" . . . an HIV-Free Generation"?! Really?

This Sunday, May 18, is the annual AIDS Walk in New York City.  This is a big event: last year, some 30,000 people participated in this 10K "non-race" in Central Park and nearby neighborhoods and raised roughly $5.5 million toward HIV/AIDS causes locally and elsewhere.

Coincidentally, a leading health policy research journal Health Affairs published articles in its March issue on HIV topics.  One of them, highlighted on the cover, has the title "Policy Choices for an HIV-Free Generation."

What a concept, to even imagine an HIV-free generation!  Accompanying articles talk about a concept almost as startling, growing old with an HIV+ condition.  How times have changed for these people.

This topic is close to our heart.  The first person we knew who died of AIDS passed away in the spring of 1983, near the very beginning of this tragic epidemic.  We have lost at least a dozen other friends through the years and even the husband of a cousin.  In a sign of the changing fortunes of this population, however, the last two HIV+ people we knew never developed AIDS itself and lived into their 70s, approaching the lifespan of the overall population.  We wrote of this at the passing of one of them in late 2012.  At that time, we were deeply moved that Bob and Michael could have pretty much normal, active lives while taking their anti-retroviral medications.  We are touched anew by the current attention this health condition is receiving and by the striking results of the now more than 15-years' worth of anti-retroviral treatments.  What dramatic outcomes there are.

First (in order, but not priority), combination anti-retroviral therapy, known as cART, more than pays for itself economically.  Researchers at the University of Southern California and at Bristol-Myers Squib analyzed the added life expectancies against the $12,000+ annual cost of the treatment.  They conclude that patients' added lifespan has an estimated value several times greater than the cost of the therapy.  Further, their study indicates that since the people are healthier while taking the ART and since it has preventive qualities, it should be started early, before the infection evolves into a more serious symptomatic condition.  The phrase taking hold is "test and treat", don't wait until people's infection rating gets worse before starting treatment.

In addition, as we just noted, the cART is "preventive".  It's not a vaccine, which just has to be administered once.  It's a continuing treatment over potentially many years.  But it works.  So the next step is to use it as a prophylactic for partners of infected individuals.  Treating them can keep them from getting infected in the first place.   This is also worthwhile economically, to say nothing of how it is stabilizing to the daily lives of the individual and the partner couple.  Other analysts in the Health Affairs issue estimate that cART has prevented 13,500 infections per year since it was introduced broadly in 1996.

All of this is not a signal that the war against this brutal health condition has been won.  Numerous issues remain.  There is still a social stigma.  HIV+ people need employment, but often face obstacles to getting a job.  Now that many are getting older and trying to lead more normal lives, they may well face obstacles to forming social relationships: they're both older and HIV+.  Further, as people enjoy the benefits of cART, they may get less cautious in their sexual practices and even lax in taking the meds themselves.  This is the situation known to economists as "moral hazard"; people who know they have added protection may take more risk.  Separately, financing their treatment can get tricky as the Affordable Care Act (ACA) meshes with the long-standing federally funded Ryan White Program and numerous state versions of Medicaid, many of which are being restructured.  At the same time, it's estimated that the ACA will facilitate HIV testing for as many as 500,000 people in just the next three years, surely a big help.

Among other lingering concerns, all the good news we describe here pertains to the United States.  A look at a few of the organization who share in the proceeds of AIDS Walk New York gives an idea of the variety of other AIDS-related issues that remain.  Among nearly 40 groups all together, funds go to Keep a Child Alive, which provides anti-retroviral drugs to African children; Africa Tikkun provides education and social services to children and families in South African villages; and AID for AIDS assists people in Latin America and the Caribbean.

Still, even with the caveats we state, we can see that the wider testing in the US and the recognition of the benefits of early administration of cART indeed create the plausibility of a generation free of HIV in the US.  We hear so much about the troubles in medical care delivery these days, and it's nice to stop and recognize a genuine triumph for potentially millions of people.

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Visit the AIDS Walk website: http://www.aidswalk.net/newyork .  DONATE!!

The Health Affairs articles are here: http://content.healthaffairs.org/content/33/3.toc .  The issue is aimed at the impact of the Affordable Care Act on outreach to HIV/AIDS patients and the jail population.  We have not yet examined the latter material.  The HIV/AIDS articles we found most interesting include "Living with HIV and Growing Old" a portrait of a particular gentleman, two articles on the costs and benefits of early cART treatments and the policy summary.  All of it is helpful and accessible to general readers.