Dr. Anthony S. Fauci, M.D., leads research to prevent, diagnose, and treat infectious diseases, such as HIV/AIDS, influenza, tuberculosis, malaria, and illness from potential agents of bioterrorism. He serves as one of the key advisors to the White House and U.S. Department of Health and Human Services on global AIDS issues. His remarks in this interview are adapted, with permission, from a recent article he wrote for the Washington Post.
What's the current state of the AIDS epidemic?
The number of people contracting HIV infection and dying of AIDS has decreased within the past decade, but the numbers are still unacceptably high, with roughly 34 million people worldwide infected with HIV, including an estimated 1.1 million people here in the United States. About 2.5 million people globally were infected in 2011 alone. And AIDS continues to be among the world's leading causes of death, claiming an estimated 1.7 million lives in 2011.
With that said, extraordinary progress has been made in the fight against HIV/AIDS, and I am convinced we can achieve an AIDS-free generation.
What do you mean by an AIDS-free generation?
An AIDS-free generation would mean that virtually no child is born with HIV; that, as those children grow up, their risk of becoming infected is far lower than it is today; and that those who do become infected can obtain treatment to help prevent them from developing AIDS and from passing the virus on to others.
Why are you optimistic that an AIDS-free generation is possible?
Initiatives such as the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria are channeling antiretroviral treatment to millions of people in hard-hit countries. Of the estimated 34 million people worldwide infected with HIV, more than 10 million have access to antiretroviral drugs. These medications reduce the levels of HIV in infected individuals, which not only improves the health of the infected person but also has the added benefit of making them less able to transmit the virus to others.
The curve of new HIV infections in many countries is trending downward. Thirteen countries receiving PEPFAR funds have reached a key "tipping point" at which the annual increase in new patients on antiretroviral treatment exceeds the annual number of new HIV infections.
What needs to be done to achieve an AIDS-free generation?
We need to expand access to antiretroviral treatment and scientifically proven HIV prevention tools to everyone who needs them. Success or failure rests heavily on human behavior. To reach and sustain an AIDS-free generation, those who are already infected or at risk of infection must faithfully practice recommended treatment and/or prevention strategies, including taking antiretroviral drugs daily as prescribed; using a condom every time they have sex; and, for those who inject drugs, always using a clean needle and syringe.
How would an HIV vaccine help achieve an AIDS-free generation?
An effective HIV vaccine would get us to an AIDS-free generation sooner and, more importantly, would help sustain the result to create a world permanently without HIV/AIDS. An HIV vaccine that is even 50 to 70 percent effective, coupled with other proven HIV prevention tools, would be immensely effective at reducing the rate of new HIV infections. It would be one component but not the only component of an HIV prevention tool kit.
Certainly, many scientific challenges remain in the search to develop an effective HIV vaccine, but we continue to gain important new insights into its potential design.
Can we achieve an AIDS-free generation without an HIV vaccine, and how long will it take?
Without an effective HIV vaccine, achieving an AIDS-free generation is still possible. However, the path to get there will take longer and be more difficult.
It is impossible to predict when we will see the first AIDS-free generation, but it is my hope that given what we have accomplished to date, it is not too far on the horizon.