Only 28 percent of all people infected with HIV in the U.S. have an undetectable viral load, which is the current goal of HIV treatment.
Medical breakthroughs in research labs do not automatically result in improved health. Bringing major new medical breakthroughs to people in need requires both a realistic agenda and a political will.
In July 2012, two well respected organizations, amfAR and AVAC, presented their An Action Agenda to End AIDS to the International AIDS Conference. This agenda has five major parts: 1) Developing the Ability to Deliver Major Medical Breakthroughs, 2) Mobilizing Enough Resources, 3) Accountability, 4) Building the Evidence Base to End AIDS, and 5) Using Resources for Maximum Impact. These organizations have issued their first report on progress towards meeting the short-term goals of that agenda (See Table “amfAR/AVAC Monitoring Report 11/2012”).
Developing the Ability to Deliver Major Medical Breakthroughs (microbicides, treatment as prevention, PrEP, voluntary male circumcision, and prevention of mother to child transmission) forms the key to all the other parts of this Agenda. In order to control the epidemic, these breakthroughs must become available across the globe. The availability of these breakthroughs will take different forms in countries that differ in number of skilled health workers, the level of development, and the social groups most affected by HIV.
Mobilizing Enough Resources involves ensuring adequate funding to bring new medical breakthroughs to people in need and enough skilled health workers to deliver that medical care. In the U.S., this may mean increasing funding for testing and treatment. In Africa, this may mean increasing funding to set up mobile clinics to make up for a shortage of skilled health workers, hospitals and labs. Medical breakthroughs that fail to get to people in need are useless.
Accountability refers to setting long term and short goals and regularly reporting on progress towards them. In a democratic society, the average citizen has to be able to find these reports and to understand them. For example, the U.S. should regularly report the number and percent of positive people in care and those with an undetectable viral load. At present only 61 percent of positive people are in care and, of those, only 28 percent have undetectable viral loads.
Building the Evidence Base to End AIDS involves steadily improving treatment and services as well as how they are delivered. The Thai vaccine trial had better results than all previous vaccine trials. Unfortunately, its results did not reach an acceptable threshold to be developed. It has, however, sparked renewed interest in vaccine development.
Using Resources for Maximum Impact involves getting the biggest bang for the buck. This can take the form of ensuring that governments and non-governmental organizations direct appropriate resources to key populations. For example, In Africa, GBMSM (gay, bi and other men who have sex with men) tend to have higher rates of infection than exclusively heterosexual Africans, but African GBMSM get minimal resources. It can also take the form of improved efficiency in the production of generic Anti-Retroviral Therapy (ART) that lowers the cost of ART. With a lower cost, the same amount of funding can bring more people into treatment.
These strategies could lead to control of the global epidemic. And even if they don’t lead to control of the global epidemic, you can learn a lot more about what will work from a failed strategy that you can from a failed non-strategy.