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World news this month appropriately focuses on containing the COVID-19 pandemic, as the first vaccines become available. Yet we can also celebrate major success in the fight against a different global viral scourge: HIV.
During my medical training in the 1980s, hospital wards were often filled with people dying of HIV. Since then, antiviral treatments have dramatically transformed the diagnosis of HIV infection or AIDS from a death sentence to a chronic illness. A normal lifespan is no longer unusual among people living with HIV. And preventive measures described below have reduced the number of people becoming infected in the first place. Since the 1980s peak of new HIV infections, the number of people with newly diagnosed HIV in the US has fallen by more than two-thirds.
Deaths due to HIV infection continue to fall
A study published in the November 2020 Mortality and Morbidity Weekly Report noted remarkable progress:
- Between 2010 and 2018, overall deaths among those diagnosed with HIV fell by more than a third, from 19.4 to 12.3 per 1,000 people.
- From 2010 through 2017, deaths related to HIV fell by nearly half, dropping from 9.1 to 4.7 per 1,000 people).
- The highest rates of HIV-related death were noted among people who were Black, people who identified themselves as mixed-race, and people living in the South.
- Men with HIV had slightly lower death rates than women.
The study authors attribute the falling death rates to early diagnosis and improved treatment.
There’s still plenty of room for improvement
While the number of new cases of HIV infection in the US has fallen dramatically over the last decade, the latest data from 2014 to 2018 suggest this may be slowing. And not everyone has access to HIV testing or the most effective treatments. This is especially true for persons without health insurance, good nutrition, or other resources.
As with so many conditions, there are significant healthcare disparities among persons with HIV. Throughout the world, gender, race, and geography matter in who becomes ill and who receives timely, effective treatment. The burden of suffering and death is borne by some groups much more than others.
While advances in prevention and treatment of HIV are worth celebrating, we have a long way to go before declaring victory.
What you can do now
If you don’t have HIV: Take measures to keep it that way.
- limit your sexual activity to one partner who is similarly committed to only having sex with you
- always use a condom
- never share needles
- if you have a high-risk exposure (such as through sexual contact or a needle stick), contact your healthcare provider or go to an urgent care clinic to consider taking a medication to prevent HIV infection.
- HIV spreads through high-risk activities, such as sharing needles or having unprotected sex with a partner who has HIV or whose HIV status is unclear. Medicine known as PrEP (pre-exposure prophylaxis) can prevent infection if taken regularly. Talk to your doctor about this.
If you already have HIV: See your doctor for monitoring and treatment. A number of highly effective drugs are available to lower the amount of virus in your body. This can prevent complications of HIV infection and reduce the risk of infecting others.
If you aren’t sure about your HIV status but have had possible exposure: Get tested. Estimates suggest that one out of every seven people infected with HIV doesn’t know it.
The bottom line
Since the HIV epidemic began, we have witnessed enormous progress: researchers identified the cause and understood how it spread; highly accurate testing became available; public health measures were undertaken to prevent spread; and effective medications were developed. However, this progress took many years. And we still have no vaccine to prevent HIV infection. New infections and related deaths remain far too common, and healthcare disparities persist in the fight against HIV.
The experience with HIV has demonstrated how dangerous a new and contagious infectious disease can be, even in places with highly sophisticated medical care — a truth highlighted more recently by the COVID-19 pandemic. There are undoubtedly many lessons to be learned from past infectious diseases, including HIV, SARS, MERS, and Ebola, as we grapple with COVID-19. But the lessons could go both ways. Perhaps the ways we combat COVID-19 — including the creation of new vaccines — can be applied to HIV.
Hopefully, the progress in fighting HIV/AIDS will continue, perhaps even to its elimination. And what we have learned from HIV infection over several decades, and from COVID-19 during the past year, should make us better equipped to fight the next pandemic.
Follow me on Twitter @RobShmerling
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