|In the US and other rich countries many HIV patients are taking a combination of antiretroviral drugs; a regimen known as highly active antiretroviral therapy (HAART). When successful, combination therapy can reduce the level of HIV in the bloodstream to very low levels and sometimes enable the body's immune cells to rebound to normal levels.
In May 2003, when antiretroviral therapies were not generally available, especially in developing countries, the US Congress approved President George W. Bush’s request for a five-year, $15 billion programme that launched the US Global AIDS initiative and the President's Emergency Plan for AIDS Relief (PEPFAR). Although President Bush advocated HIV AIDS as a health and human rights issue, it is reasonable to assume his motivation was also influenced by the pandemic’s negative impact on economic development.
Fast forward to December 2012 and Secretary Clinton commemorated World AIDS Day by unveiling the PEPFAR Blueprint: Creating an AIDS-free Generation that provides an actionable strategy to reduce and control the AIDS epidemic within the next four to five years. PEPFAR spends nearly US$7 billion a year in more than 35 countries. It is supported by state-of-the-art technology, scalable global distribution systems and influential organisations such as the Melinda and Bill Gates Foundation and the Clinton Foundation.
Researchers are working to develop new therapies known as fusion and entry inhibitors that can prevent HIV from attaching to and infecting human immune cells. Efforts are also underway to identify new targets for anti-HIV medications and to discover ways of restoring the ability of damaged immune systems to defend against HIV and the many illnesses that affect HIV-infected individuals. Ultimately, advances in rebuilding the immune system in HIV patients will benefit people with a number of serious illnesses, including Alzheimer's disease, cancer, multiple sclerosis and immune deficiencies associated with aging and premature birth.
The management of HIV AIDS is challenged by the fact that in many high-prevalence countries, the number of people becoming infected with HIV each year exceeds the number starting antiretroviral therapy, which perpetuates the growth of the epidemic. For AIDS to be controlled this phenomenon needs to be reversed. A 2011 study showed that antiretroviral therapy reduces an infected person’s chances of transmitting the virus through sexual intercourse by 96%. When HIV positive pregnant women take antiretroviral drugs fewer than 5% of their babies become infected. Circumcision reduces a man’s chances of acquiring HIV sexually by about 60%. Secretary Hilary Clinton’s Blueprint to reduce and manage the global HIV AIDS epidemic is simple: control HIV by a concerted effort that starts more infected people on antiretroviral therapy, ensures that every HIV-positive pregnant woman is treated and circumcise men in high-prevalence countries. Within four to five years, this strategy is expected to produce a tipping point that would allow the disease to start burning itself out.
Despite continued intensive research we are still a long way from achieving a safe, effective and affordable AIDS vaccine. Until such a time, using condoms is by far the most cost effective and scalable means of preventing the transmission of HIV. The No1 means of transmitting HIV infection is unprotected sex, which encompasses oral, anal and vaginal sex. Since the surest form of transmission is blood-to-blood, this risk is greatly increased with trauma to the oral cavity. Persons with bleeding gums, ulcers, genital sores or STDs have an increased risk of transmission through oral contact.
Washington’s high incidence of HIV infection is a story of sex and the city. Today, the majority of the world’s poorest people live in urban areas, which are incubators of disease and Washington DC is no exception. Worldwide, there are some 600 cities with more than one million inhabitants. In cities throughout the world there are entrenched and unresolved social issues, under privilege, lack of education, low esteem, drug abuse and alcoholism and too much unprotected sex and too many citizens not having a clue about their sexual partner’s HIV status. In the US this will manifest itself every week throughout 2013, when about 1,000 Americans, with a high concentration in Washington DC, will acquire HIV infection and some will eventually die from it.