The end of AIDS? Thirty years on, it looks as though the plague can now be beate

[Guest guest]

The end of AIDS?

Thirty years on, it looks as though the plague can now be beaten, if the world

has the will to do so

Jun 2nd 2011 | from the print edition

ON JUNE 5th 1981 America's Centres for Disease Control and Prevention reported

the outbreak of an unusual form of pneumonia in Los Angeles. When, a few weeks

later, its scientists noticed a similar cluster of a rare cancer called Kaposi's

sarcoma in San Francisco, they suspected that something strange and serious was

afoot. That something was AIDS.

Since then, 25m people have died from AIDS and another 34m are infected. The

30th anniversary of the disease's discovery has been taken by many as an

occasion for hand-wringing. Yet the war on AIDS is going far better than anyone

dared hope. A decade ago, half of the people in several southern African

countries were expected to die of AIDS. Now, the death rate is dropping. In 2005

the disease killed 2.1m people. In 2009, the most recent year for which data are

available, the number was 1.8m. Some 5m lives have already been saved by drug

treatment. In 33 of the worst-affected countries the rate of new infections is

down by 25% or more from its peak.

Related items

AIDS: The 30 years warJun 2nd 2011

The history of AIDS: Heroes and villainsJun 2nd 2011

Saving African children: Faster is not always betterJun 2nd 2011

Related topics

W. Bush

Contagious and infectious diseases

Health and fitness

HIV and AIDS

Sexual and reproductive health

Even more hopeful is a recent study which suggests that the drugs used to treat

AIDS may also stop its transmission (see article). If that proves true, the

drugs could achieve much of what a vaccine would. The question for the world

will no longer be whether it can wipe out the plague, but whether it is prepared

to pay the price.

The appliance of science

If AIDS is defeated, it will be thanks to an alliance of science, activism and

altruism. The science has come from the world's pharmaceutical companies, which

leapt on the problem. In 1996 a batch of similar drugs, all of them inhibiting

the activity of one of the AIDS virus's crucial enzymes, appeared almost

simultaneously. The effect was miraculous, if you (or your government) could

afford the $15,000 a year that those drugs cost when they first came on the

market.

Much of the activism came from rich-world gays. Having badgered drug companies

into creating the new medicines, the activists bullied them into dropping the

price. That would have happened anyway, but activism made it happen faster.

The altruism was aroused as it became clear by the mid-1990s that AIDS was not

just a rich-world disease. Three-quarters of those affected were—and still

are—in Africa. Unlike most infections, which strike children and the elderly,

AIDS hits the most productive members of society: businessmen, civil servants,

engineers, teachers, doctors, nurses. Thanks to an enormous effort by Western

philanthropists and some politicians (this is one area where even the left

should give credit to Bush junior), a series of programmes has brought

drugs to those infected.

The result is patchy. Not enough people—some 6.6m of the 16m who would most

quickly benefit—are getting the drugs. And the pills are not a cure. Stop taking

them, and the virus bounces back. But it is a huge step forward from ten years

ago.

What can science offer now? A few people's immune systems control the disease

naturally (which suggests a vaccine might be possible) and antibodies have been

discovered that neutralise the virus (and might thus form the basis of

AIDS-clearing drugs). But a cure still seems a long way off. Prevention is, for

the moment, the better bet.

There are various ways to stop people getting the disease in the first place.

Nagging them to use condoms and to sleep around less does have some effect.

Circumcision helps to protect men. A vaginal microbicide (none exists, but at

least one trial has gone well) could protect women. The new hope centres on the

idea of combining treatment with prevention.

A question of money

In the early days scientists were often attacked by activists for being more

concerned with trying to prevent the epidemic spreading than treating the

affected. Now it seems that treatment and prevention will come in the same pill.

If you can stop the virus reproducing in someone's body, you not only save his

life, you also reduce the number of viruses for him to pass on. Get enough

people on drugs and it would be like vaccinating them: the chain of transmission

would be broken.

That is a huge task. It is not just a matter of bringing in those who should

already be on the drugs (the 16m who show symptoms or whose immune systems are

critically weak). To prevent transmission, treatment would in theory need to be

expanded to all the 34m people infected with the disease. That would mean more

effective screening (which is planned already), and also a willingness by those

without the symptoms to be treated. That willingness might be there, though, if

it would protect people's uninfected lovers.

Such a programme would take years and also cost a lot of money. About $16

billion a year is spent on AIDS in poor and middle-income countries. Half is

generated locally and half is foreign aid. A report in this week's Lancet

suggests a carefully crafted mixture of approaches that does not involve

treating all those without symptoms would bring great benefit for not much more

than this—a peak of $22 billion in 2015, and a fall thereafter. Moreover, most

of the extra spending would be offset by savings on the treatment of those who

would have been infected, but were not—some 12m people, if the boffins have done

their sums right. At $500 per person per year, the benefits would far outweigh

the costs in purely economic terms; though donors will need to compare the gain

from spending more on knocking out AIDS against other worthy causes, such as

eliminating malaria (see article).

For the moment, the struggle is to stop some rich countries giving less. The

Netherlands and Spain are cutting their contributions to the Global Fund, one of

the two main distributors of the life-saving drugs (the other is Mr Bush's

brainchild, PEPFAR), and Italy has stopped paying altogether.

On June 8th the United Nations meets to discuss what to do next. Those who see

the UN as a mere talking-shop should remember that its first meeting on AIDS

launched the Global Fund. It is still a long haul. But AIDS can be beaten. A

plague that 30 years ago was blamed on man's iniquity has ended up showing him

in a better, more inventive and generous light.

http://www.economist.com/node/18774722

[Guest guest]

The end of AIDS?

