In 1996, many wondered whether the AIDS epidemic was finally over. That year, thanks to the breakthrough in medication used to treat HIV, for the first time in the history of the pandemic, deaths from the disease dropped dramatically. At that watershed moment, AIDS changed from a death sentence to a manageable illness.
Of course, the epidemic wasn't over. The disease has taken an increasing and disproportionate toll on blacks — both in Africa and in the United States. But now, 15 years later, a breakthrough in HIV medication is once again leading experts to point to the end of AIDS. This time, new research highlights a growing body of evidence that the drugs used to save the lives of millions of people living with HIV can also prevent the spread of the disease.
"This is very promising news for African Americans," Phill Wilson, CEO of the Black AIDS Institute, told The Root. "We have reached a deciding moment, HIV is 100 percent preventable, 100 percent diagnosable and, in many cases, treatable. We now have all of the tools needed to end the AIDS epidemic."
Last week the Centers for Disease Control and Prevention announced that two studies have shown for the first time that taking antiretroviral drugs every day can dramatically reduce a person's chance of becoming infected with HIV through heterosexual intercourse. Giving ARVs to people without the disease as a form of prevention is known as pre-exposure prophylaxis, or PrEP.
The recent announcements topped off a year of good news in an epidemic that has dragged on for three decades. All of the most promising advances focus on using medicine to prevent the spread of HIV.
A year ago, scientists found that a vaginal gel containing HIV-killing medication could prevent the spread of the disease in women, and several months later, PrEP proved successful in reducing infection in gay and bisexual men. Earlier this year, another study showed that taking ARVs soon after being diagnosed with the disease markedly lowered the risk of infecting others. This strategy is called treatment as prevention.
Both of the newest trials took place in Africa. The smaller of the two was conducted in Botswana and involved more than 1,200 sexually active adults. Participants took a pill containing the medication Truvada every day, and their risk of contracting HIV dropped by 63 percent.
The second study looked at 4,758 couples in Kenya, in which one partner was HIV positive while the other wasn't. The infected partners took either Truvada, Viread (another ARV) or a placebo containing no medication. Compared with the placebo, Truvada lowered the risk of infection in the negative partner by 73 percent, while those taking Viread reduced transmission by 62 percent. The results were so promising that experts decided that it would be unethical to keep giving some people the placebo, so everyone enrolled in the study will now be offered active drugs.
The news about PrEP is especially important for women. Around the world, women make up more than half of all people living with HIV. In the U.S., African-American women are 15 times more likely than white women to get infected with HIV. AIDS is a leading cause of death among black women; only heart disease and cancer rank higher.
"These trials provide data on the biomedical interventions, such as PrEP or microbicides, that work for women, who are especially at risk when their partner is HIV infected," said Dazon Diallo Dixon, founder and CEO of SisterLove, an organization in Atlanta that focuses on women and HIV/AIDS.
"Whether through a product that women could use topically to prevent HIV or STIs, or through getting early treatment for HIV, these trials are finally giving us more hope that we can find the right combination of clinical interventions, a preventive vaccine and, yes, even a cure," Diallo Dixon told The Root.
AIDS experts called the trial results both "game changing" and welcome news for African Americans, who make up half of the 56,000 Americans who are newly infected each year. Still, many worry about how PrEP will work in the real world, especially in the black community.
Activists and providers are quick to warn that PrEP shouldn't be thought of as a pill you take and then go out and party like it's 1979. For one, it hasn't been proved to work 100 percent of the time. In comparison, condoms are much more effective when used correctly and consistently, according to many, many studies. And with a price tag that can run as high as $900 a month, Truvada is out of reach for many.
This means that PrEP should be a supplement, used with another form of protection, rather than a substitute. "Ideally, PrEP works in conjunction with trying to change your behavior," Dr. Theresa Mack, an HIV specialist who has been practicing in Harlem, N.Y., for 20 years, told The Root. "You still need to use condoms. PrEP doesn't prevent other STDs. It doesn't take the place of safer sex, and it definitely doesn't allow you to practice reckless behavior."
There are also larger questions to consider. With no increased federal HIV/AIDS funding in the pipeline — and states cash-strapped by the economy — currently, 86,855 HIV-positive Americans are stuck on waiting lists, unable to afford lifesaving medications. The bulk of those without access to treatment live in the South, and most are people of color. In sub-Saharan Africa, where HIV/AIDS has hit the hardest, only 37 percent of those eligible for lifesaving treatment receive it.
So in a time of tight resources and more demand than supply, who should get medication? Those who are sick — or those who want to avoid getting sick?
Activists believe that instead of fighting over thin slices of money for HIV/AIDS medicine, the pie needs to gets bigger. And many hope that the promising results of the PrEP trials and the success of treatment as prevention will be the push that the government and pharmaceutical companies need to assure access to HIV medication for everyone.
According to Diallo Dixon, it's up to African Americans to be at the forefront of the leadership and decision making. "The next challenge is, who will drive domestic and global policy that will ensure the resources that get the medications to all the HIV-positive patients who need them?" she explained. "The community really needs to step up and get back out in front of the science."
Linda Villarosa is the director of the journalism program at the City College of New York and is contributing to a documentary about HIV/AIDS in black America for PBS.