It all comes down to math, science, policies, people on the ground and resources to support them
Global health leaders gathered on Capitol Hill Wednesday to announce a new set of HIV response goals and to say with an increasingly familiar blend of optimism and realism that while the work that is needed to stop the pandemic’s toll of preventable illness and deaths may be clearer than it’s ever been, it may also be more challenged.
The goals came with what organizers call “a super-fast-track framework for ending AIDS among children, adolescents and young women by 2020” with the slogan of “Start free, stay free, AIDS-free.” That’s 10 years ahead of the fast-track goal announced two years ago setting 2020 testing and treatment targets to end the impact of HIV as a global health threat by 2030. Speakers who included U.S. Global AIDS Coordinator Amb. Deborah Birx, National Institute of Allergy and Infectious Diseases director Dr. Anthony Fauci said they know it can be done.
“It’s not just a dream, it’s a goal,” UNAIDS Director Michel Sidibe reiterated.
Picking up where the previous “Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive” left off, the new goals include lowering HIV infections among children, from infants to 14 years, to fewer than 40,000 a year by 2018, and to 20,000 by 2020, reaching 90 percent of all pregnant women who have HIV with lifelong treatment by 2018, lowering new infections among adolescents and young women to fewer than 100,000 by 2020, and ensuring that 1.6 million children and 1.2 million adolescents living with HIV have antiretroviral treatment by 2018.
Achieving those goals will require following the numbers, said Amb. Birx, who pointed to one province in Kenya driving that nation’s incidence rate up, where, she said the investment by the President’s Emergency Plan for AIDS Relief had been smallest.
It will require applying knowledge gained by decades of clinical trials and studies, said Dr. Anthony Fauci. He noted years of progress toward eliminating mother to child transmission, since “the iconic ACTG 076 trial” proved that antiretroviral medicine administered to HIV-infected pregnant women could protect their children, and called ending mother to child transmission altogether “entirely scientifically feasible.” And he noted that treating mothers throughout their lives virtually eliminates risks of the virus being transmitted by breastfeeding. For the “staying free” goals, he pointed to TasP — treatment as prevention, PrEP — pre-exposure prophylactic use of antiretroviral medicines, and PeP — post-exposure antiretroviral administration. He pointed to more iconic studies — HPTN 052, which proved that treating people who have HIV protects their uninfected sexual partners from the virus, SMART, which showed that consistent treatment leads to better health than inconsistent treatment, and START, which proved that people should not have to wait to get sick to have access to treatment. And he pointed to the real life applications that have further validated findings from those studies.
Science has continued to improve antiretroviral treatment over decades, with simpler, more effective, less toxic regimens, and more progress lies ahead, Dr. Fauci said, anticipating the advent of long-term injectable antiretroviral medicines that will liberate people living with the virus from a daily ritual of pill-taking.
“If you follow the science and use the science in everything you do,” he said, “we will be able to end the epidemic.”
The question, as Sidibe noted, remains whether the resources to do that will be provided.
More than half the people living with HIV worldwide are still not accessing treatment, he observed, “and those are the poorest people.”