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The Most Promising New AIDS Prevention Method: Antiretroviral Drugs

How taking a pill could replace other HIV prevention methods

About 34 million people around the world live with HIV. An estimated 2.7 million people were newly infected in 2010 and about 1.8 million people died AIDS-related deaths last year. Awful as they are, those numbers belie the fact that AIDS is on the retreat. Globally, AIDS deaths have declined by 21 percent since a peak in 2005. The number of new HIV infections have been on a similarly steady decline for more than a decade.

AIDS is slowly going away for two reasons: 1) Large scale prevention programs like the distribution of condoms are reducing rates of new infections. 2) Relatively inexpensive treatment through antiretroviral drugs means people living with HIV are living longer. Traditionally, health officials have separated these two actions. Prevention was what you did before someone got infected, treatment was what happened after someone got the virus. That logic held firm for about 30 years—until last spring. Two game-changing studies now have researchers and advocates thinking that HIV treatment may be the next frontier in prevention.

When a person contracts HIV, she isn't placed on ARV treatment right away. Rather, she must wait until her CD-4 count reaches a certain threshold, which is a standard designated by the World Health Organization. That’s because once ARV treatments begin, the person living with HIV has to keep taking these drugs for the rest of her life. Better to delay that as long as possible.

This is where those game-changing studies come in. The first, published by the National Institutes of Health in May, found that treating people with with ARVs before they reach the WHO threshold reduces their chance of spreading HIV to their heterosexual partner by 96 percent. The result was so profound researchers closed the study early.

Then, a pair of studies published in July examined the effects of administering ARVs to HIV-negative people who had HIV-positive partners. The results were also striking: taking one pill a day reduced the heterosexual partners’ chance of contracting HIV by 73 percent. A similar study last year of men-who-have-sex-with-men (the clinical term for gay partnerships) showed equally promising results.

This is a big deal. HIV prevention is always an uphill battle because it requires convincing people to make major behavior changes: to be monogamous, to use a condom, to get circumcized, to use a clean needle. “Sex and addiction are powerful drives,” global health blogger Alanna Shaikh writes in UN Dispatch, “Convincing people to consistently take a daily antiretroviral (ARV) pill is far easier.”

But here's the rub: Today, there are about 6 million people on ARVs and 15 million more who should be on ARVs, but don’t have access. Most of these people live in sub-Saharan Africa. If the World Health Organization ends up recommending a lower viral-load threshold for treatment, or recommending treatment for HIV-negative people with HIV-positive partners, many more people would suddenly become eligible for ARVs. That would mean that a lot more money is going to have to be devoted to the cause, otherwise millions of people who should be on treatment will be left out.

As things stand, however, foreign aid budgets are shrinking. Money earmarked for fighting AIDS globally is on the decline for the first time in years. We can’t even reach the 15 million people who should be on ARVs today, let alone millions more who would stand to benefit from preventative treatment.

This is the real tragedy of AIDS. We know what needs to be done to stop the epidemic. We just don’t have the political will to pay for the solution.

Image: California Department of Toxic Substances Control

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