While infection rates climb, breakthroughs -- like a vaccine -- inch nearer
By Randy Dotinga
HealthDay Reporter
THURSDAY, Dec. 1 (HealthDay News) -- Still no cure, still no vaccine, and a host of new challenges: As the world commemorates the 18th annual World AIDS Day on Thursday, it might seem that nothing has changed since the epidemic began more than two decades ago.
Indeed, the numbers remain grim. Worldwide, an estimated 3.1 million adults and children will die of AIDS this year out of about 40 million individuals -- more than the population of California -- who are infected with HIV.
In the tiny south African nation of Lesotho, almost one out of every three adults is now HIV-positive; in nearby Swaziland, that number is four in 10. In South Africa, 20 percent of people 15 to 49 years old have HIV, up from 1 percent in 1990.
Asia, too, is beginning to see increasingly high numbers of HIV/AIDS cases, and prevention programs here in the United States haven't stopped the spread of illness among minorities, especially blacks.
And despite decades of research, a cure for HIV/AIDS remains a distant dream.
Still, there are encouraging developments. In the developing world, more HIV-positive people than ever have gained access to powerful antiviral AIDS drugs.
Jim Yong Kim, director of the HIV/AIDS department at the World Health Organization, pointed out that Lesotho -- hit so hard by the virus -- is planning to offer counseling and testing to every citizen, along with open access to care. And in Swaziland, health workers there are now getting HIV-suppressing medicines to at least half of those who need them.
"While the number of AIDS deaths continues to rise, the rate of increase is slowing, probably because a growing percentage of people in need now have access to HIV treatment," Kim told the Washington Post.
In fact, this year alone, wider use of these medicines will save between 250,000 and 350,000 lives, said William Thompson, manager of international affairs for AIDS Project Los Angeles. And a study published in this week's New England Journal of Medicine, the largest of its kind ever conducted in the developing world, found that poor, sick HIV-positive Haitians responded just as well as affluent Americans or Europeans when given standard AIDS drugs.
Still, only about 1 million people in the developing world are taking AIDS drugs -- there are 25.8 million people infected with HIV in Africa alone.
The prospect of an AIDS vaccine, while elusive, remains alive. An estimated 30 clinical trials of vaccines are under way, although many are in the very early stages.
At the same time, scientists are exploring ways to prevent HIV infection by giving potent drugs to people before or after they have sex. The idea is that the drugs will either prevent infection in the first place or stop it once it starts.
On the epidemiology front -- in which researchers try to understand who gets AIDS and why -- there has been progress, too. In recent years, U.S. health officials have raised the alarm about the use of crystal meth -- an amphetamine -- among gay men. Use of the drug has been linked to higher rates of AIDS infection, and education programs to fight the trend are now in place in many American cities.
Meanwhile, there's been plenty of attention focused on the "down-low" phenomenon, in which men -- often black -- have unprotected sex with other men without telling their wives or girlfriends.
Regardless of prevention efforts among U.S. blacks and other minority groups, HIV infection rates among non-whites remain high. While it's hard to get an accurate handle on the national picture, thanks to a bewildering array of state rules regarding disclosure of HIV cases, federal officials estimated earlier this month that American blacks are eight times more likely to become infected than whites.
"No one can seem to come up with a comprehensive program to address" the problem of minority infections, said Thomas J. Coates, an AIDS specialist and director of the Program in Global Health at the University of California, Los Angeles.
To make matters worse, he added, "if you're black, you're going to have less access to medical care and if you have HIV, the care will be suboptimal."
The solution, he said, "comes back to bolstering the health-care system so people who are black have equal care."
Political action is necessary on the global front too, specialists said. Although the apparent effectiveness of the Bush administration's international AIDS initiative has surprised some activists, there are calls for more to be done.
Beyond prevention and medical treatment, "there needs to be investments in a host of different initiatives" regarding factors as varied as national debt, economic growth and education, Thompson said. Major progress in those areas, he said, remains to be seen.
The WHO's Kim agreed. "More governments are moving to reduce the global HIV death rate by strengthening the health care systems that deliver AIDS care," he told the Post. "But this effort is proceeding at a maddeningly slow pace that needs to be stepped up."
SOURCES: Thomas J. Coates, Ph.D., professor, Division of Infectious Diseases, and director, Program in Global Health, University of California, Los Angeles; William Thompson, manager, international affairs, AIDS Project Los Angeles; Nov. 30, 2005, Washington Post; Nov. 21, 2005, UNAIDS report
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