Stepping up the pace in the fight to end HIV

Stepping up the pace in the fight to end HIV

Stepping up the pace in the fight to end HIV

Updated 18 July 2014, 14:08 AEST

More than 35 million people live with HIV, the virus that causes AIDS. As Australia hosts the global AIDS 2014 conference in Melbourne we review the state of play and ask: how far have we come in the battle to end AIDS?

AIDS 2014 promises to be the largest medical conference Australia has ever seen. Scientists, policy makers, activists and people living with HIV will come together to explore the latest achievements and the greatest challenges in the fight to eradicate one of the world's most destructive diseases.

The story so far is one of global cooperation and scientific advancement – but it's also one of social change, and of ongoing efforts to end discrimination and provide equitable access to healthcare.

Approximately 30 million people have died from AIDS-related illness to date, but in the last decade the number of deaths, and the number of newly infected people has declined. The United Nations says the “end of AIDS” in the Asia Pacific is achievable in the next 15 years – but we have a way to go to reach that goal.

How far have we come?
How far have we come?
The red AIDS ribbon has become a symbol of the fight to end HIV. (Flickr: CC simcsea)

Since we learned of the pandemic in our midst three decades ago, billions of dollars have been spent to advance our understanding of the disease. This knowledge has given us new treatments, and the tools to slow the spread of HIV through education, testing, and behaviour change.

Although there is still no cure, drugs called ‘antiretrovirals’ are helping to control the virus, allowing people infected with HIV to lead longer, healthier lives.But outsmarting the virus remains a daunting task. 

So how does HIV work?
So how does HIV work?
A human cell (blue) under attack by the AIDS virus (yellow). (Flickr: CC Zeiss microscopy)

HIV, or Human Immunodeficiency Virus, impairs the body’s ability to fight off infections and cancers. Like other retroviruses it attacks white cells involved in the body’s immune response and integrates itself into the cell’s DNA.

By doing this it remains invisible to the body’s immune system.

As a person becomes susceptible to these opportunistic infections we say the disease has advanced to become AIDS – Acquired Immune Deficiency Syndrome.

Antiretroviral (ARV) drugs are now our best defence against the virus. There are five classes of ARVs, and because they combat the virus at different stages of its life cycle the best results are obtained when an infected person takes a combination of these to fight the virus on many fronts.

In China the death rate has decreased by about 80% because of access to these medications.

Antiretroviral drugs also help prevent transmission of the disease, leading to a 20% decrease in the number of new infections recorded globally between 2001 and 2011.

Of course, not everyone has access to the medication they need. The World Health Organization (WHO) says there are still 19 million people considered eligible for treatment who aren’t able to get it.

The other fight: can we end the stigma?
 The other fight: can we end the stigma?
A poster promotes the use of condoms to prevent HIV infection, in India (Flickr:CC Gatesfoundation)

While science has been a huge part of the campaign to stop the spread of HIV, education, political leadership, behaviour change, activism and fundraising have all been vital to the equation.

Sexual health education in schools as well as improved access to condoms, HIV testing and medicines have all contributed to slowing infection rates, and the social and economic impacts that come with it.

Because HIV often affects marginalised groups like men who have sex with men and intravenous drug users, fighting prejudice has been at the forefront of efforts to halt HIV.

In Papua New Guinea today nearly 20% of sex workers are reported to live with HIV. In the Philippines there’s an epidemic among intravenous drug users. In Vietnam more than 15% of men who have sex with men are reported to have HIV.

Overcoming discrimination towards vulnerable populations remains a major focus of the campaign to end the disease in Asia and the Pacific.  

How close are we to a cure?
How close are we to a cure?
(Flickr:CC e-magineart)

Some of the deadliest diseases in human history are now a thing of the past. Smallpox was eradicated thanks to the development of a vaccine, and an organised campaign to deliver it. So why is there still no vaccine for HIV?

Progress has been hampered by the nature of the virus; it changes rapidly and it has many subtypes. In 2009 an experimental vaccine had promising results, showing a modest reduction in risk of HIV infection. Research continues on a number of fronts, but despite the investment of more than US$800 million a year, a safe and effective vaccine for HIV remains elusive.

The other approach is the search for a cure – a treatment that would wipe out the virus in those already infected, or reduce it to a level where lifelong medication is no longer necessary.

Hot topics in this field include the ‘shock and kill’ approach to combating the virus, and the news that a baby thought to be cured of HIV now shows signs the virus has returned

Professor Sharon Lewin, Co-Chair of the 20th International AIDS Conference in Melbourne acknowledges both the continuing advances in treatment, and the long road ahead.

“The task of finding an HIV Cure is too big for one laboratory or one country,” she says. “Ultimately, should we be successful in finding a cure, we must also ensure that any cure is affordable and available to all who need it.”

 

The goal: leave no one behind
The goal: leave no one behind
Photo: International AIDS Society/Samatha Sagona, courtesy aids2014.org

Today about 95% of HIV infections are in low- and middle-income countries.

UN Secretary-General special envoy for AIDS, Prasada Rao, has previously told Radio Australia that the next 15 years could see the disease brought down to a “negligible” level. The number of new HIV infections has already dropped by one-third in the past two years, and in Cambodia 94% of people living with HIV now have access to the ARV medications they need.

But infection rates are increasing in some parts of the region, including Indonesia, Sri Lanka and Bangladesh, and controlling the epidemic in vulnerable populations will be key to reversing this trend.

The AIDS 2014 declaration calls for “the eradication of discrimination against people living with or at risk of HIV, to ensure equal access for all people to HIV prevention, treatment and care.”

Conference co-chair Professor Sharon Lewin reiterates this.  “If we really want to change the course of HIV we must make sure that nobody is left behind.”


Follow ABC coverage of the AIDS 2014 Conference