AIDS 2012: Bill Gates skeptical of ending AIDS anytime soon

WASHINGTON, D.C. — The International AIDS Conference, a mega-meeting of more than 20,000 people, has opened here to fanfare, protests, calls to action and (overly?) ambitious proclamations aimed at fighting complacency.

The world’s biggest AIDS conference has returned to the U.S. – to a city with HIV infection rates comparable to some African nations – after 22 years of ‘separation’ due to our government’s ban against HIV-infected visitors. The Obama Administration repealed the travel ban in 2010.

It appears to be a critical moment for the global response to AIDS. The theme of AIDS 2012 is “Turning the Tide Together.”

This positive message has been accompanied by many speakers and organizations here claiming, sometimes in verbatim echo, that we are on the crest of finding a “cure” for AIDS, of creating an “AIDS-free generation” or “the end of AIDS.

  • “We can, with the technology we have today, end the epidemic,” said Mark Dybul, former director of the President George W. Bush’s ground-breaking and successful initiative to get AIDS drugs to Africa known as PEPFAR.
  •  “We look toward the end of AIDS as something realistic,” said Jim Kim, an activist physician who President Obama recently tapped to take over at the World Bank.
  • “We have everything we need to beat this epidemic,” said Michel Sidibe, director of UNAIDS, the Joint United Nations Programme on HIV/AIDS.

Most folks here are talking like that and it sounds great, very hopeful. But if you dig a bit deeper, it’s not clear if there’s evidence to support all these claims. Bill Gates, at a plenary talk today, joined the minority of skeptics questioning these rallying cries.

“We don’t have the tools to end the epidemic,” said Gates, citing the lack of an effective AIDS vaccine as the most critical weapon needed to defeat the pandemic.  “Only when we have these new tools can we seriously talk about moving toward the end.”

Bill Gates, World Bank President Jim Kim, AIDS ambassador Eric Goosby and others speak at AIDS 2012
Tom Paulson

Gates echoed other speakers at AIDS 2012 in citing the many positive steps and significant progress made over the past 10 years getting millions of people on treatment worldwide and called, like most, for more funding to expand access to treatment. He and others frequently cite a number of promising scientific discoveries over the past few years as well — of new prevention schemes and in basic research.

What’s been most celebrated as having turned the tide in the AIDS pandemic is that 8 million people in Africa and other poor countries are now on anti-HIV drugs. New studies have shown that people taking these anti-HIV drugs can almost eliminate the circulating virus from their system, thus preventing spread of the infection.

But the awful reality amid all this progress is that at least 7 million more people who need these life-saving drugs are not getting them today. More than 34 million people are infected with HIV and the pandemic is still spreading. Last year, about 2.5 million people were estimated to have become newly HIV-infected and 1.7 million died from AIDS-related problems.

Yet the talk, and news coverage, of this meeting has been mostly about ending AIDS or creating an AIDS-free generation.

“This kind of language implies we are close to ending the epidemic and it’s just not true,” said Richard Horton, editor of The Lancet. “It’s a marketing strategy, and one that could backfire.”

Won’t such inflated claims lead to unrealistic expectations, dashed hopes and, Horton says, public cynicism and complacency?

Dybul doesn’t think so. He contends the ambitious messaging is needed to combat the complacency that already exists.

“We do have the tools to end the epidemic,” Dybul said. Ten years ago, he said, few thought it was feasible to try to get everyone in Africa with HIV on treatment. But today, he said, there are an astounding 8 million people receiving these life-saving drugs. That was accomplished by scientific advances, by financial improvements (in drug pricing) and other forms of progress.

And it was all launched against much skepticism based mostly on a moral imperative, Dybul said, which has since demonstrated its economic wisdom.

But the question plaguing this conference is if the momentum can be sustained. International commitments to fund programs like PEPFAR and the Global Fund to Fight AIDS, TB and Malaria have been flat-lined, or are on a decline, due to the global economic downturn. We aren’t fully using the tools we already have. So why talk about the end of AIDS or the theoretical possibility of a cure or engage in rhetoric about the ‘end of AIDS’ when it remains only a distant hope?

Gates joined those in calling for more funds to expand anti-HIV treatment and continue the global progress made against the pandemic. But he said also felt compelled to challenge a few of the more dramatic and celebrated themes of the meeting such as the claim some scientists are making that we are on the pathway to a cure for AIDs.

“Curing AIDS. That’s very much a long shot,” said Gates. “It’s probably not in the cards anytime soon which is why the treatment imperative is so important.”

Gates said he is skeptical that all this impatient optimism (inside joke) expressed at AIDS 2012 will give the false impression — that all we need to do is take action and we can end the pandemic. There has been amazing progress, he said, but the most important next step is to expand the number of people on treatment right now.

We should stop looking for quick fixes, Gates said, and embrace the wisdom of continuing to invest in the long haul. That’s why the Bill & Melinda Gates Foundation has invested about $1.4 billion in the Global Fund to do what can be done now — getting more people on treatment — as well as $2.5 billion in the search for a long-term solution, an effective AIDS vaccine.

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Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at]humanosphere.org or follow him on Twitter @tompaulson.