An End to the AIDS Epidemic?

In a time of tight resources, who should get a breakthrough HIV medicine? The sick -- or those who want to avoid being sick?

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"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.

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