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Could We Have an AIDS-Free Generation?

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Recent advances in our understanding of HIV transmission, treatment, prevention and testing are changing the landscape of our response to HIV and generating a significant amount of optimism. The buzz at the International AIDS Conference this past July in Washington D.C. was that we may now be able to achieve an "AIDS-free generation." That means: no one will be born with the virus; as people age, they will be at a far lower risk of becoming infected than they are today; and if they do acquire HIV, they will get treatment that keeps them healthy and prevents them from transmitting the virus to others.

Similarly, the United Nations AIDS organization's "Getting to Zero" campaign for World AIDS Day, December 1, signifies the aim of getting to zero new infections, zero AIDS-related deaths, and zero discrimination.

There are many reasons why we should feel these commendable goals can be achieved. But there are also significant challenges that need to be addressed before we get there.

New understanding about HIV

First, a word about those things that give us confidence.

We now have newer medications for people living with HIV that are easier to take and have fewer side-effects, thereby making HIV treatment more manageable. These medications also allow people living with HIV to have a near-normal life expectancy. We also have a much better understanding of the importance of starting treatment earlier in order to achieve better health outcomes.

Treatment can also help prevent the transmission of HIV. Research shows that people living with the virus who are on successful anti-retroviral therapy and have a fully suppressed (undetectable) viral load are less likely to pass HIV on to others. Consequently, treatment guidelines now recommend that people living with HIV begin their therapy as soon as they are ready after diagnosis.

The importance of early detection

Further good news is that there are new testing technologies and strategies permitting us to make earlier detection of HIV. That way, HIV-positive people can learn about their status, and get on treatment, much sooner.

Early diagnosis is crucial to preventing HIV transmission. First, it may help identify people during the first few months after HIV infection when their viral load, and risk of transmission, is at an all-time high. Second, newly diagnosed individuals can start treatment earlier. And lastly, it is a fact that most diagnosed with HIV take active measures to reduce their risk of passing HIV on to others.

New prevention approaches

Although condoms and clean needles are the backbone of our prevention efforts, we are learning about additional prevention tools. We now know that the same drugs used to treat HIV can be used by HIV-negative people to help reduce their risk of an HIV infection. These new prevention approaches are promising options for HIV-negative people who are at a high risk of getting HIV.

Challenges we still face

Despite all these advances, achieving that generation without AIDS or without new HIV infections remains a big challenge. The hurdles we continue to face include limited financial resources applied to HIV prevention and treatment, and the many barriers faced by people living with, or at-risk of, HIV when trying to access HIV-related services.

Stigma, discrimination, and poverty can make it difficult for marginalized populations to access services. And that's why we see some of Canada's communities more strongly affected by the HIV epidemic. Gay men and other men who have sex with men, for example, represent a little more than half of all people in Canada living with HIV. Injection drug users represent 20 per cent of people living with HIV. People from regions where HIV is endemic (such as Africa and the Caribbean) -- 14 per cent. And Aboriginal people, 8 per cent.

Also, people living with HIV can be criminally prosecuted for not disclosing their HIV status to their sexual partners, and that can discourage them from wanting to know their status, and thereby opting out of getting tested.

Where do we go from here?

It's clearer than ever that for us to "get to zero," we must have HIV prevention, testing, treatment, care and support all working together. At CATIE, we feel that our nation's response to the epidemic must include an "integrated approach" to HIV treatment and prevention. We will be bringing together leaders in healthcare policy and practice in September, 2013, in a national forum that will explore and debate this approach.

While we are still years away from an "AIDS-free generation," we appear to be on the right path. It only takes a look back 30 years ago at the despair we once felt in the face of this unknown disease to see how far we've come.