World AIDS Day 2018: How Far Has the HIV/AIDS Pandemic Come?

Each year, 1 million individuals die because they are either unaware that they have HIV and are not receiving treatment or they begin treatment too late.

With a commitment to reducing HIV mortality and introducing treatment to all, international organizations across the globe observed World AIDS Day on December 1, 2018.

The annual commemoration was first initiated by the World Health Organization (WHO) in 1988 as a day to unite the world in the fight against HIV/AIDS. Now, 30 years later, it is an opportunity to reflect on scientific advances in the field, evaluate the quality of life of people living with HIV throughout the world, and assess the progress towards ending the epidemic.

In honor of World AIDS Day, the National Institutes of Health (NIH) released a statement reflecting on the advancements that have been made since AIDS was first reported in 1981. These advances include antiretroviral therapy, which when taken daily can suppress HIV to levels that are undetectable while preventing sexual transmission of the virus.

Additional advancements include a range of options to prevent the acquisition of HIV, including pre-exposure prophylaxis (PrEP), which can reduce the risk of acquiring HIV by up to 95% when taken daily, or emergency post-exposure prophylaxis which can prevent infection if taken 3 days after exposure for a 28-day period.

Despite these advancements, the NIH is skeptical that the pandemic can be resolved with these methods alone.

“If these methods of treatment and prevention could be widely implemented, an end to the HIV pandemic would be feasible,” the authors of the statement wrote. “However, lack of access to health care, high costs, and stigma create barriers to successfully preventing HIV and managing it across the lifespan. To bring about a durable end to the HIV/AIDS pandemic, we must develop longer lasting, more easily implementable tools, including a vaccine that can treat and prevent HIV at a lower cost.”

The NIH has indicated that the development of a safe and effective HIV vaccine is the main priority for investigators in the HIV field. While investigators across the globe are working on evaluating different ways to develop a vaccine, including an empiric approach as well as an approach focusing on broadly neutralizing antibodies, the statement acknowledges that there are several complications and conditions that can affect people living with HIV.

Complications can manifest in individuals living with HIV even when the virus is well controlled. For example, tuberculosis is the leading cause of death in people living with HIV around the world. Additionally, individuals who have HIV are more likely to have a higher risk of end-stage kidney disease, according to the NIH.

As such, global health organization, such as the WHO, are reflecting on the need to address comorbidities of HIV and provide health care and treatment to all individuals living with HIV.

“The future of the HIV response will also require looking beyond HIV care provision and ensuring that the disease response is embedded in universal health coverage.” Naoko Yamamoto, PhD, MPH, Assistant Director-General for Universal Health Coverage and Health Systems, WHO, said in a recent statement. “Ending AIDS is unlikely to ever happen without Integrated health system that provide HIV prevention, diagnosis, and treatment as well as care with other essential health services and support to other co-morbidities such as [tuberculosis], [ noncommunicable diseases] and mental health at the community level. A people-centered, human rights-based and holistic approach is crucial.”

Although the WHO is encouraging the integration of HIV treatment with other health services, the organization is alos providing a reminder to all that being aware of your individual HIV status is critical. According to the WHO, 1 in 4 individuals living with HIV are unaware of their status.

To address the gaps, the WHO has partnered with international organizations to support a self-testing initiative in several African countries, which not only provides testing but also links individuals with treatment and prevention services.

However, the WHO also acknowledged that stigma still plays a large role in hindering progress in the fight against HIV.

“When we look at our efforts in improving our fight against the epidemic in general - stigma is one huge factor that holds us back,” Mercy Ngulube, an HIV activist, emphasized in a WHO statement.

In fact, early findings from the Fast-Track Cities Quality of Life Survey indicate that 38% of individuals living with HIV report feelings of stigma by their community. Additionally, 23% of those individuals report experiencing stigma in a health care setting (23%), of which 78% identified a health care worker as the source of stigma.

The survey, developed by the International Association of Providers of AIDS Care, in partnership with the Joint United National Programme on HIV/AIDS, the Global Network for People Living with HIV, and the International Community of Women Living with HIV, supported by a grant from ViiV Healthcare, aims to provide insight into the quality of life of people living with HIV from 29 cities around the world.

The initial results provide snapshots from a variety of cities and report specific findings from Bangkok (Thailand), Durban (South Africa), Madrid (Spain), Miami (USA), and Salvador (Brazil).

The findings of the initial report demonstrate a “significant disparity” in the levels of stigma experienced in the 5 different cities.

In Salvador and Bangkok, participants reported low levels of stigma and discrimination, 16% and 11% respectively; however, in Miami, Durban, and Madrid, 66%, 42%, and 32% of respondents, respectively, reported feeling stigmatized by their communities in the past year.

“Where stigma exists against people living with HIV, the dignity that should be afforded every human being and the benefits that ‘Knowing Your Status’ (HIV prevention and treatment services) can confer are denied,” José M. Zuniga, PhD, president/CEO of International Association of Providers of AIDS Care, said in a statement. “We aim to use the findings from the Fast-Track Cities Quality of Life Survey to inform a global and local dialogue about the need to take a holistic approach to improve the quality of life of people living with HIV.”

Although World AIDS Day is a time to reflect on how far scientific advancements have come since the first documented case in 1981, it is also a day to remember that there is still more to be done to bring about an HIV/AIDS-free world.