Persistence, Promise, and Hope for the End: A New Year’s Message

Ed. Note: Cross-posted from blog.AIDS.gov

In the tumult of the holiday shopping, seasonal traffic delays, and endless bowls of eggnog, it was easy to miss the news that Science—one of the world’s leading scientific research journals—had chosen an HIV-related clinical trial as its 2011 Breakthrough of the Year. I caught that news while trying to wrap up some last-minute items, and, later, I took a moment to reflect on this announcement. This was perhaps the first time in many years that Science magazine had featured an issue related to HIV/AIDS research so prominently on its cover. I would like to highlight the importance of that piece of news and share some perspective on what it might mean for the future.

In the December 23 issue, Science said: “The year 2011 saw scientific research that stretched from the farthest reaches of the universe to the deepest mysteries of the cell. Following a yearly tradition, Science‘s editors and news staff have selected one Scientific Breakthrough of the Year and nine runners-up.” Their choice was the HPTN 052 clinical trial, an international HIV-prevention trial sponsored by the National Institute of Allergy and Infectious Diseases (NIAID).

The study found that HIV-infected heterosexual individuals who begin taking antiretroviral medicines when their immune systems are relatively healthy are 96 percent less likely to transmit the virus to their uninfected partners. The editors noted that they chose the study “because of HPTN 052′s profound implications for the future response to the AIDS epidemic.”

According to the magazine, Dr. Myron Cohen, director of the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill, and the lead researcher for the HPTN 052 trial, said the finding’s impact surprised him: “People were interested in the idea of treatment as prevention, but it (the study) created a hurricane-force wind behind the strategy.” In further conversation, Dr. Cohen told me that “the HPTN 052 study has galvanized incredibly rapid policy change, and seems to have made the somewhat cautious prevention community very, very bold.”

The HPTN 052 study demonstrated that “treatment as prevention” works—and gives us new hope and optimism for the future. This is wonderful news! It is acknowledgment of the groundbreaking work that so many have been doing to achieve the vision expressed by President Barack Obama and Secretary of State Hillary Rodham Clinton—the vision of “creating an AIDS-free generation.” It also echoes the sentiment of the leaders who recently gathered on World AIDS Day to mark “the beginning of the end of AIDS.”

For me, it was nothing short of an epiphany to hear and internalize the notion of an AIDS-free world. A little over a decade ago, I was the Executive Director of an HIV/AIDS hospice in Puerto Rico, where we provided palliative care for people who were in the advanced stages of AIDS. Weekly, I would meet with the medical staff and determine which patients were closest to death. The chaplain, clinical social worker, and I would then begin the difficult process of making calls to patient’s friends and family, exhorting them to pay a visit and take the necessary steps in advance of the patient’s death. Often, because of fear, stigma, and discrimination, many of our patients passed without a familial visit – sometimes dying with the staff and me as their last comforting voice. The notion of ending AIDS was not in our consciousness; at the time, AIDS as an end-point was our reality. We were in a race against illness, stigma, discrimination, and death, but we had little notion of how many miles we would have to run before we could rest.

Fast forward to August 2011. I was first mesmerized by the possibility of an AIDS-free world when I heard Dr. Jonathan Mermin, from the Centers for Disease Control and Prevention, speak at the 2011 National HIV Prevention Conference in Atlanta. Dr. Mermin gave a thorough summary of the state of the epidemic, advances in prevention efforts (particularly healthcare as prevention), and he had the temerity to conclude his presentation by emphatically affirming that the end of the epidemic was within reach in our lifetime.

It was the first time I truly allowed myself to envision that future.

I recently talked to Dr. Mermin about this pivotal moment and he reflected: “Today, I woke up and planned my day in the usual way, filling my mind with meetings, documents, phone calls, and paperwork–and I forgot to learn from the past. For many years, we prayed for a few more months or days with the partners, friends, and family with HIV whom we cared for during the times when compassion and love were the best medicine. But we also worked fervently on research, prevention, and care. Because of that, in 2012, antiretroviral therapy not only provides people with HIV an almost normal life expectancy, but it also greatly reduces the chance that HIV will be transmitted to others. These new possibilities join old prevention tools such as condoms, testing, education, and community mobilization. The arrival of new tools for HIV care and prevention has led the nation to consider HIV less of a problem—a solved issue from the past. Yet, the number of people with HIV in the United States has increased by 60% over the past 15 years, mostly because individuals in care are living longer. Just as we did not give up on hope and action 20 years ago, we should use the knowledge of a growing epidemic and the presence of effective interventions to inspire us to act now. For the first time, I have the realistic expectation that we can reverse the epidemic in our country. Will we?”

On Worlds AIDS Day, I sat in the audience with a tearful crowd as the President, joined by former Presidents Bush and Clinton (via video link) and a multitude of world leaders, proclaimed a global effort to mark the beginning of the end of AIDS – a notion that for me, for many years and for too many patients, seemed faraway.

As 2012 begins, we should take time to celebrate the advances that our scientists and healthcare professionals have made, including the recognition of HPTN 052 by Science. The challenge now is to continue the research progress with safer, longer-acting antiretroviral drugs that will help people living with HIV stay on their medications. Further, the ultimate tools to control and end the HIV/AIDS epidemic—a safe, effective, and durable HIV vaccine and a cure for HIV infection—must remain high-priority research goals.

There were too many years when there was no cause to rejoice. Optimism is a welcome feeling, but we cannot replace our sense of progress with complacency. We must sustain the research progress, since new and innovative strategies will accelerate our progress towards controlling and ending the AIDS epidemic. We can bolster that progress by continuing to press for the implementation of the National HIV/AIDS Strategy.

We have the momentum. We have the persistence and the commitment to ending HIV/AIDS, once and for all. And I can finally see the hope and promise of the finish line.

 James Albino is the Senior Program Manager of the Office of National AIDS Policy.