He was recounting the bitter frustration of being trained to be a healer, and having no recourse.
He was talking about “one of the greatest accomplishments in the history of medicine,” that in the three decades since has allowed people with HIV to grow old, and given the world a chance to end the epidemic.
And he was reviewing the research showing that treatment prevents transmission of the virus and more than halves risks of serious illness and death, that adds up, he says, to “absolutely no excuse whatsoever for not putting every single person with HIV on treatment.”
The director of the National Institute of Allergy and Infectious Diseases was speaking about “Ending the HIV/AIDS Pandemic: An Achievable Goal,” at the launch of the District of Columbia Center for AIDS Research, a entity that has as its goal the support and expansion of research that contributes to ending the HIV epidemic in Washington, DC, “and beyond”. And he was saying that ending the epidemic “isn’t just a feasible goal, it’s an inevitable goal.” Which has a ring of conviction from the physician scientist who has led the U.S. HIV research response since the pandemic’s earliest years, and who, no matter how optimistic he is about the latest development in vaccine research, refuses to project when it will yield results.
The confidence Fauci expressed is all the more remarkable in light of current failures in the U.S. to come close to any of the “90 percents” UNAIDS has projected as critical to ending HIV as a global health threat — 90 percent of people with HIV diagnosed, 90 percent of those diagnosed on sustained treatment, and treatment effective and consistent enough in 90 percent of them to suppress the virus — all by 2020. Efforts to achieve those in Washington, DC are doing better than other parts of the country, but still, he points out with HIV prevalence of 2.5 percent, the nation’s capital is home to a generalized epidemic by the World Health Organization’s definition.
Fauci’s confidence, which comes with an “if” at the end — if the world uses everything currently at hand, in a “cascade of prevention” as well as a cascade of care, isn’t based on successes in Washington, DC, though. It’s based on success in Rwanda.
There treatment for as many as 79 percent of HIV patients is consistent and effective enough to suppress the virus, and Fauci cites an article he recently read by Rwanda Minister of Health Agnes Binagwaho and Partners in Health co-founder Paul Farmer detailing the role of decentralized services and community-based supports.
“Getting everything at the community level, decentralizing everything we do,” is essential to bringing the fruits of three decades of science where it needs to go, he said.
“We’re going in the right direction,” Fauci said. “If you look at the trajectory, its going down . . . but it’s not steep enough.”