Scientific breakthroughs have helped us chart an impressive course in the HIV/AIDS response such that in the fourth decade of the epidemic, we are already talking of ending AIDS. Despite the fact that a vaccine for this disease still eludes us and a cure is not yet possible, we have been able to not only control but have also managed to reverse the epidemic in large parts of the globe.
For us to reach this stage, contributions have come from a wide variety of stakeholders — governments, funding agencies, development agencies including the United Nations that collaborated and joined forces to support countries in addressing the epidemic and last but not the least, communities which continue to relentlessly fight for people’s right to affordable and equitable access to treatment.
Moving ahead, we need to ensure that the biomedical response addresses both prevention and treatment. The division is now more blurred than ever with the scientific advances that have firmly positioned treatment as prevention. Starting treatment early not only improves the quality and longevity for the infected individual but also prevents further transmission of the infection.
With effective HIV control, we have been able to reduce the number of direct HIV-related deaths and adverse outcomes. As people continue to live longer on antiretroviral treatment, not only do they face the common problems of aging like the non-HIV population, they are at heightened risk of non-AIDS conditions such as heart disease due to persistent inflammation. These conditions, so far mostly studied in the US and Europe, are now becoming important in the developing world. These additional co-morbidities and the shift of HIV care to chronic disease management could overburden already stretched healthcare systems.
These could be addressed if we were to find a potent vaccine to prevent HIV and a cure for HIV once infected. A number of cases, including the so-called ‘Berlin patient’, the ‘Mississippi baby’, and the ‘Visconti’ cohort, have given us hope and impetus in our search for an HIV cure. Though a scalable cure or a vaccine is not foreseen in the near future, we must continue and enhance our efforts to ensure that health systems are prepared to safely and effectively deliver long-term chronic HIV and related care.
For an AIDS-free world, we need to blend the biomedical and social-behavioural interventions that ensure universal access to prevention and care of HIV in a health and social system that respects human rights, sexual diversity and gender equity.
Poonam Khetrapal Singh is regional director-elect, WHO, South East Asia region
The views expressed by the author are personal