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Eliminating HIV/AIDS: How We'll Get to Zero

By Myles Helfand and Kellee Terrell

Eliminating HIV/AIDS: How We'll Get to Zero

Since we first learned about HIV/AIDS more than 30 years ago, we've been on a mission to destroy it. So far, the virus has eluded every one of our efforts to wipe it off the face of the earth.

But we're getting there. We don't have a cure, and we don't have a vaccine. But what we do have is a growing number of ideas and methods that can each do their part to control HIV. And we have a planet filled with brilliant, dedicated people who have committed their careers, and in many cases their lives, to eradicating HIV.

Here are seven pieces of the puzzle. None of them can stop HIV on their own. But combined, they have the power to end one of the great plagues in human history, regardless of whether a true cure is discovered.

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HIV Treatment for All

HIV Treatment for All

It's a simple idea: Today's HIV meds work amazingly well with few side effects, and they also dramatically reduce the risk that someone with HIV will transmit the virus. So why not give meds to everyone who needs them?

The answer, of course, is money. The drugs themselves often have huge price tags, plus it costs a ton to test people for HIV, make meds available worldwide, and help people with HIV stay on treatment.

Universal HIV treatment access is a mind-bogglingly huge undertaking. But we're making progress. Many groups, including PEPFAR, the William J. Clinton Foundation and the Medicines Patent Pool, keep fighting to reduce drug costs. Meanwhile, Brazil stands as a shining example of how universal treatment is possible. Other places, like British Columbia, Canada, hope to follow suit.

Universal, Routine Testing

Universal, Routine Testing

It's no secret that a key step in the fight against HIV is ensuring everyone knows his or her status. But that isn't happening.

In the U.S. alone, 1.2 million people are living with HIV, and 20% of them are unaware of their HIV status, despite official recommendations that virtually everyone be tested. Not knowing your status means you are not on treatment and are at much greater risk of transmitting the virus to others. The key is early and consistent testing.

In very few parts of the world is getting an HIV test as routine as getting a regular checkup from a doctor. One exception: Thanks to "opt-out" and mandatory testing rules for pregnant women, a growing number of countries have virtually eliminated mother-to-child HIV transmission. Another exception is in Vancouver, Canada, where two hospitals seek to test all people who are admitted.

Economic Empowerment

Economic Empowerment

HIV preys on the communities that are most vulnerable, most fragmented and possess the least amount of power. Systematic poverty plays a huge factor in that vulnerability: Less money, mo' problems.

Add in gender-related oppression and a lack of economic independence, and you see why so many women are at risk. Women have to grapple with physical and sexual violence; sex trafficking; an inability to negotiate condom use; and lack of access to education, contraception and health care.

Thankfully, there are strategies to change that reality, although many are imperfect and underfunded. In countries such as South Africa, Kenya and India, money is being channeled to fund programs that help women become less reliant on men economically; take educational and skill-building classes; start businesses; and negotiate condom use with their partners.

Needle Exchange

Needle Exchange

Of the 33 million people living with HIV across the world, 3 million are injection drug users (IDUs).

Study after study has shown that needle-exchange programs can dramatically reduce new infections. Just look at Australia: It has seen zero HIV outbreaks among IDUs since it began running needle-exchange programs in 1995. There's also British Columbia, whose Insite safe-injection site has had a huge impact on HIV and hep C infections in the area.

Yet despite these successes, there is still resistance to needle exchange. The U.S. Congress, for instance, refuses to federally fund these programs. There are areas in the U.S., including California, New Jersey, New York, and Washington, D.C., that offer modest needle-exchange services, but more needs to be done to make a large impact.

Eliminating Stigma

Eliminating Stigma

Even today, there are people who believe that HIV only happens to "those" people; that the pandemic is a result of going against God; or that you can get HIV from sitting on a toilet or sharing a fork with someone who has HIV.

Over the years, we have seen strides taken around the world to reduce stigma from all different angles. In South Africa, Ghana, the U.S. and the United Kingdom, soap operas have educated viewers about HIV. We've seen tons of ad campaign posters plastered on buses and subway stations. And we've seen advocates fight to end HIV criminalization laws -- and even win, some of the time.

But it hasn't been enough. There are still people who, even in the U.S., are afraid to disclose their status for fear of rejection, of losing their job, of being imprisoned -- or even of being killed. Obviously, we have a lot more work to do.

Fighting More Than HIV

Fighting More Than HIV

As tempting as it is to focus solely on HIV, the HIV pandemic isn't just about the virus itself. For one thing, it's about the social and economic conditions that put people at greater risk for becoming HIV positive, that make them less likely to be tested, and that make it harder for them to access lifesaving care once they're diagnosed.

For another, the HIV pandemic is about all of the other viruses and diseases that swirl around it. People with malaria are more likely to get HIV, and vice versa. Tuberculosis is the No. 1 killer of people with HIV worldwide. People with genital herpes outbreaks are more likely to get or transmit HIV during sex.

HIV doesn't exist in a vacuum. To beat it, we must join forces with, rather than compete with, efforts to fight the other issues and health problems that intertwine with HIV and make it so much more deadly.

Teaching a New Generation

Teaching a New Generation

HIV isn't going away anytime soon. Part of the reason is simple science and the realities of how HIV works. But it also has to do with the way our society works: What we teach our children, through our words and our actions, about what matters to us and what judgments we make about others.

Our children will have to clean up the messes we've made. That includes not just continuing, but accelerating, the fight against HIV. And that means getting a better, more complete education about HIV than most of us got when we were younger.

There are some amazing programs out there educating youths about HIV in a way that truly resonates. In Africa, there's an HIV-positive muppet. In the Netherlands (and Philadelphia!), there's a music-and-dance group. We need more efforts like this to help ensure that, when today's HIV fighters pass on the torch, it will burn more brightly in the hands of those who follow.




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