Suddenly, people have begun to talk seriously about ending the global HIV epidemic.

Medical breakthroughs have changed the global HIV landscape.  These new developments include the following: Microbicides, treatment as prevention, PrEP, voluntary male circumcision, and preventing mother-to-child transmission.

These new developments can neither stand alone nor replace condom usage.  Researchers and providers now favor mixing these new developments with each other, and with condoms.  As condoms have low cost and multiple uses, they will remain a key component of HIV prevention for a long time.  Condoms not only prevent transmitting HIV, but they also prevent transmitting syphilis, gonorrhea, chlamydia, and significantly reduce the risk for HPV and herpes.

Recent Developments

Microbicides are chemical mixtures applied vaginally or anally to kill the virus before it enters the body.  When researchers announced the results of the first successful microbicide study at the Vienna AIDS conference, the audience gave the results a standing ovation.  It should be possible to develop microbicidal mixtures that could also prevent transmitting other STIs as well as HIV.

Preventing Mother-to-Child Transmission occurs when a pregnant HIV-positive woman takes Anti-Retroviral Therapy (ART, the class of drugs that changed HIV from a fatal disease to a manageable one) to make her viral load undetectable and to prevent transmitting HIV to her child. Last year in Broward, only 2 babies were born with HIV.  Globally, 570,000 children became newly infected with HIV in 2003.  Eight years later that number had decreased to 330,000 children newly infected with HIV, a 42 percent decrease.

If treatment could prevent a HIV positive pregnant woman from passing the virus to her children, then a positive person with an undetectable viral load might not transmit the virus to their sexual partners.

One study (HPTN052) that examined this supposition, now called “treatment as prevention”, found that an undetectable viral load reduced HIV transmission in mixed HIV status couples by 96 percent.  This development, however, has raised ethical concerns about treating positive people to protect negative people rather than to improve their own health.

Among all these developments, the most controversial has been Pre-Exposure Prophylaxis (PrEP), providing ART to HIV negatives to prevent them from becoming infected.  As the number of negative people far exceeds the number of positive people, PrEP would be too expensive as a prevention tool for all those who are negative.

While we know what happens to positive people when they lack access to ART, we have no idea how long-term use of ART will affect negative people. ART involves new and powerful drugs that affect basic biologic processes.  Other people have proposed giving PrEP to people in abusive relationships to give the abused partner more control.  This promises to be a major controversy over the next few years and we had all better become familiar with it.

Voluntary male circumcision has been shown to be effective in reducing female-to-male vaginal transmission.  No evidence currently shows it to be effective for reducing anal transmission. It will have a greater impact in those areas with high rates of male-female sexual transmission and low rates of circumcision than those areas with low rates of male-female sexual transmission and high rates of circumcision.  As most gay/bi men have no doubt literally observed, most males in the U.S. have been circumcised. In addition, most HIV infections in the U.S. occur through male/male anal intercourse.  Consequently, this development will have minimal effect in the U.S.

As a result of these breakthroughs, people and organizations are now developing coherent plans to end the HIV epidemic.

Recent Global Breakthoughs in Global HIV Treatment and Prevention

Sources:

http://aidsaccountability.org

Main portal for action agenda

http://endingaids.org/

Quarterly reports about the action agenda

http://www.avac.org/ht/a/GetDocumentAction/i/47321

The Action Agenda to End AIDS

http://www.avac.org/ht/a/GetDocumentAction/i/44984

www.avac.org

www.amfar.org


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