AIDS epidemic turns 30

By Dr. Ananya Mandal, MDMay 31 2011

It is 30 years since the beginning of the AIDS epidemic. It was fatal then but has now become a treatable, if still incurable, chronic illness. AIDS therapy now has tools that prolong the lives of people infected with the virus and prevent others from acquiring it. They range from antiretroviral therapy (ART), to circumcision and campaigns to reduce promiscuity. On the horizon are gels and pills that protect against infection during intercourse. Even the outlook for an AIDS vaccine is no longer as bleak as it used to be.

AIDS first came to public attention on June 5, 1981 in a report on a rare type of pneumonia in five gay men, but scientists now believe the virus entered human beings early in the 20th century. In Africa, where the epidemic began and has had the most devastating effect, the rate of new infections – incidence - peaked in the late 1990s.

Last year, the world spent $16 billion on the task of combating AIDS, half of which was donated by rich countries and charities. A recent projection estimated that, by 2031, global AIDS costs could reach the equivalent of $35 billion a year. A recent United Nations report declared frankly: “The trajectory of costs is wholly unsustainable.”

In fact nearly 6 million people in the developing world are now receiving life-extending ART. While that is less than half the 14.6 million HIV-infected people who should be getting treatment under the World Health Organization’s latest guidelines, it nevertheless represents an accomplishment that was inconceivable when the epidemic turned 20 in 2001. That number is likely to grow in the wake of a recent study showing that ART dramatically cuts a person’s infectiousness, and thus is itself a tool for prevention. About 33.3 million people around the world are infected with HIV, the virus that causes AIDS. In 2009, the last year for which there are complete statistics, 2.6 million people became infected and 1.8 million people died. Those numbers are down from previous peaks.

Nevertheless, the number of people living with HIV is still on the increase. Part of the reason is that AIDS patients are surviving longer, thanks to the expansion of antiretroviral therapy in the developing world, where 200 times as many people are getting it now than were just eight years ago. But for every person who starts treatment, two others become infected.

By 2031 when the epidemic turns 50, about 3.2 million adults will become infected each year, according to a recent projection. By the middle of the century, there could be 70 million people living with HIV in Africa alone.

“Money is important, but money alone will not make it,” said Michel Sidibe, director of UNAIDS, the United Nations AIDS program. “We need to have a solidarity around issues which are going beyond money. The solution will be found through a genuinely shared responsibility.” Three-drug ART combinations cost $10,000 to $12,000 a year in 1996 when they became standard AIDS therapy in the United States. Lowering drug prices is just one of several strategies to make money go further.

Since 2006, a charity based in Geneva, UNITAID, has collected $1.5 billion and used it for AIDS, malaria and tuberculosis projects. A campaign called (RED) has raised $170 million since 2006 by partnering with companies that give the Global Fund a share of profits from the sale of computers, mobile phones, baby strollers and other products.