WASHINGTON – The theme of the 2012 International AIDS Conference is “Turning the Tide Together.” The opening speaker, Dr. Anthony Fauci, has spent much of his career leading AIDS research in the United States at the National Institutes of Health. He spoke recently with VOA’s Carol Pearson before the AIDS Conference got underway and explained how the tide of the AIDS epidemic is being turned.
DR. FAUCI: “Well, in 2012 we’ve reached a point where the science has given us a number of interventions, particularly in the form of treatment and prevention of HIV, that if in fact we scale up the implementation of these by making treatment available by aggressively testing people, linking them to care, getting them on treatment, by implementing some of the prevention modalities particularly in the developing world, like circumcision or treatment as prevention, pre-exposure prophylaxis, prevention of mother to child transmission, that we have an opportunity now that we never had before because of the number of interventions that have proven to be efficacious, to actually tip the tide of the epidemic in the sense of the trajectory of the epidemic. For a long time it had been going up and then it started to flatten.
What we really need to do to end the AIDS pandemic is to turn the deflection of that curve so that it goes in the direction of fewer and fewer people getting infected, fewer and fewer people dying, and fewer and fewer children being born with HIV. That's what we mean by 'turning the tide,' and this is an important meeting in Washington, D.C., because it's at this gathering that a lot of people are going to get together and talk about the feasibility of actually implementing this turning of the tide."
CAROL PEARSON: So at this point, are you seeing more people getting infected than there are medicines to treat them?
DR. FAUCI: "Yes. That’s the problem. Right now we - a few years ago - had very few people in the developing world receiving therapy. Right now, in low and middle income countries, there are close to seven million people who are receiving anti-viral therapies. That's the good news. The sobering news is that, for every person that you put on therapy, two people get newly infected. So we still need to ratchet up our prevention modalities at the same time as we try to get as many people who need to be on therapy on therapy. One of the great breakthroughs over the past year and a half has been the realization that when you treat people early in the course of their disease, as opposed to waiting until their disease becomes advanced, that not only do you save and benefit the lives of the people who you put on therapy, but you decrease by an astounding 96 percent the likelihood that that infected person will infect their uninfected sexual partner. So, you really get two for the price of one: You save someone’s life who is infected and you prevent them from infecting other people. And it’s the implementation of this treatment-as-prevention program - which is getting people very hopeful - that will be able to turn the tide of the epidemic."
CAROL PEARSON: Male circumcision has been found to be highly effective in preventing transmission. What other kinds of things have been?
DR. FAUCI: "Well, you mention male circumcision. That’s very important because male circumcision early on in the trials that were done first in South Africa and then in Kenya and in Uganda showed that it was anywhere between 50 and 60 percent efficacious in preventing the acquisition of HIV...
"Now we know that five years out from those studies, the results are even better than they were in the early part of the studies. So now, [data show that it is] between 70 and 75 percent effective in preventing the acquisition of infection in the circumcised individual. So male circumcision is clearly emerging as a highly effective way to prevent HIV infection."
CAROL PEARSON: Are we any closer to a vaccine?
DR. FAUCI: We are closer to a vaccine now than we were several years ago, although you can't predict how long it's going to take for us to get a vaccine, but we are much more optimistic that we ultimately will achieve that goal."
DR. FAUCI: “Well, in 2012 we’ve reached a point where the science has given us a number of interventions, particularly in the form of treatment and prevention of HIV, that if in fact we scale up the implementation of these by making treatment available by aggressively testing people, linking them to care, getting them on treatment, by implementing some of the prevention modalities particularly in the developing world, like circumcision or treatment as prevention, pre-exposure prophylaxis, prevention of mother to child transmission, that we have an opportunity now that we never had before because of the number of interventions that have proven to be efficacious, to actually tip the tide of the epidemic in the sense of the trajectory of the epidemic. For a long time it had been going up and then it started to flatten.
What we really need to do to end the AIDS pandemic is to turn the deflection of that curve so that it goes in the direction of fewer and fewer people getting infected, fewer and fewer people dying, and fewer and fewer children being born with HIV. That's what we mean by 'turning the tide,' and this is an important meeting in Washington, D.C., because it's at this gathering that a lot of people are going to get together and talk about the feasibility of actually implementing this turning of the tide."
CAROL PEARSON: So at this point, are you seeing more people getting infected than there are medicines to treat them?
DR. FAUCI: "Yes. That’s the problem. Right now we - a few years ago - had very few people in the developing world receiving therapy. Right now, in low and middle income countries, there are close to seven million people who are receiving anti-viral therapies. That's the good news. The sobering news is that, for every person that you put on therapy, two people get newly infected. So we still need to ratchet up our prevention modalities at the same time as we try to get as many people who need to be on therapy on therapy. One of the great breakthroughs over the past year and a half has been the realization that when you treat people early in the course of their disease, as opposed to waiting until their disease becomes advanced, that not only do you save and benefit the lives of the people who you put on therapy, but you decrease by an astounding 96 percent the likelihood that that infected person will infect their uninfected sexual partner. So, you really get two for the price of one: You save someone’s life who is infected and you prevent them from infecting other people. And it’s the implementation of this treatment-as-prevention program - which is getting people very hopeful - that will be able to turn the tide of the epidemic."
CAROL PEARSON: Male circumcision has been found to be highly effective in preventing transmission. What other kinds of things have been?
DR. FAUCI: "Well, you mention male circumcision. That’s very important because male circumcision early on in the trials that were done first in South Africa and then in Kenya and in Uganda showed that it was anywhere between 50 and 60 percent efficacious in preventing the acquisition of HIV...
"Now we know that five years out from those studies, the results are even better than they were in the early part of the studies. So now, [data show that it is] between 70 and 75 percent effective in preventing the acquisition of infection in the circumcised individual. So male circumcision is clearly emerging as a highly effective way to prevent HIV infection."
CAROL PEARSON: Are we any closer to a vaccine?
DR. FAUCI: We are closer to a vaccine now than we were several years ago, although you can't predict how long it's going to take for us to get a vaccine, but we are much more optimistic that we ultimately will achieve that goal."
