Back to the Future?
December 16, 2016
I'm always a bit of a basket case when World AIDS Day comes around each year. The day, which usually stretches into a week's worth of events for me, stirs up a complex set of emotions in me. The memories of what it was like being diagnosed with HIV on World AIDS Day in 1994. The pain of watching friends and acquaintances waste away and suffer one devastating infection after another as they struggled to stay alive another week, another month. The memories of those in my life who lost their battles with HIV . . . Andy, Paul, Peter, Robert, my partner John, and so many others who died in their youth and still had so much more to give the world. But what haunts me the most are my memories of being a volunteer HIV testing counselor in the late 1980s and early 1990s. I can still see the faces of dozens of men and women whom I had to tell that they had the virus -- before effective HIV treatment was available. I see the color drain from their faces. I see their tears. And I see their strength, courage, and resolve in that moment. That moment when they learned that their lives would never be the same; that their lives might be cut short by a virus that had invaded their bodies without their consent, without their permission.
Looking back also makes it clear how far we've come as a result of hard-won progress in science, advocacy, policy, prevention, and health care at the local, state, national, and international levels. New diagnoses and deaths have plummeted from their peak levels and are continuing to decline.
We have powerful HIV treatment options with relatively few side effects. Their impact has been miraculous -- they have given healthy and productive lives back to millions and millions of men, women, and children around the world.
HIV treatment is not only keeping people alive -- it is also stopping HIV transmission. People who are taking HIV treatment and have achieved viral suppression have a zero or almost-zero chance of sexually transmitting HIV to others. PrEP is more than 90% effective in preventing HIV infection if taken every day. HIV testing is saving lives and making it possible for people living with HIV to get the medical care and prevention services that stop disease progression and transmission to others. Syringe services programs and medication-assisted treatment have driven down new HIV infections among people who inject drugs. These and other signs of progress are evident in the National HIV/AIDS Strategy Progress Report [PDF 1.44 MB] that was released on World AIDS Day.
This World AIDS Day, I continued to feel the concern that I mentioned in my first blog post as Director of the Office of HIV/AIDS and Infectious Disease Policy last January. That concern came from the realization that all of the gains we worked so hard to achieve could be lost. New diagnoses and deaths have gone down only because of the commitment we've made to making HIV prevention, testing, medical care, treatment, and supportive services available to those who need them. If fewer people have access to these services, fewer people will be able to protect themselves, and fewer people will be able to achieve and maintain viral suppression. If this happens, more people with HIV will get sick, their health care costs will rise, and more new infections will occur.
More Americans have died with HIV than Americans who have lost their lives in combat over the last 100 years. When the number of HIV-related deaths was at its peak in 1995, 43,115 Americans died because of HIV-related causes. Almost 20 years later, that has dropped 84% to 6,721 deaths related to HIV in 2014.
The only thing that is stopping us from going back to death rates like we saw in 1995 is the system of care that has been put in place to provide access to HIV prevention, testing, care, treatment, and supportive services. If fewer people with HIV are on HIV treatment, more will get sick. Healthcare needs will rise, more Americans will die, and worker skills and productivity will be lost.
We can't let ourselves backslide to the dark days of the epidemic when HIV infections and deaths were so high. We have to maintain the gains that have been achieved, and continue to look ahead to the future -- a future without new HIV infections or HIV-related deaths. Advances in science, prevention, and health care over the past 35 years have gotten us to this point where that future could be a reality. We need to finish the work that we've started, that we've invested so much in, to make that future a reality for all Americans. We've come too far, sacrificed too much, to go backwards.
Richard Wolitski, Ph.D., is director of the Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services.
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