June 7, 2011 - Much activist activity brewing regarding the upcoming UN Special Session on AIDS this week. Funding countries are refusing to commit to putting up the resources to get 13 to 15 million people on treatment by 2015. On the basis of HPTN - 052 (see above) I have been arguing forcibly that we need to make the investment now or else not only will lives be lost, but we will have to pay more later for the infections that we could have prevented. See my interview published today in Nature with Erika Check Hayden Drug treatment for HIV infection is effective in preventing its spread, but implementing this fully will require more resources, says leading NIH scientist. Erika Check Hayden Anthony FauciBloomberg News/Landov/Photoshot This week, political leaders meet in New York for a United Nations summit that will frame the ongoing fight against HIV/AIDS. The conference comes a decade after the UN meeting at which heads of state committed the first major funding to the battle; as a result, 6.6 million people are now receiving antiretroviral drug therapy to keep their HIV infection under control -- 22 times the number in 2001, according to estimates by the Joint UN Programme on HIV/AIDS (UNAIDS). But 9 million people who need treatment are still not getting it, and global economic woes threaten to weaken international AIDS programmes. Anthony Fauci, head of the US National Institute of Allergy and Infectious Diseases, explains what scientists hope the UN meeting will achieve. How is the research landscape different going into this meeting than it was a decade ago? A considerable number of people have been put on therapy. But for every person who goes on therapy, two or two-and-a-half people get newly infected, so there's been this question of the balance between treatment and prevention. A real game changer occurred just a few weeks ago with the clear demonstration in heterosexual couples that when you start treatment earlier rather than later, you not only benefit the person infected, but that person is also 96% less likely to transmit the virus to [V treatment shown to 1 more confidence that their uninfected partner than if they were not treated (see 'HIV treatment shown to prevent spread of virus'). So people can say with a good deal more confidence that treatment is prevention. What does that imply for global AIDS policy? We have now so many types of prevention in our armamentarium, including treatment. So rather than have the tension between treatment and prevention, as there was previously, let's try to seek out, test, and treat as many people as we possibly can, because when you treat people, you are doing prevention. So that brings up the big question -- which is that it's going to require a lot of resources. How do you frame that question? The fundamental policy decision is: is it better to make investments now, even with the restricted resources we have available, and slow down or even get control of the pandemic, rather than not making the investment now, and only having to pay down the line, and possibly paying more. The UN wants countries to commit to treating 13 million people by 2015 at a cost of $22 billion, but this would not even treat all the people who will need it by that time. Is this where we should aim, given what we know about treatment as prevention? It's a reasonable goal. The issue at hand -- the big elephant in the room -- is are the parties responsible able to come up with the resources to make this happen? We have a confluence of enormous opportunity to turn around the global pandemic at the same time that we have an almost unprecedented constraint on resources. This is going to be the subject of some serious discussion in New York. Despite the constraints on resources, we have a real opportunity not only to save a lot of lives, but in the long run, to save money. Many researchers are now saying that we have the tools needed for effective prevention, and social phenomena are the main obstacle to slowing the spread of HIV (see Comment: 'Stigma impedes AIDS prevention'). What more can researchers do to solve this problem? It isn't as if we're going to be able to access every individual immediately, but there are programmes that can be enhanced that will allow us to penetrate into those areas of society that have been difficult to reach. Can we do this tomorrow? No, but we don't have to. We can start doing it over the next couple of years and we'll get better and better at it. What are researchers looking for out of the meeting? What I'm going to do in New York is put the data on the table. There's no more doubt that treatment can serve as prevention. My purpose is to say to policy makers: here are the data; you have to make up your mind about whether you want to implement the 1S programmes that have been proved to work -- to make it almost scientifically obvious to them what they need to do. June 8 - July 1, 2011 - Much activity and excitement around my coming out publicly pushing for more resources for expanded