The Outlook Is Bleak

America is losing the fight against HIV/AIDS.  Last year, CDC leaders summarized the evidence in the New England Journal of Medicine.  The most compelling data show that for the last 20 years the annual number of new HIV infections in the United States has stayed the same, at approximately 45,000 cases. The long-range plan for control of HIV infection is to identify new cases as quickly as possible and provide the patients with medications that will reduce their viral load to a level that will render them non-infectious. Successful treatment reduces the chance of sexual transmission not to zero, but to a very low rate.  But CDC data show that only about 30% of the estimated 1.2 million persons living with HIV infection in the United States have reached the desired low viral load.  Many complex reasons account for this, but the conclusion is clear, HIV control efforts are not working well enough to bring the epidemic under control.  

It is important to understand that CDC has no authority over implementation of HIV control measures.  The states hold this authority, and implement HIV and other sexually transmitted diseases (STD) control measures through their state and local public health departments.  State funding for public health has always been low, and CDC provides annual funding for every state.  In recent years, more than half of state public health program budgets have been cut and more than 20 states have closed STD/HIV clinics. In addition, Planned Parenthood, which screens both men and women for STD/HIV and provides treatment, has been defunded by many states, thus severely limiting access to STD prevention services.  Within the last month, CDC reported that in 2015 syphilis, gonorrhea, and chlamydia cases have escalated to unprecedented numbers.  We are apparently losing our battle with these diseases also.

We are in desperate need of an effective vaccine to prevent HIV infection.  If the United States can’t control its HIV epidemic, just think of what is happening in the rest of the world, especially Africa.  Many drugs have been developed for the effective treatment of HIV infection, but they are either not in reach for the majority of HIV-infected persons or too many infected people are unaware that they have HIV.

It is critical that The World Health Organization (WHO) organize an intensive international effort to develop an effective HIV vaccine, a collaborative effort in which all who participate will be recognized.  Competition among scientists should be limited and cooperation and sharing of information maximized.  No Nobel Prize on the line, only the satisfaction of saving millions of lives if it is successful.  WHO did not receive the Nobel Prize for carrying out the successful worldwide smallpox eradication program. The credit went rightly to thousands of participants.  Another very prestigious prize equal to the Noble should be established for public health successes and the first goal for that prize should be the development of a safe and effective vaccine that prevents HIV infection.

 

Mary Guinan, PhD, MD, was the founding dean of the School of Community Health Sciences at the University of Nevada, Las Vegas, and is now professor emerita. She was the first woman to serve as the chief scientific advisor to the director of the Centers for Disease Control and Prevention. Her recently-published memoir is entitled Adventures of a Female Medical Detective: In Pursuit of Smallpox and AIDS.