December 1, 2002
The toll of the pandemic is staggering: HIV claimed more than 3 million lives worldwide in the year 2002 alone. Another 42 million people worldwide are living with the virus. Most HIV infections and deaths have occurred in resource-poor countries, where HIV frequently is superimposed on other significant health challenges, including endemic diseases such as malaria and tuberculosis, and malnutrition. In the United States, approximately 470,000 deaths have been attributed to HIV/AIDS since the beginning of the pandemic. Nearly a million other people are living with HIV in the United States; about 40,000 were infected this year.
Much has been accomplished since the early days of the HIV/AIDS pandemic, including significant advances in treatment and prevention. However, much remains to be done, as the spread of HIV continues to accelerate in many parts of the world. Even in countries that have managed to slow the spread of the virus, rates of new HIV infections continue at an unacceptably high level.
Unfortunately, the worst of the HIV/AIDS pandemic may lie ahead, unless the global community pulls together to bring proven tools of treatment and prevention to all nations, communities and individuals who need them. In this regard, the past two years have brought increasing hope that the resources and commitment to slow the HIV/AIDS pandemic are within reach. International organizations, governments, philanthropies, academic researchers, activist groups and pharmaceutical companies have mobilized significant resources and have shown that HIV care and prevention services can be successfully delivered, even in resource-poor settings. As we seek to build on this progress, many challenges face us, including overcoming the stigma and discrimination frequently associated with HIV infection. Unlike many individuals afflicted with other chronic diseases, people living throughout the world with HIV frequently face prejudice -- and even physical violence -- solely because they have had the misfortune of being infected with a virus. All too often, HIV-infected individuals become outcasts, shunned by their friends and co-workers, and even their own families. For a person living with HIV, institutional discrimination also can be harrowing, as they may be denied housing, employment or insurance. For the HIV-infected individual and his or her family, the medical consequences of stigma and discrimination are serious, as people may avoid life-saving treatment and suffer needlessly because of fear. The psychic toll of isolation and ostracism also can be profound. From a public health perspective, stigma and discrimination are a disaster. Faced with prejudice -- or even physical violence -- people may avoid HIV testing altogether. Not only will an untested, infected person miss the opportunity for needed treatment, they also will be less apt to access prevention programs that could help them avoid passing on the infection to others. We are at a pivotal point in the HIV/AIDS pandemic. We know that HIV treatment and prevention, when appropriately applied, can be enormously effective. Now, we must overcome the financial and logistical challenges -- as well as those posed by stigma and discrimination -- to make HIV treatment and prevention the rule, not the exception, for all the citizens of the world, rich and poor alike.
Dr. Fauci is the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland. The National Institutes of Health is an agency of the U.S. Department of Health and Human Services.