When growing up, things seemed simple:
eat, sleep, chores, play. There was
little to worry about and nothing besides the proverbial here-and-now mattered
much. I started elementary school in
Central Florida, in a community that was exposed to HIV in unsettling ways. At school, I remember playing "tag” during
school recesses. In the late 1980s, “tag”
took on a different name. Inspired by
what we constantly saw on evening television, “tag” on the playground became
known as the “AIDS game” where being tapped meant one had AIDS. As children, we knew little about the disease
and few parents, including my own, made efforts to further describe it.
People that we knew or “knew
about” were gradually disappearing. I
often found myself reading their obituaries in the local newspaper, which I have
to say was both weird yet intriguing. These
obituaries revealed a lot about what was happening during this time. Young faces--ages 16, 22, 24, 30—mostly male,
hemophilic, and sometimes gay seemed to die in the same way. “After a long fight with a terminal disease,
he passed away from complications caused by pneumonia.”
The rumor mills were in full
force to fill the gaps. Eventually,
rumor gave rise to fear and AIDS made its way from the obituaries to the front page. In 1987, the house of local family with three
HIV-positive sons was set ablaze. The
news was shocking: How could anyone do this?
Was AIDS so feared that neighbor could be pitted against neighbor in
blind efforts to control it? The news
made many of us doubt if AIDS could ever be viewed in the same light as other diseases
as cancer and diabetes.
In 1996, good news came in the
form of a group of medications called anti-retroviral therapy (ARVs). This news gave hope to ending what was then considered
the worst disease imaginable. It gave optimism
to people who were otherwise destined to die. With ARVs, a diagnosis with HIV/AIDS could no
longer be viewed as fatal, but rather a manageable, long-lasting illness.
Test and Treat?
Fast forward to May 12,
2011. On this day, results of the HPTN 052 clinical trial
announced that if a heterosexual, HIV-positive person continually takes their ARV
medications, the risk of transmitting HIV to their sexual partner could be
reduced by 96%.[1] In other words, HIV-positive people
taking ARVs were more than 20 times less likely to infect their partners than
untreated people. The
study was groundbreaking. In the words
of UNAIDS executive director, Dr. Michele Sidebe, the HPTN 052 findings were a
definite “game changer” in how we thought of HIV prevention.
Previously, doctors were reluctant to start people on
treatment as soon as they tested positive.
They were often concerned with the costs of doing so and the harms that
came with starting early treatment. This
study provided the first evidence from a clinical trial--the gold standard in
medical research—that “test and treat” was actually effective in reducing HIV.
In spite of the study’s great news, we still have a long
ways to go. Right now, the money that we currently have for
HIV/AIDS programs is very limited. Many
clinics in Sub-Saharan Africa are turning away patients who are not just
infected but close to death. In some states,
the money provided by the Ryan White Care Act is running thin leaving poor
uninsured people on waiting lists for medications.
The news of HPTN 052 brings new hope in the nearly 30 year
fight against HIV. Now, we can no longer
think of AIDS an incurable disease and actually start imagining what an “AIDS
free generation” could look like. Still,
we must not disregard the difficult days of 20 years ago. We should be reminded of the images that
plagued our newspapers and news broadcasts—images of young men dying from AIDS-related
causes, children thoughtlessly assuming that AIDS was death, and communities turning
against each other for fear of the disease.
Ray is a Doctoral Candidate in Health Policy and
Management at Emory University. He is
originally from Idaho and has worked in Zambia and Thailand on programs related
to HIV and TB care/treatment.
