10 HIV/AIDS Stories That Defined 2011 in the US

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As the calendar marches toward 2012, there is good news and not-so-good news on the HIV pandemic. The good news: This year brought huge advances in fighting HIV/AIDS, including major steps forward in prevention and expanded access to treatment, which has helped slash the number of global infections and deaths.

Now the not-so-good news: Much of the U.S. media's HIV reporting focuses on the epidemic outside of the U.S. Within the U.S., new infections are rising among gay men, especially men of color. The economy has forced many U.S. states to decrease funding for HIV services. And pervasive stigma and the criminalization of HIV remain a problem.

Let's take a look at some of the major HIV stories that rocked 2011 in the U.S.

Berlin Patient: A "Cure"?

It's an unlikely story of hope: that of Timothy R. Brown (the "Berlin patient"), who doctors say has been "cured" of HIV via a stem cell transplant. In 2007, Brown was an American expatriate living in Berlin and facing death due to HIV-related complications and a relapse of leukemia. His German doctor had a radical suggestion: a stem cell transplant from a donor with an extremely rare genetic mutation that is resistant to most types of HIV.

The procedure was expensive and dangerous, but it worked. Brown has seen his viral load rendered undetectable without the need to take HIV medications. While the complexity, cost and risk of Brown's procedure make such a "cure" impossible for the larger population, it raises the question: By genetically modifying a person's stem cells, can we wipe out their HIV? Research is underway to find out.

30 Years of HIV/AIDS

June 5, 2011 marked a somber milestone: 30 years since the first published reports of what we now know as HIV/AIDS. AIDS has exacted a devastating toll since that discovery.

More than one million Americans are living with HIV. That number has increased over the past decade, but for a good reason: In the "dark days" of the 1980s and early '90s, a diagnosis was often a death sentence. But life expectancies have increased and HIV is now treated as a chronic, manageable condition.

The "color" of the domestic epidemic has also changed. Originally, HIV was considered a problem for white, gay men. Today, African Americans are barely 14% of the population, yet make up half of all those living and dying with HIV/AIDS in the U.S. Latinos and other minority groups are also disproportionately affected, especially gay men of color and women of color.

The PrEP Debate

Taking a daily pill to reduce HIV risk -- better known as pre-exposure prophylaxis, or PrEP -- remains one of the most exciting biomedical prevention strategies on the horizon. Daily use of some antiretrovirals has shown up to 73% efficacy in preventing HIV transmission among men who have sex with men (MSM). San Francisco will soon become the first city in the nation to offer PrEP to MSM.

PrEP's potential efficacy among women has been less clear, but this year we finally saw promising study results for heterosexual couples.

Still, PrEP is a polarizing topic. Depending upon whom you ask, it's often described as either a "magic bullet" or an unrealistic, "boutique" intervention. And questions abound, such as: Who will pay for it? And what are the health consequences of placing HIV-negative people on HIV medications they don't really need?

Microbicide News

There have been setbacks in the development of a gel spiked with tenofovir -- a microbicide that can be used vaginally or anally to prevent HIV. The CAPRISA study, unveiled to much fanfare in 2010, found such a gel worked pretty well in women. But this year, another study called VOICE was partly cancelled after researchers discovered that one of the gels it was testing failed to prevent infection. Scientists are unsure why the latest trial was unsuccessful.

Meanwhile, researchers are conducting trials of an antiretroviral-containing vaginal ring that potentially could "prove to be more effective and easier to use than" microbicides. And earlier this year, scientists announced that they had successfully pilot-tested an anal microbicide gel. The risk of HIV infection is up to "2,000 times greater with receptive anal sex than vaginal sex" they said, so the potential there could be huge.

"Treatment as Prevention"

Public health experts now believe that quickly linking people with new HIV diagnoses to treatment reduces their likelihood of transmitting the virus. Study results announced this year showed that HIV treatment can reduce sexual transmission of the virus by up to 96%.This approach has come to be known as "treatment as prevention," or TasP. In the U.S., TasP has special implications for blacks, who make up 56% of all "late testers." Late testers may benefit less from antiretrovirals and may also be at increased risk for transmitting HIV due to higher viral loads.