treatment and prevention for global HIV/AIDS. The activist community is delighted. I will past in below the editorial that I wrote in Science that was published by agreement with the Science editors to be ready for the International AIDS meeting in Rome as well as the note that Gregg Gonsalves sent to his list-serve (every activist in the world) regarding my note. Science 1 July 2011: Vol. 333 no. 6038 p. 13 DOI: 10.1126/science.1209751 EDITORIAL: AIDS: Let Science Inform Policy 1. Anthony S. Fauci + Author Affiliations 1. Anthony S. Fauci is director of the National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health, Bethesda, MD. 1. E-mail: afauci@niaid.nih.gov. CREDIT: NIH Thirty years have passed since the first cases of acquired immune deficiency syndrome (AIDS) were reported by the U.S. Centers for Disease Control and Prevention. How does this anniversary compare to the 20th or the 10th? The differences are considerable, because we now have an unprecedented opportunity, based on solid scientific data, to control and ultimately end the AIDS pandemic. More than 60 million people have been infected with human immunodeficiency virus (HIV) worldwide. More than 30 million have died, and 34 million are currently living with HIV infection. In 2009, the most recent year for which data are available, 2.6 million people became newly infected. The burden of HIV/AIDS is overwhelmingly felt in resource-poor countries, especially in sub-Saharan Africa, which are least equipped to deal with the disease. Although the toll is staggering, the scientific progress in HIV/AIDS research over 30 years has been extraordinary, particularly in the development of antiretroviral therapy (ART), which has proven to be life-saving to many millions. CREDIT: FOTOSEARCH For decades, the idea of ending or even controlling the pandemic was a distant aspiration because we lacked sufficient evidence-based tools to convert the hope to reality. At this 30th anniversary, the situation has dramatically changed: We finally have scientifically validated prevention modalities that clearly work, suggesting that ending the pandemic is feasible. Older, proven prevention tools include the proper use of condoms, needle exchange programs for injection drug users, and antiretroviral treatment of HIV-infected pregnant women to prevent transmission of the virus to their newborn infants. Building on this foundation, recent HIV prevention research also has provided strong scientific evidence that adult male circumcision is highly effective in preventing infection in heterosexual men, that an antiretroviral-based topical gel prevents infection in heterosexual women, and that pre-exposure prophylaxis with ART in men who have sex with men is effective at preventing infection. And in May 2011, a randomized controlled clinical trial demonstrated that early initiation of ART by the infected partner in heterosexual couples, where one partner is HIV-infected and the other not, is highly effective in decreasing transmission of HIV to the uninfected partner. The fact that treatment of HIV-infected adults is also prevention gives us the wherewithal, even in the absence of an effective vaccine, to begin to control and ultimately end the AIDS pandemic. Of course, the development of an AIDS vaccine would be the ultimate game-changer, and efforts toward this goal are intense. However, the existing armamentarium of scientifically proven interventions immediately offers an unprecedented opportunity to make major gains in the fight against HIV/AIDS. Global implementation of HIV interventions, including scale-up of the delivery of ART, must be accelerated, and this will be costly. Certainly, there are many competing priorities for scarce resources in the global health arena, such as other infectious diseases, maternal and child health, and tobacco control. But if one accepts the tenet that science should inform policy, then the scientific data are speaking loud and clear. Global policy-makers must seriously consider these new data in their priority-setting and decision-making. Last month, world leaders at the United Nations General Assembly Meeting on AIDS called for providing ART for 15 million people in low- and middle-income countries by 2015, an increase from the 6.6 million currently receiving therapy, plus additional efforts toward universal access to HIV prevention, treatment, and care. An estimated $22 billion to $23 billion annually will be needed by 2015; current spending is approximately $16 billion. Such targeted investments could prevent 12 million infections and 7.4 million AIDS-related deaths by 2020. For the first time in the history of HIV/AIDS, controlling and ending the pandemic are feasible; however, a truly global commitment, including investments by those rich and middle-income countries whose contributions have thus far been limited, is essential. Major investments in implementation now will save even greater expenditures in the future; and in the meantime, countless lives can be saved.