This month’s global news rightly focuses on bringing the COVID-19 pandemic under control, as the first vaccines become available. Yet we can also celebrate a major achievement in the fight against another global viral scourge: HIV.
During my medical training in the 1980s, hospital wards were often filled with people dying of HIV. Since then, antiviral treatments have radically transformed the diagnosis of HIV infection or AIDS from a death sentence to a chronic illness. A normal lifespan is no longer unusual for people living with HIV. And the preventive measures described below reduced the number of people infected in the first place. Since the peak of new HIV infections in the 1980s, the number of people newly diagnosed with HIV in the United States has fallen by more than two-thirds.
Deaths from HIV infection continue to decline
A study published in November 2020 Weekly report on mortality and morbidity noted remarkable progress:
- Between 2010 and 2018, the total number of deaths among people diagnosed with HIV decreased by more than a third, from 19.4 to 12.3 per 1,000 people.
- From 2010 to 2017, HIV-related deaths fell by almost half, from 9.1 to 4.7 per 1,000 people).
- The highest rates of HIV-related deaths were seen among people who were black, people who identified as mixed race, and people living in the south.
- HIV-positive men had slightly lower death rates than women.
The study authors attribute the lower death rates to early diagnosis and improved treatment.
There is still a lot to do
While the number of new cases of HIV infection in the United States has declined significantly over the past decade, the latest data from 2014 to 2018 suggests that this may be slowing. And not everyone has access to HIV testing or the most effective treatments. This is especially true for people without health insurance, without a good diet or without other resources.
As with many conditions, there are significant disparities in health care among people living with HIV. All over the world, gender, race and geography matter in who gets sick and who gets prompt and effective treatment. The burden of suffering and death is borne by some groups more than others.
While advances in HIV prevention and treatment deserve to be celebrated, we still have a long way to go before we declare victory.
What you can do now
If you don’t have HIV: Take steps to keep it that way.
- limiting your sexual activity to a partner who similarly commits to only having sex with you
- always use a condom
- never share needles
- if you are at high risk (such as through sexual contact or a needle stick), contact your healthcare professional or go to an emergency care clinic to consider taking medicine to prevent infection by HIV.
- HIV is spread through high-risk activities, such as sharing needles or having unprotected sex with a partner who is HIV-positive or whose HIV status is unclear. Medicine known as Preparation (pre-exposure prophylaxis) can prevent infection if taken regularly. Talk to your doctor.
If you already have HIV: See your doctor for monitoring and treatment. There are a number of very effective drugs available to reduce the amount of viruses in your body. It can prevent complications from HIV infection and reduce the risk of infecting others.
If you are not sure of your HIV status, but have had a possible exposure: Have it tested. Estimates suggest that one in seven people infected with HIV don’t know it.
The bottom line
Since the start of the HIV epidemic, we have seen tremendous progress: researchers have identified the cause and understood how it spread; very precise tests have become available; public health measures have been taken to prevent the spread; and effective drugs have been developed. However, this progress took many years. And we still don’t have a vaccine to prevent HIV infection. New infections and associated deaths remain far too common, and health care disparities persist in the fight against HIV.
The HIV experience has demonstrated how dangerous a new contagious infectious disease can be, even in places with highly sophisticated medical care – a truth brought to light more recently by the COVID-19 pandemic. There are undoubtedly many lessons to be learned from infectious diseases of the past, including HIV, SARS, MERS, and the Ebola virus, as we fight COVID-19. But the lessons can go both ways. Maybe the ways we are fighting COVID-19 – including creating new vaccines – can be applied to HIV.
Hopefully, progress in the fight against HIV / AIDS will continue, perhaps even until its elimination. And what we have learned from HIV infection for several decades and COVID-19 over the past year should enable us to better fight the next pandemic.
Follow me on twitter @RobShmerling