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AIDS at 30: Who’s at Greatest Risk of Infection Now?

In the spring of 1981, young gay men in New York and California were being sickened by rare forms of pneumonia and cancer, and the unknown disease fueled fears across society. What we now know as HIV/AIDS was once considered a death sentence. Ray Suarez reports on the state of the disease, plus the risks, treatment and research.

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    The AIDS epidemic 30 years later.

    Ray Suarez has our report.


    It started in the spring of 1981, reports of young gay men in New York and California sickened by rare forms of pneumonia and cancer.

    By summer, June 5, the first federal announcement from the Centers for Disease Control — it concerned five young gay men in Los Angeles with a pneumonia almost exclusively limited to patients with severely compromised immune systems. Within months, it became clear the underlying illness was neither pneumonia, nor cancer, but a sexually transmitted disease that damaged the immune system.

    Initially called gay-related immune deficiency, or gay cancer, before being renamed acquired immune deficiency syndrome, AIDS, in 1982, it went on to become a pandemic, infecting more than 60 million people worldwide. It would take another two years to identify HIV, the virus that causes AIDS, and epidemiologists quickly discovered HIV could also be transmitted with heterosexual sex, from infected women to newborns, in blood transfusions, and via contaminated needles, especially among I.V. drug users.

    The discovery of the virus that caused AIDS and a way to test for it offered hopes for a means to stop the spread of the deadly disease.


    We hope to have such a vaccine ready for testing in approximately two years.


    But, since 1981, only four major trials of HIV vaccine have been conducted, to varying success. The world's largest trial, administered to 16,000 people in Thailand in 2009, did reduce the risk of contracting HIV by nearly a third. While a medical milestone, that percentage may not be enough to blunt the 7,000 new infections that occur daily, according to the U.N.

    And the international scope of AIDS has been staggering. According to the U.N., it's killed nearly 30 million people since the first five cases were recognized in 1981, over 600,000 in the United States. An additional 34 million people globally are presently HIV-positive, one million in the U.S.

    Overall, roughly two million people die of the disease worldwide each year. Still, there have been some significant breakthroughs in the last three decades, activists, public health campaigns.

    DR. C. EVERETT KOOP, U.S. surgeon general: It puts to rest rumors about catching AIDS through casual non-sexual contact.


    Advances in testing have all helped prevention efforts. The global rate of new HIV infections declined nearly 25 percent in the last decade; 1994 saw the introduction of antiretroviral drugs, which slow the reproduction of the virus, prevent the development of full-blown AIDS, and allow the HIV-infected to live longer, healthier lives.

    EARVIN "MAGIC" JOHNSON, former NBA player: Because of the — the HIV virus that I have attained, I will have to retire from the Lakers.


    In one high-profile case, former basketball star Magic Johnson marks 20 years of living with HIV this year, thanks to antiretroviral therapy.

    But even in the U.S., where an estimated 55,000 new infections occur each year, with some of the highest rates of infection occurring among African-Americans and women, those lifesaving drugs are expensive. Some 8,300 Americans are on waiting lists under AIDS drug assistance programs in 13 states to obtain drugs to treat HIV.

    Access is also scarce in developing countries, especially in sub-Saharan Africa, home to two out of three of all the infected people worldwide. The World Health Organization estimates nearly 14 million globally need treatment, but, at the end of 2010, nine million people were without access to such drugs.

    But, at the same time, the U.N. reports 1.4 million people started treatment in 2010, more than any year before, and 6.6 million were receiving antiretroviral therapy in low- and middle-income countries by the end of last year.

    For more on the 30-year battle with AIDS in the United States and around the world, we go to two officials who have been on the front lines.

    Dr. Anthony Fauci was among the early researchers into the disease and is now director of the National Institutes of Health's Division of Infectious Diseases. Michel Sidibe is executive director of UNAIDS. He has been with that program since 2001.

    Gentlemen, welcome to you both.

    Michel Sidibe, if I asked you to define the struggle at this point, AIDS at 30 years, what would you say is the state of play?


    I think I will just say that the world needs to remember that, 30 years ago, this disease was just called a shunned disease. It was called a gay plague.

    And today, we have to recognize that we have been able to break the conspiracy of silence. We have been mobilizing the world in unprecedented way. We have even built, I can say, a compact, social compact between the global north and the south. And we mobilize resources and we produce results.


    Anthony Fauci, looking more specifically at the situation in the United States?

    DR. ANTHONY FAUCI, National Institute of Allergy and Infectious Diseases: Well, the situation in the United States, we still have a problem. As we all know, there have been 56,000 new infections each year.