U.S. officials are excited enough about TasP that it was highlighted in a major speech by Secretary of State Hillary Clinton on the global pandemic. But some advocates wonder: Will a focus on TasP hurt other prevention efforts and make people with HIV unfairly responsible for keeping all of society negative?"

The ADAP Funding Game

The past two years have seen an aggressive push within the U.S. to increase HIV testing. Increased testing usually translates into more diagnoses, but who will help pay for the expensive medications that newly diagnosed people need to take?

A rise in diagnoses has coupled with the economic downturn to force major cuts to the AIDS Drug Assistance Program (ADAP), a network of state-run programs that help low-income people living with HIV. About 175,000 Americans rely on ADAP for their meds. But this year, ADAP waiting lists climbed as high as 9,217 -- an all-time record -- and many ADAPs have instituted, or are considering, additional measures that reduce coverage.

In response, advocates have launched a wave of ADAP-related policy and social media activism. The message: Increase ADAP funding now!

HIV Spikes Among MSM

The overall number of new domestic HIV infections is about 50,000 every year. Gay and bisexual men -- or "men who have sex with men" (MSM) in public health jargon -- account for nearly two-thirds of new infections.

Infection rates in almost all groups are relatively stable -- except among young MSM, especially young MSM of color. Infections in that group have soared by 48% from 2006 to 2009. A recent study found almost one in three black MSM are positive, compared to about one in six white MSM. Young, positive black MSM are also among the least likely to be aware of their infection, putting their own health at risk (and potentially that of others).

Researchers, policy experts and advocates are trying to pinpoint why this is happening (there are many theories), and hope to mobilize a better response to the issue.

Criminalizing the Epidemic

Pop quiz: Who are the global leaders in prosecuting people for potential HIV exposures? The surprising answer: the U.S. and Canada.

Recent years have seen a surge in arrests and harsh prosecutions of people with HIV -- such as the gay, black man living with HIV in Michigan who faced bio-terrorism charges after he allegedly bit another man during a brawl. Another poz man was convicted of assault even though his partner was aware of his status! Even spitting caused controversy this year, despite the fact that HIV can't be transmitted through saliva.

The U.S. National HIV/AIDS Strategy emphasizes that stigma and discrimination remain "extremely high," and calls for a review of all criminalization laws. Rep. Barbara Lee recently introduced the REPEAL HIV Discrimination Act in Congress. Let's hope there is some serious progress in 2012.

HIV/AIDS Among Latinos

As the U.S. epidemic has matured over 30 years, the demographics have changed. Originally, HIV was considered a problem among white, gay men. Now it's a "black and brown" epidemic -- disproportionately affecting African Americans and Latinos.

Of the 1.2 million Americans living with HIV, over 200,000 are Latino. Latinos account for 16% of the country's total population (and rising), but 20% of all new HIV infections. The infection rate among Latinos in 2009 was nearly three times that of whites.

Latino men who have sex with men are particularly vulnerable. Latino men often test late, and the situation among Latinas is not much better. Poverty, lack of access to insurance and health care, the language divide and immigration issues are among the many barriers that we need to overcome.

The Vaccine Hunt

While treatment for HIV has dramatically improved in the past several years, there is no substitute for prevention. Many antiretrovirals are expensive, not everyone has access to them, there are side effects, and people sometimes don't (or won't) take them.

That's why an HIV vaccine remains the holy grail. In the past year, there has been a number of promising steps. The University of Maryland School of Medicine announced its biggest research gift ever: $23.4 million for vaccine development. The team is being lead by Robert C. Gallo, the physician who co- discovered HIV and later developed the first HIV test. Meanwhile, this year, clinical trials began on two promising vaccine designs in Kenya. And researchers discovered a protein that prevents HIV from replicating in white blood cells. These are just a few of the encouraging developments, though only time will tell what comes of them.