Before highly-active antiretroviral therapy (HAART) made its debut, contracting the human immunodeficiency virus, which leads to the development of AIDS, meant certain death within the span of a few years. Before 1996, there were a few treatment options available (like the drug AZT), but they were highly invasive, had poor treatment outcomes, and mainly worked as a palliative measure. But HAART changed everything. It transformed HIV from a deadly burden into a serious — but manageable — lifelong illness.
Having a HAART
The scale-up of delivering HAART medicines to those who need them since the mid-1990s is one of the best examples of public health intervention in recent memory. The Joint United Nations Program on HIV/AIDS, also known as UNAIDS, estimates that global mortality declined by a whopping 35% in the period from 2005 to 2013, largely due to the ramping up of efforts to distribute HAART medications. The reason this effort has been so successful is that resources flowing from high- to low- and middle-income countries targeting HIV/AIDS totaled $51.6 billion from 2000 to 2011. That’s a significant amount of money, but more is needed — especially in places like Sub-Saharan Africa, where about 23.5 million people, about 5% of all adults, are infected with HIV.
AIDS in Developed Countries
Despite the tremendous advances made by HAART therapy, the Centers for Disease Control estimates more than 1.2 million people are living with HIV infection in the United States. About 14% of these people have no idea they are infected, which means they are more likely to transmit the virus.
And some communities are more impacted than others: gay and bisexual men of all races and ethnicities remain the population most affected by HIV/AIDS. Across the nation, Hispanics and African-Americans bear the heaviest burden when it comes to the disease. According to the CDC, while blacks make up 12% of the U.S. population, they account for around 40% of those living with HIV infection. One study suggests that, unless the course of the disease changes, at some point in their lifetime 1 in 16 black men will be diagnosed with HIV.
Reasons for this disproportionate picture of American health aren't entirely clear. Some have suggested that limited access to preventative healthcare (including testing) in underprivileged minority communities is a major factor. The disproportionate percentage of minorities incarcerated in U.S. prisons — where unprotected sex and drug use occur at a higher rate — may also play a role.
An Ounce of Prevention
Once upon a time, the majority of HIV/AIDS prevention work focussed on getting men to wear condoms to halt the spread of the disease. But 20 years of safe sex messages are now often falling on deaf ears, due to what sexual health workers call “condom fatigue.”
Unfortunately, a vaccine for HIV is a long way off; although Canadian scientists have been hard at work developing one, there are still many hurdles to be overcome. But what if current therapies could be used to prevent transmission of the disease? In 2012, the US Food and Drug Administration approved the use of Truvada — an HAART medication — for preventative use. That means a person at risk of contracting HIV could take a daily dose of Truvada to ward off infection. It’s an intervention called PrEP — or pre-exposure prophylaxis. Some say it could mean the end of HIV in rich countries, like in North America. A clinical trial is under way in Toronto to test the effectiveness of PrEP in vulnerable populations. However, until we know whether PrEP works for sure, the best advice to stay safe hasn't changed much in the last two decades or so: practice safe sex and avoid sharing intravenous needles.
