December 1st is dedicated to celebrating World AIDS Day. This year, the event pays tribute to the people and organizations which have played a vital role in driving progress to end the epidemic.
Road Map to Ending AIDS
During the last two decades, progress in the prevention and control of HIV/AIDS has stimulated a debate on the possibility of ending this epidemic as a public health threat. The Joint United Nations Programme on HIV/AIDS (UNAIDS) has promoted a campaign and goal to end it by 2023.
Countries around the world have signed onto the ambitious program with the goal of reducing the rate of new HIV infections and AIDS-related deaths to below the reproductive rate of 1. This means that each person with HIV would infect fewer than one additional person in their lifetime.
At the end of 2013, it was estimated that 35 million people all around the globe were living with HIV. Last May, the CDC reported that the number of new HIV infections and deaths was falling. However, the UN has called for far more international effort as the current pace cannot end the epidemic.
Despite the incredible progress, HIV remains a global public health threat, with 1.3 million new infections in 2022 alone. Since their peak in 1995, new HIV infections have steadily dropped where infected people live longer with the disease. However, the pool of people who are HIV-positive has grown and they must consistently take medications to prevent the virus from being transmitted. This means that new infections could rebound fast if health authorities cannot increase the number of people being regularly treated, tested, and protected from new HIV infections.
If UN's Project 2030 becomes successful, we would only see 200,000 new HIV infections and 130,000 AIDS-related deaths worldwide in 2030, about 90% fewer than in 2010. Eradicating the virus would need the need of vaccines and other medications, but UNAIDS special ambassador Abdool Karim believes that we can drive the infection and death rates to near zero even without them.
The road to ending the AIDS epidemic may also face many obstacles, but the authorities hold all of the tools to get there. By using those tools effectively, the UN could start driving the number of new HIV infections towards zero. At that point, HIV would become a manageable, chronic disease.
Controlling AIDS in Vulnerable Populations
One of the challenges to ending the AIDS epidemic is the availability of treatments to vulnerable populations, including children. In 2022, only 57% of the 1.5 million HIV-infected children under 15 years of age received treatment. About 46% were virally suppressed and almost 84,000 died of AIDS-related illnesses.
Among the populations who receive HIV medications, young children are the likeliest to die, usually due to late diagnosis or treatment interruptions. One possible reason is because many children under 5 already have severely weakened immune systems by the time they were diagnosed with HIV. Another reason is because children are not typically included in initial clinical trials for treatments, so there are only a few child-friendly formulas.
Long-acting ART options, or those that do not require daily pills, are also nonexistent for children under 12. To make them suitable for young children, the National Institutes of Health supports research on adapting drugs approved for adults. However, that grant opens in 2024, so it is still unclear if it could make an impact before 2030.
Even if better drugs become widely available, children are not going to access antiretroviral therapy in a vacuum, according to Albert Einstein College of Medicine professor Dr. Anjali Sharma. She suggests that the pediatric care needs to be integrated with other services, like in maternal treatment or activities that work with the family as a unit.
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