End of AIDS—Hype versus Hope

By Wafaa M. El-Sadr, Katherine Harripersaud, Ronald Bayer – July 11, 2014

Science Magazine

Since 2001, HIV incidence has declined by 33% worldwide, and more than 9.7 million people with HIV have gained access to treatment.* The Joint United Nations Programme on HIV/AIDS launched the Getting to Zero strategy (2011–2015) that includes zero new infections, zero deaths from HIV, and zero discrimination. Aspirational statements such as “the end of AIDS” have also prevailed. However, do such pronouncements help or hurt? Do they motivate action, or do they risk incredulity, leading to inaction? Do such aspirations epitomize hype or hope?

The history of public health is replete with aspirational campaigns, with varying success. In 1971, the United States launched a “war on cancer,” increasing funding for cancer research. Although great progress has been made in our understanding, diagnosis, and management of cancer, this war has not yet been won. With a few exceptions, cures are rare, disparities in cancer outcomes remain, and investments in research are in question. On the other hand, despite skepticism about eradicating smallpox, the World Health Organization began a campaign in 1958 that focused on vaccination, surveillance, and containment. Twenty years later, smallpox was successfully eradicated.

As for HIV, there are certainly reasons to be optimistic. Many countries with high HIV prevalence have scaled up programs for preventing mother-to-child transmission, and new pediatric infections are rare in several countries. Changes in therapy include earlier initiation of antiretroviral therapy (ART) and the treatment of pregnant HIV-infected women for life. These approaches have the potential to provide individual benefit to those living with HIV and prevent further HIV transmission. Additionally, new investments in health systems offer a foundation on which prevention and treatment services can be expanded further. However, implying imminent success may be perceived as minimizing the challenges that remain, resulting in the withdrawal of resources and a consequent resurgence of the presumed “controlled” disease. This risk is particularly relevant, because HIV expenditures are currently well short of the annual global target of U.S. $22 billion to $24 billion. Donor complacency would have catastrophic consequences.

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