World AIDS Day: Many Gains, Much to Do

Today is World AIDS Day; this is the 25th anniversary of the event. In the past quarter century there have been incredible gains in both HIV prevention and treatment, turning the disease into one that was nearly universally fatal to what is for many a chronic illness with a near-normal life expectancy. On the patient level the gains that have been made are due to antiretroviral drugs ("ART"); access to these life-saving drugs is still a major issue in much of the world, however.

In 2012 there were 2 million new HIV infections and 1.6 million HIV/AIDS related deaths. There are an estimated 35 million people living with HIV globally, with approximately 75% of all new infections occurring in sub-Saharan Africa.

I volunteered providing medical care in a small village in rural Kenya back in 2001. I remember having a conversation with a local health worker about HIV in this particular community and was amazed when she told me the HIV prevalence was over 40%. At the time the people living in the area had essentially no access to life-saving ART and many of the patients I saw had findings consistent with advanced HIV/AIDS and more likely than not are now dead. HIV/AIDS absolutely has devastated many communities in sub-Saharan Africa.

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The picture is not entirely grim, however. The President's Emergency Plan for AIDS Relief (PEPFAR) has led to millions of people in Africa receiving ART, and it is estimated that one million new infections in children have been prevented over the past decade. Many people who once had little to no hope of obtaining ART (such as those living in the community I described above) can now do so.

In the United States it is estimated that 1.1 million people are living with HIV, with 1 in 5 people

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unaware they have the infection. There are an estimated 50,000 new infections per year. There are racial disparities in HIV infection risk that are believed to be due, at least in part, to differences in access to care, poverty and discrimination. Although the incidence of new infections is going down in some subgroups (such as black women), it is increasing in others (such as men who have sex with men).

Much more needs to be done to prevent new infections, identify new infections early and to get patients with HIV into care. Health disparities need to be addressed both in the U.S. and globally. New therapies need to be developed (including a preventive vaccine).

See here for some terrific resources on HIV/AIDS, including more about World AIDS Day.