AIDS extinction after 30 years, 30 million lives

AIDS extinction

After 30 years and 30 million funerals, the end of the global AIDS epidemic is unexpectedly, within sight. It would be a final victory for this clever killer if America were too preoccupied and inward-looking to notice.

During the last 18 months, the science of AIDS prevention has been transformed. Studies have shown dramatic results from male circumcision — a more than 60 percent reduction in the risk of transmission from women to men. New technologies such a microbicides, used before exposure to the disease, have proved effective.

Then, three months ago, came an article in the New England Journal of Medicine called “Prevention of HIV-1 Infection with Early Antiretroviral Therapy.” The study found a 96 percent decrease in transmission to a heterosexual partner when AIDS treatment was begun early. Treating AIDS sooner than later is a dramatically effective form of AIDS prevention.

Scientists began considering something previously unimaginable. What if these methods of AIDS prevention were combined — along with condom use and the prevention of mother-to-child transmission — and aggressively applied in the most affected regions and among the most vulnerable groups in Africa? Scientific models project that transmission rates, already declining in most places, would fall an additional 40 percent to 60 percent.

The Obama administration has officially adopted the goal of “creating an AIDS-free generation.”

But the political timing of these scientific breakthroughs is poor.

The budget crisis has created a Darwinian competition for resources. Clinton accompanied her ambitious AIDS objective with the not-very-ambitious reprogramming of $60 million for demonstration projects in four countries.

Additional resources can eventually be squeezed from existing AIDS programs. In 2004, the cost of treatment averaged about $1,200 per person. Today, it is less than $350 and still declining. Other donor nations, along with African countries themselves, can take additional burdens.

Yet the objective is not a minor one. Earlier AIDS treatment in the developing world would expand the pool of people in need of medicine. In the main U.S. HIV/AIDS program, Africans currently start drugs when their cd4 count — the measure of immune system strength — is, on average, about 150. Beginning at a cd4 count of 350 — the recommendation of the World Health Organization — would require the number of Africans on treatment to increase by more than 5 million. An aggressive treatment-as-prevention program would start treatment even earlier.

In normal economic times, the case for this effort would be fairly easy.

American spending on all humanitarian aid programs amounts to about 0.7 percent of the budget. What other marginal spending increase could save millions of lives, end an epidemic and allow public officials to take part in a historic enterprise as admirable as the Marshall Plan? The proposed prevention strategies do not involve much culture war controversy. Religious conservatives have no objections to treatment and are neither shocked nor alarmed by circumcision, an old biblical acquaintance.

But with economic times far from normal, the case is complicated. Ending the global AIDS epidemic would require a major presidential push. It would also require congressional Republicans to make a human life exception to austerity.

This uphill effort would, however, be aided by a pragmatic argument.

Since 2003, the United States has helped place millions on AIDS treatment.

In the process, we have assumed what economists call a “treatment mortgage” — obligations that can’t be abandoned without catastrophic consequences.

A major prevention effort — reducing the number of new infections to below the number of new people placed on treatment — is the only morally acceptable strategy that eventually reduces American commitments on AIDS.

Having abruptly gained the scientific tools to defeat this epidemic, what remains is a test of will and conscience.

 Michael Gerson’s email address is

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2 responses to “AIDS extinction after 30 years, 30 million lives”

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  2. Hugh7 says:

    “Dramatic”? Hardly! Less than two years after circumciing a total of 5,400 men, 64 of them had HIV, and of the control group, left intact, 137 men. The difference, 73 circumcised men without HIV yet is the sum total of “protection” so far. It is not “more than 60%” but up to 60% (and down to 0%).

    Contacts were not traced, so we don’t know if they got it heterosexually, and 327 circumcised men dropped out, their HIV status unknown. In 10 out of 18 countries for which USAID has figures, more of the CIRCUMCISED men have HIV than the non-circumcised. A study in Uganda started to find that circumcising men INcreases the risk to women (who are already at greater risk), but they cut that one short for no good reason before it could be confirmed. Claims about future or widespread protection from circumcision are pure guesswork and wishful thinking.

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