The Current State of HIV/AIDS
The first scientific report describing the disease that later came to be known as AIDS (acquired immune deficiency syndrome) appeared more than 40 years ago. Since then, it is estimated that at least 70 million people around the world have been infected with HIV and that about half of them have died.
Much has happened in the years since AIDS was first identified, including many positive developments in both prevention and treatment. Today, we seem to be hearing less and less about this epidemic in the media, which may inadvertently give the impression that we’re out of the woods. But we’re not.
Given that we’re currently in the midst of AIDS Awareness Month let’s take a look at the state of HIV/AIDS in the world today, where we are in the search for a cure, what you can do to protect yourself (and your partners) from this virus, and what the future holds with respect to HIV and AIDS.
How Have Rates of HIV Changed Over Time?
Worldwide, HIV infections reached their peak in the mid-1990s. Since then, we’ve managed to cut the infection rate in half. Deaths are also down by about two-thirds from their peak. Undoubtedly, this is all good news; however, the epidemic is far from over.
There are still around 1.5 million new HIV infections occurring each year and about 650,000 AIDS-related deaths annually.
In the United States specifically, there are around 35,000 new infections each year and around 18,000 associated deaths.
It is important to note that, within the U.S., infections disproportionately impact men who have sex with men, persons of color, young adults, and those living in the south. Worldwide, however, infection rates are highest in sub-Saharan Africa, and a majority of all individuals who carry the infection are women and girls. Thus, the picture (and burden) of HIV/AIDS looks different across the globe.
Where Are We in the Search for a Cure?
Despite decades of research and billions of dollars in funding, we still don’t have a cure for HIV/AIDS. The nature of this virus makes it extraordinarily difficult to eradicate from the body because the virus essentially hides inside of certain cells.
HIV drug treatments take care of any virus that exists and escapes outside of these cells and can lower the level of the virus in the bloodstream to undetectable levels. The problem, though, is that this “latent” or dormant virus is still hanging out, and we have not yet figured out a way of safely targeting it.
That said, one newer approach that is still being tested involves a medication that essentially “wakes up” the virus inside of the cells that carry it and then puts a target on their back. Known as the “kick and kill” method, the drug forces the dormant virus to activate itself and, in doing so, it alerts the immune system to the presence of those infected cells and essentially puts a hit out on them (i.e., other immune cells come to take them out).
It’s a clever technique that shows promise in animal studies, but it will require a lot of further testing before we know whether it will work in humans. However, this development suggests that maybe—just maybe—we’ll have a cure one day.
How Can I Prevent HIV Infection?
Scientists are hoping to one day develop a vaccine against HIV—in fact, they’ve already spent billions of dollars trying to find one. Again, however, the nature of this virus has made it quite difficult to prevent it through vaccination efforts.
That said, there are many things you can do to protect yourself against infection. First, however, you need to understand how the infection is most likely to be spread. The most common modes of transition include sexual intercourse (both anal and vaginal), injection drug use, and mother-to-child (e.g., through childbirth or breastfeeding).
For injection drug users, shared needles are the most common way HIV spreads, which is why many local communities have set up needle-exchange programs. Thus, avoiding dirty needles is key to avoiding infection for this type of transmission.
For pregnant women and new mothers who are HIV+, it is possible to lower the risk of HIV transmission to one’s child to near zero through a combination of the mother taking HIV medicine, the infant taking HIV medication for a few weeks after birth, and avoiding breastfeeding.
For protection during sexual activity, historically, the main method of prevention has been the use of barrier methods, particularly condoms. Condoms are one of the most powerful (and accessible) tools we have available for preventing HIV and other STIs.
However, condoms are imperfect because people make a lot of use mistakes, such as tearing the condom, putting it on after sex has started or before sex is over, using it more than once, and using a condom that is expired. It is, therefore, important to use condoms correctly and consistently to maximize protective benefits!
A more recent innovation in HIV protection is the medication PrEP (pre-exposure prophylaxis). Taken in the form of a pill (or, more recently, as an injection), PrEP can reduce the risk of HIV infection through sexual activity by as much as 99% if you take it as prescribed. PrEP can also reduce the risk of HIV infection through injection drug use.
If you’re interested in learning about whether PrEP might be right for you, please talk to your healthcare provider. However, be aware that PrEP only provides protection against HIV; acquiring other STIs is still possible, which is why combining PrEP with condoms is recommended.
What Does the Future Hold?
Advances in HIV prevention and treatment mean that we have dramatically reduced the number of new infections and are now at a point where infected individuals are projected to have a near-normal lifespan. However, now is not the time to get complacent at what has been accomplished.
We could reduce infection rates further if more infected people started HIV therapy. It is estimated that nearly 1 in 5 people who are infected with HIV do not know it, which creates a significant opportunity for the virus to spread. As a result, we urgently need to do more testing and education around this STI.
We also need to redouble public health efforts with respect to HIV because they faltered during the COVID-19 pandemic. With all the attention turned to COVID, STI testing dropped off, and people had difficulty accessing treatment—and, at the same time, people still had sex.
While life is returning to normal in many ways, the global economic situation means that resources are stretched, and with so much of it still going toward the pandemic, progress on HIV prevention has stalled, with rates of new infections decreasing at slower rates than before. However, most worrisome is that, in some parts of the world, HIV infection rates are on the rise after years of falling, including in parts of Europe, Asia, Africa, and Latin America.
Prominent HIV and AIDS organizations have promised an end to the epidemic by 2030, and that remains within the realm of possibilities. But in order for that to happen, we all need to do our part.
References:
Kim, J. T., Zhang, T. H., Carmona, C., Lee, B., Seet, C. S., Kostelny, M., … & Zack, J. A. (2022). Latency reversal plus natural killer cells diminish HIV reservoir in vivo. Nature communications, 13(1), 1-14.
Lehmiller, J. J. (2017). The psychology of human sexuality. John Wiley & Sons.
UNAIDS. (2022). Global HIV and AIDS statistics – fact sheet. Retrieved from: https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf
UNAIDS. (2022). Millions of lives at risk as progress against AIDS falters. Retrieved from: https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2022/july/20220727_global-aids-update
World Health Organization. (2022). Why the HIV epidemic isn’t over. Retrieved from: https://www.who.int/news-room/spotlight/why-the-hiv-epidemic-is-not-over
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