Despite advances, lingering challenges in the global fight against AIDS

On World AIDS Day, we take a look at efforts being made to improve prevention and treatment of the virus. While encouraging advancements have been achieved, AIDS is still the number one killer of women ages 18 to 55. William Brangham speaks with Jon Cohen of Science magazine about recent developments, why adolescents present a particular challenge and securing global funding to fight the disease.

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    But first: Today is World AIDS Day. While the death toll from AIDS has dropped dramatically, the virus still claims over a million people every year, and nearly 40 million remain infected.

    William Brangham has an update.


    With the growing use of medications to treat and prevent the spread of HIV, some say ending the AIDS epidemic is actually within reach. But AIDS is still the number one killer of reproductive-age women, and in many places, those lifesaving drugs are barely available.

    Scientists are also seeking a vaccine. A new trial is under way right now in South Africa. But many remain skeptical.

    I'm joined now by "Science" magazine's Jon Cohen, who's covered this epidemic for nearly 30 years and was a collaborator with us on our recent series about HIV and AIDS.

    Jon Cohen, welcome back to the "NewsHour."

    Let's start off by talking about this vaccine trial in South Africa. As you well know, you wrote a book about the hunt for an HIV vaccine. What is happening in South Africa right now? Is this as promising as some think it is?

  • JON COHEN, “Science” Magazine:

    Well, the AIDS vaccine is the Holy Grail.

    People can come in, get a few shots, be protected for life. That's the dream. In Thailand in 2009, it was revealed that a vaccine being studied there protected people with about a 31 percent reduction in risk.

    That's not very good. That's extremely low, but it was something. It was the first glimmer of hope. The vaccine trial in South Africa is building off that Thai trial. The results from the Thai trial were extremely controversial. There are people who wonder why that vaccine strategy has moved forward in South Africa, and there are South Africans who argue very strongly that this is a great hope for them, and even if they get some protection, in addition to other protective measures, it could make a big difference.


    OK. Now let's talk a little bit more broadly

    Where are the successes currently in the fight against HIV? And where are those happening?


    Well, clearly, preventing mother-to-child transmission has been a huge success all around the world. It's one of the easiest things to do in terms of prevention.

    And some countries like South Africa have reduced it to below 2 percent of pregnant women who are infected passing on the virus. That's a great success. Treatment now has scaled up from basically being zero in poor countries around the world in the year 2000 to 18.2 million of the 36.7 million infected people. Phenomenal success story.

    People who are treated and stay on treatment fully suppress the virus and they rarely transmit to others. So that is leading to hope that epidemics can stop petering out.


    What about the remaining challenges? Obviously, there are still troubling high rates of HIV among particular populations around the world. You and I saw that as we traveled through Africa and here in the U.S.

    What are the other big challenges facing AIDS?


    So, one big challenge is that only half the people who need treatment are getting treatment. So, that's an enormous challenge.

    And the other one, as you mentioned, is there are a lot of young people who are getting infected. I mean, 2.1 million people are still getting infected every year. And that number isn't changing very much. So something needs to be done particularly to reach young women in much of sub-Saharan Africa, who are highly vulnerable.

    And it is really unclear in many places, like South Africa, why they're becoming infected at such extraordinarily high rates.


    UNICEF recently put out a very stark warning, saying that if prevention efforts weren't ramped up, we would see what they argued was a real spike in new incidences amongst adolescents.

    What can be done to do that? Are you hopeful that we can actually nip that in the bud?


    It's one of the most vexing problems.

    I mean, there are a few problems. One is adolescents are risk-takers. Any of us who have adolescents certainly know that. And they don't perceive themselves as being in harm's way, even when it's clear that there is a lot of HIV in their community.

    The other is, some adolescents are infected at birth, and they are only learning about their infection, as you and I saw in Rwanda, when they get to be teenagers and get sick. And then they have trouble staying on medication because there is a lot of resentment about the fact that they were infected and nobody told them the truth about, let's say, how their mother died.

    So, both of those things combined create a really, really big problem. And there's no easy solution.


    Lastly, Jon, what about the issue of funding? As we traveled across much of South Africa, we heard repeatedly that funding is an issue. What is the trend line looking in that regard?


    The world is short about $7 billion a year, according to UNAIDS' estimates.

    And so the question is, where is more money going to come from? Is it going to come donor wealthy countries or domestic sources? Both are strapped.

    There's hope that, with evidence of things working in countries like Malawi and Zimbabwe and Zambia, which today report that they have had phenomenal success keeping people suppressed and on treatment, that that will lead funders to think this investment is worth it and let's put some more into control this thing once and for all.


    All right. Science magazine's Jon Cohen, thank you so much.

    You can find additional reporting on AIDS from our series that aired last summer. That's on our Web site,

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