The world’s experts on HIV/AIDS are gathered this week in Amsterdam for the 22nd International AIDS Conference as a collective anxiousness has set in. The 2016 optimism that fueled a United Nations declaration that the end of AIDS was near has been replaced by a gnawing fear among experts. If properly treated with available drugs, today’s 37 million infected people no longer face mortal illness as did their counterparts in the pre-treatment days of the 1980s and 1990s. That much is true.
But given the rest of the equation, it’s remarkable that the mood in Amsterdam isn’t one of panic. Danger surely looms.
For years, humanity had the virus on the run, and death tolls plunged to joyously low levels. But the disease is now poised, for the first time in recent memory, to add massively to its global death toll of 35 million since 1981. Three factors are contributing to its runaway resurgence: flawed public health strategy, rapidly shifting demography, and diminished resources.
A flawed strategy for HIV control
Let’s start with strategy. In 1996, researchers from multiple institutions and pharmaceutical companies announced the discovery that a combination of drugs, taken daily, could drive HIV levels down so dramatically that the treated individuals could live normal lives. And more than a decade ago, it was shown that the anti-HIV drugs worked so well that viruses were forced into hiding in parts of the body from which they couldn’t spread to other people sexually, through shared needles or blood, or in utero from mother to child.
A worldwide strategy for HIV control was set upon, aiming to place all HIV-positive people on the drugs, both to spare their lives and to stop the spread of the virus. The year 2030 was set as the world’s deadline for halting the spread of HIV, stopping AIDS deaths, and having the first generation since 1980 born and raised completely free from infection. To make the dream a reality, a cocktail of anti-HIV drugs was manufactured cheaply, bringing the annual cost down from a 1996 high of well over $10,000 per person to less than $75. And a multibillion-dollar infrastructure was created to find infected individuals, provide them with those drugs, and monitor their health.
But the strategy was a gamble. The drugs didn’t cure anybody—HIV still lurks in the bodies of the nearly 22 million treated individuals. Any interruption in taking the medicine allows hidden viruses to flood into the individual’s bloodstream, endangering the health and survival of the patient and making him or her a contagious risk to others. War, a transport breakdown, government financial glitches, loss of international donor support, patient migration, individual forgetfulness—hundreds of personal, financial, and political factors can interrupt treatment. Read more via Foreign Policy