World AIDS Day 2011: Creating an AIDS-free generation

As a physician, I’ve cared for people living with HIV/AIDS for more than two decades. And as I honor World AIDS this December 1, I’ll remember the many people affected by this disease that have changed my life. Each faced unique challenges and struggles. Many demonstrated remarkable resilience. Everyone reminded me of how quickly life can change.

We’ve seen tremendous success in the treatment of HIV since 1996. In the summer of that year, new anti-HIV medications became available and we learned how use medications together to control this virus.

I remember that time well — because in early 1996, I questioned my own ability to continue HIV work. Many people were dying and the emotional toll was, at times, overwhelming. When someone asked me how long they might live, I tried to balance hope with reality. But the prognosis was grim. The average life expectancy was only 15 years.

When patients moved, they moved home to die. When they could no longer work, it was because of a HIV-related illness. And as they faced their own mortality, they watched friends, partners, parents, and children die of the same disease.

But HIV has changed. It’s now a chronic disease — one we manage and control with medications as people live their lives. Now when people move, they’re chasing a dream. With excitement, I watch patients return to school, start new careers, accept promotions, run marathons, and start families.

I celebrate this success. But as I do so, I worry about an epidemic that marches on.

With HIV control, we’ve created a climate of HIV complacency. Prevention is no longer a priority. And data confirm that prevention efforts have failed, both at home and around the world.

Many young people don’t know about HIV or don’t think they’re at risk — they never heard the effective prevention messages of the past. Some think that HIV medications are a “cure,” so they worry less about what might happen if they become infected. Current testing efforts are inadequate. Too many people infected with HIV are unaware of their positive status and unknowingly transmit the virus to others. Finally, despite a devastating disease that we know is preventable, only four percent of federal AIDS funds are targeted at prevention.

Worldwide, more than 33 million people are living with HIV/AIDS. Only 40 percent of those infected know their positive status. While an estimated two million people will die this year of AIDS, another 2.7 million will become newly infected.

In the U.S., where more than a million people are living with HIV, a new infection occurs every nine and a half minutes. And for every person in this country diagnosed with HIV infection, another four people are infected and don’t know it.

On Nov. 8, Secretary of State Hillary Rodham Clinton called on the world to join the U.S. in working together to achieve an AIDS-free generation. But in order to do so, we must replace complacency with aggressive, coordinated prevention efforts guided by science. These prevention efforts must include multiple strategies: targeted evidence-basedprograms aimed at persons at risk, broader testing programs to identify those infected, and increased referral to care and treatment services when people test positive.

This will be a challenge. Comprehensive HIV prevention will require adequate funding, political courage, individual commitment, and community action. But if we want to save lives, we have no other option.

Given everything we know, there’s no excuse for new infections. As we all honor World AIDS this December 1, let’s commit to prevention. Let’s stop this epidemic — now.