Thirty years on, it looks as though the plague can now be beaten, if the world

has the will to do so

Jun 2nd 2011 | from the print edition

ON JUNE 5th 1981 America's Centres for Disease Control and Prevention reported

the outbreak of an unusual form of pneumonia in Los Angeles. When, a few weeks

later, its scientists noticed a similar cluster of a rare cancer called Kaposi's

sarcoma in San Francisco, they suspected that something strange and serious was

afoot. That something was AIDS.

Since then, 25m people have died from AIDS and another 34m are infected. The

30th anniversary of the disease's discovery has been taken by many as an

occasion for hand-wringing. Yet the war on AIDS is going far better than anyone

dared hope. A decade ago, half of the people in several southern African

countries were expected to die of AIDS. Now, the death rate is dropping. In 2005

the disease killed 2.1m people. In 2009, the most recent year for which data are

available, the number was 1.8m. Some 5m lives have already been saved by drug

treatment. In 33 of the worst-affected countries the rate of new infections is

down by 25% or more from its peak.

Related items

AIDS: The 30 years warJun 2nd 2011

The history of AIDS: Heroes and villainsJun 2nd 2011

Saving African children: Faster is not always betterJun 2nd 2011

Related topics

W. Bush

Contagious and infectious diseases

Health and fitness

HIV and AIDS

Sexual and reproductive health

Even more hopeful is a recent study which suggests that the drugs used to treat

AIDS may also stop its transmission (see article). If that proves true, the

drugs could achieve much of what a vaccine would. The question for the world

will no longer be whether it can wipe out the plague, but whether it is prepared

to pay the price.

The appliance of science

If AIDS is defeated, it will be thanks to an alliance of science, activism and

altruism. The science has come from the world's pharmaceutical companies, which

leapt on the problem. In 1996 a batch of similar drugs, all of them inhibiting

the activity of one of the AIDS virus's crucial enzymes, appeared almost

simultaneously. The effect was miraculous, if you (or your government) could

afford the $15,000 a year that those drugs cost when they first came on the

market.

Much of the activism came from rich-world gays. Having badgered drug companies

into creating the new medicines, the activists bullied them into dropping the

price. That would have happened anyway, but activism made it happen faster.

The altruism was aroused as it became clear by the mid-1990s that AIDS was not

just a rich-world disease. Three-quarters of those affected were—and still

are—in Africa. Unlike most infections, which strike children and the elderly,

AIDS hits the most productive members of society: businessmen, civil servants,

engineers, teachers, doctors, nurses. Thanks to an enormous effort by Western

philanthropists and some politicians (this is one area where even the left

should give credit to Bush junior), a series of programmes has brought

drugs to those infected.

The result is patchy. Not enough people—some 6.6m of the 16m who would most

quickly benefit—are getting the drugs. And the pills are not a cure. Stop taking

them, and the virus bounces back. But it is a huge step forward from ten years

ago.

What can science offer now? A few people's immune systems control the disease

naturally (which suggests a vaccine might be possible) and antibodies have been

discovered that neutralise the virus (and might thus form the basis of

AIDS-clearing drugs). But a cure still seems a long way off. Prevention is, for

the moment, the better bet.

There are various ways to stop people getting the disease in the first place.

Nagging them to use condoms and to sleep around less does have some effect.

Circumcision helps to protect men. A vaginal microbicide (none exists, but at

least one trial has gone well) could protect women. The new hope centres on the

idea of combining treatment with prevention.

A question of money

In the early days scientists were often attacked by activists for being more

concerned with trying to prevent the epidemic spreading than treating the

affected. Now it seems that treatment and prevention will come in the same pill.

If you can stop the virus reproducing in someone's body, you not only save his

life, you also reduce the number of viruses for him to pass on. Get enough

people on drugs and it would be like vaccinating them: the chain of transmission

would be broken.

That is a huge task. It is not just a matter of bringing in those who should

already be on the drugs (the 16m who show symptoms or whose immune systems are

critically weak). To prevent transmission, treatment would in theory need to be

expanded to all the 34m people infected with the disease. That would mean more

effective screening (which is planned already), and also a willingness by those

without the symptoms to be treated. That willingness might be there, though, if

it would protect people's uninfected lovers.

Such a programme would take years and also cost a lot of money. About $16

billion a year is spent on AIDS in poor and middle-income countries. Half is

generated locally and half is foreign aid. A report in this week's Lancet

suggests a carefully crafted mixture of approaches that does not involve

treating all those without symptoms would bring great benefit for not much more

than this—a peak of $22 billion in 2015, and a fall thereafter. Moreover, most

of the extra spending would be offset by savings on the treatment of those who

would have been infected, but were not—some 12m people, if the boffins have done

their sums right. At $500 per person per year, the benefits would far outweigh

the costs in purely economic terms; though donors will need to compare the gain

from spending more on knocking out AIDS against other worthy causes, such as

eliminating malaria (see article).

For the moment, the struggle is to stop some rich countries giving less. The

Netherlands and Spain are cutting their contributions to the Global Fund, one of

the two main distributors of the life-saving drugs (the other is Mr Bush's

brainchild, PEPFAR), and Italy has stopped paying altogether.

On June 8th the United Nations meets to discuss what to do next. Those who see

the UN as a mere talking-shop should remember that its first meeting on AIDS

launched the Global Fund. It is still a long haul. But AIDS can be beaten. A

plague that 30 years ago was blamed on man's iniquity has ended up showing him

in a better, more inventive and generous light.

http://www.economist.com/node/18774722