A series of “happy birthday AIDS” articles have been appearing in various news outlets this week, including the New York Times and a piece by Anthony Fauci in the Washington Post. It was thirty years ago when health professionals in New York and California identified several gay men as suffering from rare cancers found only among people with severely compromised immune systems. Ironically, HIV is much older than 30, and yet it would not be until a few years after 1981 when HIV would be conclusively identified as the culprit for those cancers… But I suppose the emotional panic associated with those cases can be usefully remembered as the start of the AIDS crisis. And like at so many other periods in the epidemic’s history, concerned activists have successfully used dates and history as a framing device to garner additional resources and attention.
Reading these stories brings back vivid memories: Growing up in New York at the time, one could not be certain where, how, and from whom you might contract this deadly disease. Teachers urged calm and explained how we could protect ourselves, even as they were not yet confident about the facts they were presenting. But as frightening as it all was, I think most of us assumed that it would pass. I definitely would not have guessed how the spread of HIV would reach such global proportions over the next few decades, and I surely imagined that in 30 years, we would have both a vaccine and a cure. And of course, today, we have neither.
While it has been a painful history, with tens of millions killed in the wake of the pandemic, it does feel as though the tide is finally turning. Infection rates are coming down in many countries, the majority of people in need of treatment are on it, at radically reduced drug costs as compared with several years ago, and even the stigma of being infected is not what it once was. In South Africa, almost 12 million people were tested for HIV last year, a fact that would have been unthinkable a few years ago.
For every favorable fact, one can find a compelling counter-point – stigma is still bad in some places, new infections outpace treatment coverage, many are not receiving the treatment they need, and current treatment levels are threatened by shifts in global and domestic spending priorities in the wake of global economic crises. And yet, the simple reality is that people around the world acted to arrest what could have become a much, much worse source of human destruction, and given the complicated biological properties of HIV, this is a remarkable achievement.
Not surprisingly, this week there have been calls to redouble efforts to find a cure – for example from the director of the International AIDS Society. And Tina Rosenberg wrote this week about the incredible case of a man whose HIV was no longer detectable following a stem-cell transplant, also hinting at the possibility of finding a cure. Incidentally, it was Rosenberg’s article on the incredible Brazilian response to AIDS that helped spark my interest in the politics of AIDS, so I am always keen to hear what she finds is a promising new development.
Next week, a “high level” meeting sponsored by UNAIDS will be held in New York City. When I attended a UNAIDS workshop back in April, a few participants wondered aloud how many truly “high level” dignitaries would show up given the range of crises and more politically salient priorities on various agendas. While it is understandable that political leaders would turn their attention to other issues, it would be a shame if the incredible opportunities to pursue radical reductions in prevention – for example through reduced viral loads from combination drug therapies – and yes maybe even a cure or vaccine, were wasted. I am not sure that the “30th anniversary” metaphor will carry much weight, but the history of the epidemic has revealed an incredible well of creativity for capturing the imagination and generosity of others, and perhaps this will work yet again.