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?


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.