World AIDS Day, December 1, 2001

Earlier this year, we marked the twentieth anniversary of the recognition of the first cases of the acquired immunodeficiency syndrome (AIDS). From a handful of initial reports, AIDS has grown into a global pandemic, touching every corner of the world. The human immunodeficiency virus (HIV), the cause of AIDS, has now infected more than 60 million people, according to estimates of the Joint United Nations Programme on HIV/AIDS (UNAIDS). In the year 2001 alone, 5 million people worldwide were infected with HIV, and 3 million individuals with HIV/AIDS died. More than 95 percent of these infections and deaths occurred in underdeveloped countries, most of which are also burdened by other significant health challenges. In these nations, HIV/AIDS threatens not only human welfare, but social, political and economic stability as well.

The theme of this World AIDS Day is "I Care . . . Do You?" It is a challenge to all of us to do more to slow the scourge of HIV/AIDS at home and abroad: as individuals, protecting ourselves and our loved ones from HIV; as healthcare workers and caregivers, helping to ease the suffering of those living with HIV/AIDS; as researchers, developing the tools to help those infected with HIV and to prevent future infections; and as policy-makers and activists, helping to bring advances in treatment and prevention to the countries that need them most.

In the United States and other western countries, potent combinations of anti-HIV drugs (highly active antiretroviral therapy or "HAART") have dramatically reduced the numbers of new AIDS cases and AIDS deaths. Meanwhile, the toll of AIDS has accelerated elsewhere in the world, especially in poor countries where expensive HAART regimens are beyond the reach of all but a privileged few. Fortunately, this disparity in access to life-saving medications may be changing. Recent events, including dramatic reductions in the price of antiretroviral drugs for developing nations and the commitment of world leaders to address the AIDS problem globally, provide hope that AIDS therapies and prevention services will begin to reach more of the people who could benefit from them. In 2001, we witnessed an unprecedented galvanization of resources and commitment toward curtailing AIDS in the developing world by governments, private foundations, activist groups, the United Nations, World Bank and other international organizations, and private industry. This momentum must continue, even as our nation's attention is diverted by warfare and terrorism.

Many organizations and individuals -- including the National Institute of Allergy and Infectious Diseases (NIAID) -- have challenged long-held assumptions that comprehensive approaches to the prevention and treatment of HIV are not feasible in resource-poor settings. In the past, attempts at pursuing prevention efforts in resource-poor settings such as sub-Saharan Africa have been hampered by the fact that little could be offered to the people who participated in prevention efforts. Now, with dramatic reductions in the price of HAART, it appears that antiretroviral treatment may be feasible for many more people in poor regions. Building on the research infrastructure NIAID has helped establish in Africa and elsewhere in the developing world, we are actively working with our international colleagues to link the provision of anti-HIV therapy to efforts in prevention research, with the goal of facilitating a comprehensive approach to the AIDS pandemic in poor countries. Concurrently, NIAID-supported investigators are testing a diverse range of HIV vaccine strategies, several of which in recent months have shown remarkable promise in tests in non-human primates. The best candidates are rapidly being moved into human clinical trials at sites of NIAID's global HIV Vaccine Trials Network, and at the NIAID Vaccine Research Center. I am optimistic that a safe and effective vaccine can be found that will prevent HIV infection and/or slow the progression of disease in people who are already infected with the virus.

Of course, research conducted by NIAID and our sister institutes at the National Institutes of Health (NIH) is only a part of a broader and more comprehensive approach needed to fight HIV/AIDS globally. Our ultimate success will require a sustained effort involving people from all walks of life, a robust commitment to fighting HIV/AIDS by the governments of rich and poor countries, and the resources and expertise of both the public and private sectors.

For our part, the NIAID will continue to strengthen our role as an active member of this global team. As we search for solutions to HIV/AIDS in the months and years ahead, let us not expend our energies searching for reasons why we should not act and why our efforts might fail; rather let us apply ourselves, collectively, to the task of developing sustainable programs and interventions that will overcome the scourge of HIV/AIDS.