June 2, 2011 | by Michael Weinstein
The road ahead is ‘test and treat’

John Lennon said that, “life is what happens to you while you’re making plans.”

We know the best-laid plans don’t always work out. On the other hand, we’ve seen that many solutions to problems often come from serendipity. Penicillin, one of the most important scientific breakthroughs of modern times, grew accidentally in a dish. Viagra was intended to treat hypertension; however, it did not, as researchers hoped, reduce blood pressure. In our chase to find an AIDS vaccine we have tripped upon something even better.

For three decades we have dreamed about a shot or a pill that would make it impossible to become infected with HIV without any real success. We were concentrating on how we could wall off the non-infected from the virus by inoculating them with a substance that would cause their body to mount a defense against the virus that would protect them. Unfortunately, HIV is not like most other diseases. The antibodies that our own bodies create are not protective. All the experimentation using parts of the virus’ shell or another virus in order to trigger a protective response failed despite tens of billions of dollars in funding spent on it.

As that door closed, another one has opened. We now know we can render a person who is HIV-positive virtually non-infectious. A widely reported recent study of couples in which one partner was positive and the other negative showed a 96 percent reduction in new infections of the negative partner when the HIV-positive partner was in treatment and on antiretroviral therapy—a truly phenomenal result.

So it turns out that we in essence have an AIDS vaccine. However, instead of administering the vaccine to the HIV-negative individual, we must give it to the person who is already infected. Treatment as treatment and treatment as prevention.

Out of the billions of people who now populate our world, a fraction has HIV. If we find them and treat them, new infections will plummet.  This has now been conclusively proven. With or without effective prevention methods (which I wholeheartedly support) we can drastically reduce new infections among the negatives while also keeping tens of millions of HIV-positive individuals alive and well. Testing and treating is a winning strategy all around, and it is cost-effective to boot.  Efficient methods of treating patients in poor countries for less than $200 a year are a reality. Each HIV-infected person on the planet that needs medication and medical care could get it for the money that we are already spending on global AIDS.

Here in the United States we need to find the quarter of a million people who are HIV-positive and don’t know it and get them into care and treatment. People who dropped out of care need to be persuaded to come back. Testing needs to be dramatically stepped up both in healthcare and community settings.

Thirty years into this epidemic America’s response to AIDS is still a failure. From Reagan, who would not even mention the word ‘AIDS’ for six years, to Obama who seems content to preside over an escalating gap in providing lifesaving medications to low-income Americans that now approaches 10,000 people, national leadership has always been sorely lacking. Today, the road ahead is clear: ‘test and treat’ is how we can win the battle against AIDS.

Marking thirty years of AIDS in America would be as good a time as any for President Obama and Congress to declare a true war on AIDS now that we know we have the tools to control it.

Michael Weinstein is president of the AIDS Healthcare Foundation. Reach him via aidshealth.org.

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