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HIV/AIDS: The Prioritization of Prevention

Earlier this year, two major international meetings reminded us of the scourge of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Since HIV/AIDS was first recognized in 1981, this emerging disease has spread relentlessly throughout the world to more than 40 million HIV-positive people, 95% of whom live in developing countries. It now threatens to surpass in total fatalities both the fourteenth-century ‘‘black death’’ and the 1918–1919 influenza pandemic, which killed tens of millions of people. Now as HIV/AIDS is in its third decade the 2004 World Health Organization (WHO) report Changing History calls for a comprehensive HIV/AIDS strategy that links prevention, treatment, care, and long-term support. Similarly, the XV International AIDS Conference inBangkok also endeavored to link community and science to galvanize theworld’s response to HIV/AIDS through increased commitment, leadership, and accountability. In 2003 alone, 5 million new infections occurred—14,000 each day—with an estimated 3 million people with HIV/AIDS dying, 500,000 of whom were children. The growing numbers do not adequately represent the devastation to individuals, families, communities, and societies coping with HIV/AIDS. Further, they do not demonstrate the devastating impact on economies and political stability. The moderate success claimed thus far has largely been biomedical. Two decades of basic research into the mechanisms by which the virus propagates itself and evades and destroys the immune system have characterized HIV/AIDS from probable death to a chronic disease. With more than 20 antiretroviral drugs available, the level of virus in an infected person can be reduced so that he or she can maintain health for many years and also prevent mother-to-infant transmission of HIV. Yet, in 2003 only about 400,000 of the 6 million people requiring treatment actually received it. Clearly, while the treatment opportunities are remote for many, the WHO created a ‘‘3-by-5 initiative’’ with the goal to provide access to antiretroviral treatment (ART) for those in developing countries who need it. The WHO and its partners are working with full commitment to achieve the 3-by-5 target—providing access of ART to 3 million people living with HIV/AIDS in developing countries by the end of 2005. Even with the WHO response, according to the Global HIV Prevention Working Group, an international panel of nearly 50 experts in HIV prevention, a major shift in HIV prevention tactics will be needed to avoid a rise in HIV transmission and acceleration of the epidemic. Underfinancing of prevention activities is severely limiting the group’s impact, they report. Since 2002, prevention often is characterized by an approach called ‘‘A.B.C.,’’ which stands for abstain, be faithful, use condoms.