Near normal

Back in the 1990s, scientists who were working on antiretroviral drugs to treat HIV—as it had been established that treating the virus would prevent the patient from developing AIDS—had predicted that in time and with better drugs, HIV would become like incurable communicable diseases in the sense that as long as those infected took their medications and followed doctors’ instructions as regards lifestyle adjustments they would live long, fairly healthy lives.

At the time, it had seemed like pie in the sky for several reasons, the main one being that apart from antiretroviral therapy being extremely expensive, many people, especially those who constituted the high-risk population and particularly in developing countries, were not being tested early enough for the drugs to really make a difference.

By 1996, scientists had discovered that use of several drugs together, which they called highly active antiretroviral therapy (HAART), targeted the virus in such a way that it decreased the HIV burden and bolstered the immune system, therefore preventing the development of opportunistic infections that caused AIDS and led to death. But HAART proved to be even more expensive until countries such as Brazil and India began to manufacture low-cost generic HAART drugs, which worked though they contravened international laws.

HIV and AIDS, long recognized as a global pandemic, continued to rampage through the world, killing adults, mostly from the productive sector, but also a surprising number of youths, babies, and young children. Developing countries, particularly on the African continent, were the worst hit and the least able, financially, to do anything about it. Ignorance about how HIV was being spread and foolish myths concerning supposed cures only compounded the issue.

In January 2002, Microsoft billionaire Bill Gates and his wife Melinda Gates along with former UN secretary-general Kofi Annan, professor of economics, leader in sustainable development Jeffrey Sachs and law and medicine professor Amir Attaran founded the not-for-profit organisation, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, following a call made by Annan the previous year for such a fund. The following year then US president George W Bush launched the US President’s Emergency Plan for AIDS Relief (known as PEPFAR), making the largest commitment by any nation to combat a single disease in history. The spending down of HIV and AIDS had begun.

Suddenly, there was money for education, sensitization, counselling and testing, drugs and research among other things. These organizations found that the disease took everything they threw at it and then some. Unfortunately, as it happens, there was some squandering of resources and in the early days, duplication of effort. However, with time and dedication, the tide began to turn; the deaths slowed and today those predictions made more than 20 years ago, have come to pass.

According to a recent study published in the Lancet, young people on the latest HIV drugs now have near-normal life expectancy because of improvements in treatments. The researchers from the University of Bristol found that 20-year-olds who started antiretroviral therapy in 2010 are projected to live 10 years longer than those who first used it in 1996.

This is good news, or is it? One must consider that persons who were 20 years old in 2010 would have been born in 1990, six years before HAART became the saving grace of people living with HIV. They grew up in the two decades when there was a bombardment of information on how to avoid contracting HIV; statistics on rates of infection among age groups and at-risk populations were everywhere, still, they seem not to have avoided it. What is worse is that today, right now, people are still contracting HIV and in some places where numbers had contracted and infections had slowed they seem to be on the rise again. This is a global as well as a regional and local phenomenon, so no one should be viewing this in the abstract.

Unfortunately, spending on HIV has contracted as well. This was to be expected. A global response funded by generous grants from well-meaning sources could only last so long; none of the organizations responding to this pandemic is making a profit. National governments would have long been expected to take responsibility for their individual country’s responses, and countries like Guyana have been doing so, but must now increase national investment for HIV to fill the gaps that will be left when they fully transition from donor funding.

Today’s near normal is not nearly normal enough, or is it? Despite good responses in the past, will a lack of action and follow through really leave HIV forever with us? This is a disease that could be eradicated, unlike diabetes, hypertension, arthritis and the like.  But this will only occur if governments and people take serious action now. Action to get people tested to know their HIV status; action to help people who are living with HIV to adhere to treatment so that they can become virally suppressed; action that focuses on primary prevention of HIV; action to address stigma and discrimination that are significant barriers to individuals’ access to prevention and treatment services, and action to increase HIV investment to ensure that the gains of the last ten years are not lost. Such collective action can lead to the end of AIDS.

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