Getting to Zero
Getting to Zero: Experts weigh in on what it will take to end the AIDS epidemic
By Martha McKenzie | Rollins Magazine | May 16, 2016
It’s been 35 years since the first cases of AIDS were reported. Since then, there has been tremendous advances in prevention, testing and treatment. Yet, despite all of the progress, there are new challenges, frustrations and a continual need for more action.
HIV/AIDS Statistics Worldwide
- Every day about 5,600 contract HiV — more than 230 every hour
- Since the beginning of the pandemic, nearly 78 million people have becoming infected and close to 39 million have died to AIDS-related causes
- Nearly 37 million people are now living with HIV
Emory Voices on HIV/AIDS
For more perspecttive, see the full article in Rollins Magazine.
Carlos del Rio
The novelty of HIV has been lost. Treatment advances that have turned HIV into a chronic condition rather than a death sentence have led to a sense of complacency. And while it’s true that we now have the tools to end the epidemic, much work remains to be done. That means we can’t allow funding for research, prevention, and treatments to wane. In the United States, where just 30% of the 1.2 million people living with HIV are treated effectively enough to suppress their virus, it’s clear we need to design better health care systems that can get patients’ viral loads to undetectable and keep them there. Even then, it’s unlikely treatment alone will be powerful enough to end the epidemic. For that reason, research toward long-acting treatments, a cure, and a vaccine must continue. We have the tools to end the AIDS epidemic. We just need the will to do it.
Carlos del Rio is Hubert Professor and chair of the Hubert Department of Global Health and professor of medicine in the Emory School of Medicine. He is co-director of CFAR at Emory and chair of the HIV Medicine Association.
Natalie D. Crawford
Racial and ethnic disparities are persistent across every facet of HIV—from transmission to diagnosis to treatment. Specifically, black and Latino Americans compared with white Americans have a higher incidence of HIV, are diagnosed at a later stage of disease, and are less likely to receive and achieve successful treatment. Research has consistently shown that racial and ethnic minorities engage in fewer sexual and drug-using risk behaviors that would put them at risk for HIV compared with whites. So, it’s clear that social determinants operating on individual and institutional levels are creating differential risk for minorities through higher-risk social networks, lower health care access, higher policing, and poorer neighborhood environments. We cannot get to zero in HIV without concerted public health research and practice that change or circumvent these very salient structural systems that are unique to racial and ethnic minorities.
Natalie D. Crawford is assistant professor in behavioral sciences and health education at Rollins. Her research aims to inform interventions and policies designed to reduce substance abuse and high-risk sexual behaviors.
A daily pill that can provide powerful protection against HIV has been available since 2012, yet few take advantage of it. Pre-exposure prophylaxis (PrEP) reduces the likelihood of contracting the virus among HIV-negative individuals who engage in high-risk behaviors by as much as 90%, yet currently less than 3% of men who have sex with men have ever taken it. Why? Many of the people who need it most don’t know about it. At Emory, we’re thinking about new ways to use mobile apps to provide high-risk gay men with information about PrEP, to help them decide whether PrEP might be right for them, and to help them find a provider near them who can prescribe PrEP. To increase uptake of PrEP, it will be critical to take advantage of new technologies.
Patrick Sullivan, professor of epidemiology at Rollins, has 21 years of experience in HIV epidemiology, prevention, and behavioral surveillance. He developed AIDSVu, a compilation of online maps that show the most recent HIV prevalence data at national, state, and local levels.
The key to ending the HIV epidemic is a protective, affordable vaccine that prevents the virus from establishing infection. The beauty of a vaccine is that once a person has been vaccinated, the body automatically responds to protect itself against infection— it doesn’t require a conscious action on the part of the potentially exposed person. Indeed, history teaches us that a protective vaccine, as opposed to treatment alone, is the only way to eradicate a pathogen—the vaccines for polio or smallpox are great examples of this. Because HIV attacks and can lay dormant in cells of the immune system, developing a vaccine against it is one of the more difficult scientific problems of our time. Progress is being made, and what we learn will also be important for developing vaccines against other viral diseases.
Eric Hunter, professor of pathology and laboratory medicine at Emory School of Medicine, is co-director of CFAR at Emory. In his laboratory at the Yerkes National Primate Research Center, he studies how HIV enters cells.