Men’s Health Foundation’s Anthony Mills MD on what lies ahead in the next decade
BY ANTHONY MILLS MD
In 2015, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched an ambitious goal of ending the worldwide HIV epidemic by 2030. The aim is that no child will be born with HIV and anybody already infected will be given medicines that will treat the HIV, keep that individual healthy, and prevent transmission of HIV to others.
This goal is in stark contrast to the early days when the HIV virus wreaked havoc on whole communities. In 1981, Dr. Michael Gottlieb first reported a mysterious disease he saw in five patients which would come to be known as HIV. Mathematical models suggest that at that time in 1981, more than 250,000 Americans had already been infected with HIV. Today, 36.7 million people live with HIV/AIDS worldwide, 1.2 million of those in the United States.
“Until we address health inequity and the social and structural causes of poverty in the United States, the HIV epidemic unfortunately will continue to exist and to affect those individuals who are most vulnerable.”
In the 1980s and 90s, an HIV infection was almost always fatal. But treatment has come a long way since then. We have made tremendous progress since the disease was first identified. We’ve implemented effective prevention efforts (such as teaching safe sex, de-stigmatizing HIV, and addressing structural issues like stable housing and access to healthcare), and we’ve introduced advanced biomedical tools (like antiretroviral treatment and PrEP). These steps have led to a decline in HIV diagnoses in some communities over the past decade and the possibility of normal, healthy lifespans for people living with HIV. Still, more than 20,000 HIV-positive individuals die and nearly 40,000 are infected in the US every year. What is the future of this epidemic?
The World Health Organization (WHO) formed a plan about a decade ago which became known as 90-90-90. The goal was for each country to target having 90% of people living with HIV to be diagnosed, 90% of those diagnosed to be linked to care and on medications, and 90% of those on medications to have no detectable virus in their bloodstream, making it impossible for them to transmit HIV. Statisticians felt that if we could achieve 90-90-90, then the incidence of new cases of HIV would decrease and we would be heading for the end of the epidemic. Sadly, though several countries have reached and even surpassed the 90-90-90 goals, the incidence of new cases in those countries has not turned around. While these goals are certainly admirable, they do not appear to be the final answer to the epidemic.
For the last 5 years, we have all felt that we had the tools necessary to end the epidemic. We have amazingly effective treatments for HIV, treatments that are not only potent but are well tolerated. We have the medications to kill 99.9% of the HIV that exists in humans. Likewise, we have amazingly effective prevention tools to stop new cases of HIV from being transmitted. We have biomedical prevention tools that are effective nearly 100% of the time. So why do we still have people who get infected with HIV and who die from HIV?
I spent the last 20 years of my career working in HIV clinical research developing new medications to treat and to prevent HIV. The issues that I struggle with most today center on how we can make certain that those who need these medications have access to them. 95% of my work today is focused on social determinants of health. We have medications and therapies that work but ongoing struggles with housing, food instability, access to healthcare, and a variety of other social conditions stemming from economic imbalance creates a health inequity that prevents us all from succeeding.
Until we address health inequity and the social and structural causes of poverty in the United States, the HIV epidemic unfortunately will continue to exist and to affect those individuals who are most vulnerable.
Anthony Mills MD is the founder of the Men’s Health Foundation in Los Angeles. www.menshealthfound.org