ID Week: A last look at AIDS, from beginning to end

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SAN DIEGO, CA — Do you remember where you were at the beginning of AIDS?

Diane Havlir, who gave ID Week’s final talk on the epidemic, likes to ask that at the start of a talk, although she is increasingly aware that some of the physicians and researchers she is speaking to were children back then, more than 30 years ago now.

Dr. Diane Havlir, who began her career at the start of the AIDS epidemic and heads combination prevention research projects in Uganda now, gives ID Weeks Joseph E. Smadel Lecture: Ending AIDS - View of a Scientific Realist.

Havlir does remember. She was in medical school, about to begin a career that would have gone differently if AIDS hadn’t appeared when it did. As it turned out she followed the epidemic, going straight from school to one of AIDS’ epicenters  at San Francisco General Hospital. There she and other young doctors were struck with the irony of starting their careers only to watch members of their own generation fall, as the epidemic spread like fire.

The title of her talk last week was “Ending AIDS — View of a Scientific Realist.”

“Are we at the beginning of the end of AIDS?” she asked. “The answer is yes.”

It is a popular question, and a popular answer these days, which she acknowledged by, adding that her answer was based on “evidence, not emotion.”

The evidence —  research that has shown the effectiveness of treatment as prevention of HIV transmission, of administering antiretroviral medicine before exposure to prevent HIV acquisition, of medical circumcision to lower odds of getting the virus, of the practical possibility of a cure, and of how a vaccine can work.

It will take decades of work, she added, while work to improve care of the aging ill continues, of their HIV, and of organs damaged by years of sickness and treatment.

Her list of answers to the epidemic was matched to a list of obstacles that stand in their way — but then matched those to answers as well.

“The cascade of care is really quite broken,” she said, pointing to loss at every stage of response, following testing, monitoring, treatment, and continuation of lifelong care. Some of the greatest attention to the gaps patients fall through will have to focus on some of the most affected, but still neglected people, “if we’re going to get serious,” she noted.

Testing for hypertension and diabetes, along with HIV, as a pilot program she heads in Uganda has done, addresses the stigma associated with HIV-only care settings, as well as prevalent health issues, and raises community participation, she added. The aim of the project: To test and treat with the hope of contributing to the growing body of evidence that aggressive treatment scale-up will significantly reduce HIV incidence and the risk of acquiring HIV infection at the community level.

She moved on to money — while continued funding is a challenge, working with economists to show the worth of the investment is an answer, she said, “pay now, or pay forever.”

Until the cure, until the vaccine, the tools exist, she said, to cut new infections, end mother to child transmission, and turn the course of the global epidemic.

“Those who say it can’t be done,” she concluded, “should get out of the way of those doing it.”



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