AIDS treatment has progressed, but without a vaccine, suffering still abounds

I mentioned to a friend, a gay man nearing 60, that World AIDS Day, which has been observed on Dec. 1 since 1988, was almost upon us. He had no idea that World AIDS Day still exists.

This lack of knowledge is a testament to the great accomplishments that have occurred since World AIDS Day was created 30 years ago. It is also due to an accident in the timing of his birth that my friend escaped the devastation wreaked by AIDS among gay men in the U.S., before there was antiretroviral therapy.

Many people have forgotten AIDS, but there are consequences to forgetting. The fight against AIDS is at a tipping point. Increasingly, there are signs that we may be heading in the wrong direction.

Many successes, yet the grand prize is elusive

I am a social epidemiologist with more than 20 years of research experience in HIV and STD prevention. I am also the founder of The Basics with Dr. Mo, a sex health communications project that translates prevention science directly for people who need it most.

It is true that global HIV/AIDS success stories abound: Mother-to-child transmission can be reduced to below 5 percent, 75 percent of people living with HIV know their status and 59 percent receive antiretroviral therapy.

Most recently, Pre-Exposure Prophylaxis (PrEP) – the use of antiretrovial drugs to prevent HIV infection among those exposed – has proved to be a successful prevention approach.

Yet the prize – a vaccine that can prevent HIV infection – remains elusive, and makes impossible the use of the only known strategy to have ever eradicated an infectious disease: widespread vaccination. That disease was smallpox, in 1980.

The seeds of unease

A demonstration for AIDS advances in July 2018 in The Netherlands, with Princess Margaret Van Orange pictured at the center. Paolo Amorim/Shutterstock.com
Despite the lack of a vaccine, in 2016 United Nations member states adopted a political declaration on ending the AIDS epidemic by 2030.

As part of the accountability framework, interim 2020 goals set a target of 500,000 new HIV infections for that year. A review of the most recent data estimated 1.8 million new HIV infections in 2017, exactly the same number as in 2016.

Prominent scientists have already begun to question the ability to eradicate AIDS by the 2030 deadline, and concede that the situation has stagnated. The attainment of eradication looks bleak, without the aid of either an effective vaccine or the immediate large-scale promotion and utilization of existing prevention tools (i.e., condoms, voluntary circumcision and potentially PrEP). Given that the vast majority of new HIV infections are sexually transmitted and that condoms have played a decisive role in the global control of HIV transmission, ongoing condom availability and use will be essential to future eradication.

Condoms – both male and female – remain a highly effective mechanism of HIV/AIDS prevention, as well as of other sexually transmitted infections that greatly enhance the risk of HIV transmission.

Condom use is also strongly advised by global public health institutions, including the World Health Organization and the U.S. Centers for Disease Control and Prevention, in conjunction will all other HIV prevention tools including PrEP, because of their lower levels of effectiveness in preventing transmission.