa as the country was rapidly becoming the epicenter of the HIV epidemic. Patients with HIV perished before his eyes, he recalls. The streets were lined with coffin makers. Every weekend, Warren’s colleagues spent their time traveling from one funeral to another.

At the time, HIV was a death sentence, and the only preventative tool doctors and public health officials had was the male condom, which prevented the spread of the virus during intercourse but did nothing to protect drug users or same-sex couples who often did not use condoms. Do not use condoms because they are not trying to prevent pregnancy. Condoms, of course, don’t prevent pregnant people from passing the virus to their fetuses, another way that HIV can spread.

In the first decade of the epidemic, drug companies developed an antiretroviral therapy treatment that kept the amount of virus in the body — known as viral load — to such a low level that the virus could not spread from person to person. Although these treatments helped reduce the huge number of HIV deaths, they were not enough to end the epidemic because these early treatments required patients to take dozens of pills a day. (And they were given after already having HIV, so they weren’t preventive.)

Even leaving aside the sheer cost and numerous side effects of taking so many drugs so frequently, getting patients to take all those pills was a big challenge, even in rich countries. In places like South Africa and other developing countries where there are very few medical centers and doctors, distributing and stocking enough drugs and getting them to patients was overwhelming.

It wasn’t until 2006 Pharmaceutical companies that have developed a “one pill, once a day” approach to treating HIV-positive patients have helped ease logistical and compliance challenges. Then, in 2012Food and Drug Administration approved pre-exposure prophylaxis, or PrepTherapy, which allows people without HIV to take drugs to prevent infection. Although PrEP is not a cheap option – it can cost up to $2,000 per patient per month in the United States — HIV advocates hail PrEP as an important tool in the fight against HIV.

Along the way, massive HIV programs like PEPFAR have launched other campaigns and interventions — such as promoting safe sex practices, encouraging male circumcision, and rapid HIV testing services — to curb the spread of HIV.

But despite these amazing scientific breakthroughs, HIV remains an enduring challenge not because of science but largely because of stigma, discrimination and marginalization. when something 20 million Almost all people around the world today take HIV drugs 20 percent People with HIV have no access to treatment.

Gay men, sex workers and those who use IV drugs are all at increased risk of contracting HIV, but are often reluctant to get tested or treated because they fear doctors and nurses will mistreat them or worse, report authorities. . Sex acts are at least illegal 100 country, and IV drug use is illegal but approx 30 countries. Even homosexuality remains a crime 64 countriesincluding approx 30 out of 54 African countries, where the burden of HIV is highest. Legal challenges have made it difficult for public health officials to implement certain interventions even though we know they work. Giving clean needles to IV drug users, for example, reduces the spread of HIV among drug users and is still rarely, and even then controversially, implemented in very few countries.

Then there is the challenge of gender equality. Adolescent girls and young women are also at particularly high risk of contracting HIV, especially in some parts of the world. In 2023, 62 In sub-Saharan Africa, a percentage of all new HIV infections were among girls and young women. in some parts In these countries, young girls, who lack institutions to emphasize safe sex practices, are married to older men who have multiple sexual partners, increasing the risk of HIV infection. Unfortunately, rape is common in conflict-affected areas. In other situations, particularly in refugee camps or places with limited economic opportunities, girls and women are forced into sex work to survive.

“We see HIV as finding fault lines in society,” Warren explains. “It is a virus that spreads through sex and drug use. These are two behaviors that have been stigmatized and criminalized not just during the 40 years of HIV, but for hundreds and thousands of years.”

How likely is it that we can make more progress against HIV/AIDS?

Bridging cultural and logistical divides is what makes public health so challenging. I have worked in global health for almost 10 years, and I know that achieving public health goals like eliminating HIV is not just about inventing and rolling out drugs and interventions but about changing social practices and cultural beliefs.

But without addressing the persistent global challenges of discrimination and inequality, we can do more to ensure people worldwide continue to have access to preventive care, testing services and treatment. To do this, we need money – a lot of it.

Over the past decade, the US government has given more grants than that $5 billion A year in the global fight against HIV; About half of these funds are routed through it PEPFAR. Historically, PEPFAR has enjoyed bipartisan support, but in recent years, politicians — especially on the right — have threatened to end or dramatically reduce global health funding to focus on increasing domestic spending and improving the lives of Americans. Other politicians want to end PEPFAR because some of the funds are spent on improving and expanding access to sexual and reproductive care. After all, HIV is transmitted through sex. But the proximity of HIV care to abortion services is too close for many Republican politicianMeaning, with this rising tide of anti-abortion opinion, the US government should also stop funding HIV.

The fight against HIV is losing momentum around the world. Globally, funding for HIV has fallen by approx 8 percent from $21.5 billion in 2020 to $19.8 billion in 2023, according to the Joint United Nations Program on HIV/AIDS, or UNAIDS. Between 2022 and 2023, other major donor countries, including the United States and the European Commission, have reduced their global funding for HIV and are likely to More Funding for global health has been cut more broadly. The future could be bleaker: President Donald Trump announced Tuesday that the U.S cut ties with World Health OrganizationThe United Nations Health Organization plays a role main role To provide HIV treatment and care to millions of people, especially in low- and middle-income countries.

The simple fact is that if global funding for HIV is cut, we will see an increase in HIV cases and deaths. The world community has achieved much, but the fight is not over.

This story was featured in the Explain It to Me newsletter. sign uphere. For more from Explain Me,Check out the podcast.

Source link