Thursday, November 06, 2014

Thinking about HIV/AIDS

There have been about 39 million deaths from AIDS. More than 35 million people are living with HIV/AIDS. Fortunately, a lot of them who started treatment early (not always true), get the right drugs, and persist in the treatment (not always true) can live long lives with the infection; still, more than a million died last year from HIV/AIDS. A couple of million were infected last year; if all the available means were used to treat and prevent HIV infections, the vast majority of the new infections could be averted. If governments and the donor community perseveres -- and it seems likely that they will -- then the number of new infections per year should decrease in coming years.

An HIV vaccine trial in Thailand some years ago achieved 31 percent protection of the persons receiving the vaccine. This was not enough to make the vaccine useful for public health purposes, but after years of lack of success, it indicated that immunization was possible. Considerable progress has been made since, and researchers are hopeful that they are now on track to develop a vaccine which in combination with other prevention means and treatment will end the pandemic. One estimate is that such a vaccine will be ready by about 2029.

Two shadows on the horizon. 
  1. Funding for HIV/AIDS research and development should be increasing as more is learned and the world gets closer to real tools for dealing with the pandemic, but it has been cut since the beginning of the Great Recession. 
  2. There is a precedent for rebound after a relatively successful public health campaign. The World Health Organization after World War II began a campaign for the global eradication of malaria. Unfortunately, it was not possible (then) to eradicate the disease worldwide, but it was eradicated from some areas and the incidence and prevalence were greatly reduced. However, "fatigue" occurred and governments reduced their efforts and malaria rebounded in much of the world. That could happen with HIV/AIDS if a vaccine is not developed relatively soon, and countries tire of the heavy effort of prevention of HIV infections and treatment of HIV/AIDS victims.

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