    We have made major, somewhat breathtaking advances in therapy. And when you get people on therapy who need to be therapy, you could completely transform in a very positive way their lives. The big challenge we have now domestically is to make sure, of the 1.1 million people, 21 percent of the infected people in the United States don't know they're infected.

    So, we need to seek them out, get them under voluntary testing, and link them to care and treatment. We have a much greater challenge in the developing world, as Michel just mentioned, because there are millions and millions of people in the developing world that are infected that would benefit from linking to care and getting on treatment. That's a major implementation challenge that we have in the years ahead.


    Over the years, Dr. Fauci, various strategies have been tried. Some have been discarded. Some have been reinforced. What works in AIDS prevention?


    Well, you know, there are a number of combination things that work.

    We know that circumcision is highly effective in preventing acquisition. We know that the use — the proper use of condoms, we know that needle exchange programs work. We have some evidence now that topical microbicides in women work. And we also have some very profound evidence over the last just month that, if you treat people early in infection, not only do you benefit them by helping them to be able to lead a healthy life, but you also remarkably diminish the likelihood that they would transmit their infection to an uninfected partner.

    So, you now have a number of modalities which, when used in combination, we feel we have the tools right now to have a major impact globally on this HIV pandemic.


    Director Sidibe, with all those weapons in the arsenal, there are still 34 million infected and 7,000 new infections a day. How do you drive that number down?


    I think what we need is certainly to continue to make the world understanding that we need to invest today more than yesterday.

    We have proof, like Tony was just mentioning, that the science is there. And we have the responsibility, not just have a moral responsibility and obligation, but we have also the responsibility to push the envelope of funding.

    It's not acceptable that we will continue to say that we will have been able to be successful because we have put those six million people on treatment and say to the world that, when nine million people were waiting for treatment, we cannot do anything about them.

    I think it is of course a shared responsibility. It's important to bring the developing world and also emerging nations on board, but we cannot abandon nine million people who are waiting for treatment.


    Dr. Fauci, who is contracting HIV in the United States today?

    Now, these decades on since we have been doing educational messaging and training and all kinds of getting the word out, who is getting AIDS today?


    Well, there's a big disparity in this country, Ray. There's — 12 percent of the American population is African-American. And of the new infections, close to 50 percent of them are among African-Americans.

    Sadly, among African-Americans who are gay or bisexual men, they're still the leading proportion, if you look at the slice of the pie of people that are getting infected. There has been less among injection drug uses, but an increase among heterosexual transmissibility, which accounts for the increasing percentage among women in the United States.

    But, still, men who have sex with men is still the largest fraction of the individuals who are — get newly infected. And there's a great disparity racially in that, with African-Americans bearing the brunt of the burden.


    And, Michel Sidibe, if we move away from Europe and North America to the global south, to Latin America, Asia, Africa, is the profile different for who the newly infected are?


    We have a growing epidemic in Eastern Europe, Central Asia. But, at the same time, we still have major, major problems in Africa, even though we are seeing for the first time that more than 35 countries have been able to stabilize and even to decrease the number of new infections significantly.


    You know, for all the trouble getting people on ARV treatment, Michel Sidibe, there are millions who testify to the fact that now their disease is being managed. It's no longer a death sentence.

    Has this moved people away from being panicked and perhaps allowed some people to think that they can still engage in risky behavior?


    And I think what is — it's certainly very important now to say that we are today facing a major challenge, because 6.6 million people are in treatment. And nine million people are waiting for treatment.

    But we know also that you can live longer with the treatment. And the risky behavior is something which is a part of education and certainly sensitization programs, which we need to also improve, also.


    And, Tony Fauci, finally, same question to you.

    In the American context, as we have moved AIDS from a death sentence to a chronic illness that can be managed by medication, are people still willing to engage in risky behavior because they're not as afraid as they once might have been?


    That's unfortunately, Ray, a fact that, in some segments of the population, we do see that.

    There's the — less of the fear that we saw years and years ago before therapy was available. We used to have people in hospices. A lot of people had friends and colleagues who were sick and dying. Because of the effectiveness and the success of lifesaving therapies that we have now, there isn't that fear factor as much as it used to be.

    That's the reason why we have got to make sure we're not victims of our own success. And together, with seeking out, testing voluntarily and treating people, we have got to make sure that, just because the treatment is effective, people don't get the wrong and really tragic impression that it's OK to get infected, because it's not.


    Dr. Fauci, Director Sidibe, gentlemen, thank you both.


    You're quite welcome.


    Thank you very much.

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