Political Minutes: A Future without HIV/AIDS

Under the rotunda of Low, four of the biggest names in the fight against HIV/AIDS all voiced the opinion that the tide has turned in the struggle against the disease. The panelists featured Columbia’s own Wafaa El-Sadr, the director of International Center for AIDS Care and Treatment Programs and professor of epidemiology at the Mailman School of Public Health.  Joining her was Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, Eric Goosby, the United States Global AIDS coordinator in the Obama administration, and Michel Sidibé, the executive director of the Joint United Nations Progamme on HIV/AIDS.

The moderator Ray Suarez of PBS immediately inquired: What exactly changed that allows us to say we can achieve an AIDS free generation?  Dr. Fauci claimed that we have all the scientific tools, but until now we had no idea that they worked.   Dr. Saadr also added to this point; we have sufficient knowledge and many key scientific advances, we need to have a unifying effort.  For the first time, the number of new HIV cases will be lower than the number of new patients receiving treatment.  The trend suggests more people are becoming aware of their status and receiving treatment, a key step to containing viral spread.

Treatment whether antiretrovirals or prophylaxis, raises the question that seems to always arise in the HIV/AIDS debate: Which is better treatment or prevention?  There are ardent supporters behind each side, but Thursday afternoon the theme of a unified effort arose again.  Dr. Fauci said prevention requires behavioral change, something that can be demanding and difficult in the face of poverty and sexual stigmas.  Dr. Sidibé also explained a regiment of pills are also challenging, as individuals often have to leave jobs and travel for more than half a day to get their medicine from local clinics.  Yet, together, these two methods offer greater chance for success.

While there are significant improvements, there were also reminders of where efforts have stagnated.  Dr. Saadr informed us that the rate of infections in the U.S. has not budged.  Dr. Goosby emphasized that in order to lower infection rates, repetition is essential, on the national level and between patients and local healthcare providers.  We can learn from how the personalization of programs to different cultures in Sub Saharan Africa has greatly improved program success.  We know who is getting infected and in what general regions, with this information we can personalize treatment programs down to the level of the neighborhood, increasing the amount of access points for care.  Social stigmas surrounding AIDS are also a big problem in rural communities where the central tenet of anonymity in healthcare is in jeopardy due to the community’s size.

The optimism expressed should not overshadow the amount of work necessary to achieve an AIDS free generation.  While we have many tools to work with, the challenge still remains to implement them at a local level.  Running individualized programs to each community and managing the numerous organizations represents massive logistical problems.  Dr. Sidibé also raised the important issue that much of this global health effort is funded by the U.S.  In order to be self sufficient, African nations need to provide healthcare and fund their own initiatives in order to ensure long term success.   For the short term, Dr. Goosby called for  a diversification of the global AIDS resources to provide security in case one country experiences financial difficulties.