CAPE TOWN, South Africa – Ebola has grabbed all the headlines, but HIV still remains the world’s deadliest infectious disease – killing nearly the same number of people every day that the Ebola outbreak in West Africa has so far killed in 9 months.
“We are in the middle of an extraordinary crisis,” said Tony Fauci, America’s top infectious disease doc and, officially, director of the National Institute of Allergy and Infectious Disease (NIAID).
The crisis Fauci was referring to here in a video presentation at the opening day of the HIV Research for Prevention conference featuring some 1,300 researchers, health workers, activists and policy makers was, of course, the Ebola outbreak. What’s happening in West Africa is indeed a global health emergency that deserves our full attention and assistance, he said.
In the United States, Fauci noted, the crisis is mostly “an epidemic of fear and concern” that, among other things, has prompted a few elected officials to do unwise and potentially counter-productive things (like putting healthy people into quarantine). Doing damage control at home meant Fauci had to cancel his plans to speak in person at this meeting.
South Africa is also in the middle of an extraordinary crisis. It is the epicenter of the global HIV/AIDS pandemic, with the highest prevalence of HIV infection in the world. Nearly one out of every five South Africans is infected with HIV. The country has been successful at getting millions of people on anti-HIV drugs, but there is a sense of desperation nevertheless.
“The call for an AIDS-free generation is aspirational,” said Helen Rees, one of South Africa’s leading medical researchers. “But we’re probably not going to get there any time soon.”
Rees’ sober assessment is based on a cold-eyed look at the still-expanding spread of HIV worldwide – more than 2 million new infections per year, according to UNAIDS.
Funding by the international community for fighting AIDS in poor countries has gone flat, or even declined, in recent years even as new infections outpace the ability to get people on drug treatment. Out of some 26 million people who today need these life-saving drugs, only about 10 million are now getting them. Deaths from HIV overall are down thanks to major initiatives like Pepfar or the Global Fund, but still more than 1.5 million die from AIDS every year.
Ebola, most experts agree, is unlikely to ever compete with HIV’s horrific scope and scale. Below is how South Africa’s Mail & Guardian Online newspaper tried to put it in context:
Some 30 years ago, when AIDS first emerged, the world reacted much like it is now doing for Ebola – with a sense of urgency and a good share of similarly hysterical and bad policy decisions to boot. But the AIDS pandemic, even before the Ebola crisis, has not gotten much attention lately despite its still terrible global toll. That was partly what prompted the launch of this meeting, aka HIVR4P.
“There was a need to bring everyone working on prevention together, to share knowledge and create a more powerful synergy,” said Mitchell Warren, executive director of the AIDS Vaccine Advocacy Coalition. Prior to this, the vaccine scientists had their own meetings as did those working on microbicides (mostly vaginal gels that can kill HIV), on male circumcision (which studies show can reduce HIV risk by 60 percent) and other means of prevention.
Those holding the purse strings, like the National Institutes of Health and the Bill & Melinda Gates Foundation, wanted to see the HIV prevention community working more in concert, Warren said. This became even more imperative as those working on vaccines or other preventative methods were coming up with findings that had implications for treatment, he said, and vice versa.
Drugs developed for treating HIV are now being exploited for preventive use, so-called ‘PrEP’ or pre-exposure prophylaxis. All sorts of gels, vaginal (inserted) rings and delayed-release materials are being studied as a means to protect against HIV. The conference is overwhelming with all of its various techniques and technologies aimed at preventing HIV.
“We have a sense of optimism today,” said Naledi Pandor, the South African minister of science and technology. “Thirty years ago, the global picture was depressing, offering very little hope for most of those infected.”
Today, Pandor said, people who have access to drugs have dozens to choose from, many millions of lives have been saved and major success stories – such as the reduction in mother-to-child transmission of HIV and the overall decline in the AIDS death rate – gives us all many reasons to celebrate.
“However, the main challenges remain,” she said. “The epidemic continues to outpace our efforts to control it.”
And that is more than a scientific challenge. The Nobel Peace Prize laureate, and local Anglican archbishop emeritus, Desmond Tutu was among the speakers for the opening ceremony (also by video).
“We are at a point where we can tell how far away we are from victory,” Tutu said. And with perhaps an eye to how some governments and world leaders are reacting to the Ebola crisis by closing borders and refusing people entry based on nothing but fear, he added: “Prevention cannot be forced. It must be implemented within the context of human rights.”
Maybe officials here should heed their local hero. One of the rumblings at HIVR4P’s first day was about the government of South Africa’s refusal of entry to one of the world’s leading HIV/AIDS researchers, Wafaa El-Sadr of Columbia University.
Like many here who have learned that medicine and human rights go hand-in-hand, El-Sadr went to West Africa to offer her expertise there in the fight against Ebola. For doing so, South Africa has refused to let her come here to assist in the fight against HIV.