The End of HIV Is in Sight

After 35 years, a deadly virus has been tamed. Soon it could be history.


Ryan White and I would be the same age if he were alive today. He's not. He died in 1990 at the age of 18, right before he was going to graduate from high school, of an AIDS-related respiratory tract infection.

For the final few years of White's life he became famous—a household name—fighting for the right to attend school in Indiana at a time when Americans were still not entirely certain about how the human immunodeficiency virus (HIV) was spread. He was a hemophiliac who became infected from a blood transfusion, but at the time, most of American culture thought of HIV and AIDS as something that only afflicted gay men and those who injected street drugs.

White's court fight with the local school board became a cultural rallying point to drive an important point home: HIV and AIDS were going to kill off a whole lot of people unless Americans got serious about addressing the risks.

If you were a closeted gay teen, like I was, White also represented a fearful look at a dangerous future. I reached sexual maturity as a member of a high-risk class. My early adult life was shaped by the full awareness that I could very easily share White's fate.

White was one of more than 18,000 people in the United States to die of AIDS-related illnesses by 1990. But life today for people who have HIV and for those who are at risk of infection is remarkably, wonderfully different than it was in his time. While HIV has not yet been cured, medical research across nearly 35 years has brought us to a place where the virus can be fully suppressed. Not only are HIV-positive people able to enjoy normal life spans, they're also able to be sexually active with HIV-negative partners without the risk of passing on the virus.

In 1995, AIDS was the top killer of Americans between the ages of 25 and 44, according to Centers for Disease Control and Prevention (CDC) data. By 2016, HIV-related illnesses no longer cracked the top 10 causes. More people now die of kidney disease.

'You Can Live a Happy Life'

The decline in the spread of HIV and the dramatic drop in AIDS-related deaths are among the biggest health-related good news stories of the first part of the 21st century.

"It's an uplifting story with a lot of twists and turns," explains Myron S. Cohen, a professor of medicine, microbiology, immunology, and epidemiology at the University of North Carolina at Chapel Hill. He would know: He's partly responsible for one of the story's more significant chapters. In 2005, Cohen organized a massive international study of more than 1,700 primarily heterosexual couples where one partner was HIV-positive and the other was HIV-negative. As the quality of drug therapy had been improving, a theory needed to be explored: Do these treatments suppress HIV levels to the point that the virus could not be transmitted to partners?

"Can that drug, when you treat somebody, also render them less contagious?" Cohen asks. "We've spent forever working on that question."

His team got part of the answer in 2011, when an oversight board stopped Cohen's study prematurely after an important discovery. As part of the testing, HIV-positive members of one group were given immediate access to drug treatment, while the other group was scheduled to delay drug treatment until later. A review determined that only one participant in the group given drug treatment had infected his or her partner during the trial, compared to 35 partners in the other study group. They restarted the study and offered the drug therapy to all HIV-positive participants, not just one group.

When the effort concluded, researchers found just eight cases in which an HIV-positive person on drug treatment infected his or her partner. In four of those cases, the transmission likely happened before the medication kicked in.

Science magazine named this discovery its "Breakthrough of the Year" for 2011. Since that time, more and more research has arrived at the same conclusion. The study Cohen led focused on heterosexual transmission, but similar results are bearing out among gay men. A study released this May in The Lancet tracked more than 700 male couples in Europe where one man was HIV-positive and on suppression drug therapy and the other was HIV-negative. During the eight years the couples were monitored, not a single study participant transmitted the virus to his partner.

This research has all led to a significant shift in how HIV prevention and treatment are approached as public health issues. In the virus's early days, when HIV infection was likely to lead to AIDS-related illnesses and death, most public service messages offered dire warnings against unprotected sex and encouraged regular HIV testing among those at risk. As medical advances made HIV more manageable, the warnings continued—but for those who had become infected, new messages stressed the positive outlook. HIV was no longer a death sentence, and people who were infected could live healthy lives with treatment.

Advances in research also led to the discovery that people who are HIV-negative could take the same medications used to treat people with HIV and thereby resist becoming infected themselves. A drug called Truvada, manufactured by Gilead, was approved for use to treat people who were infected with HIV in 2004. Subsequent tests found it was also effective in preventing the virus's spread when taken by those who were not infected but were sexually active with those who were. In 2012, Truvada was approved as a form of pre-exposure prophylaxis (PrEP)—a preventive medication for those in high-risk categories.

We're now seeing a new public health approach, one designed to push HIV-positive people to seek treatment by helping them understand that this will actually stop them from infecting others. The campaign's message is "undetectable=untransmittable," or "U=U" for short. It simply means that if an HIV-positive person's viral load has been suppressed enough through treatment that it doesn't show up in blood tests, then that person is unable to infect others. The treatment for HIV is also the mechanism to prevent the spread of HIV.

The campaign was launched in 2016 (with Cohen as an endorser of its message statement) via the Prevention Access Campaign, a group that partners with organizations across the world to spread the "U=U" message. According to Bruce Richmond, the founding executive director of the campaign, the goal is to reach even further into at-risk communities and reduce the HIV stigma that keeps people from getting tested or treated.

"We're moving away from fear-based campaigns," Richmond says. "We're realizing terror and fear about people with HIV doesn't work. We're using the carrot, not the stick. The focus is really on medicine and staying on care. You can live a happy life and won't pass on HIV.…That's a revolutionary message."

'Study After Study Has Shown It Does Work'

There's a challenge, though, in actually getting the word out. The "U=U" campaign boasts hundreds of partnerships with organizations in 97 countries. Richmond explains that he's working with Vietnam's Ministry of Health on a national rollout in Hanoi, for example, translated to "K=K." But he says he's actually struggling to get the word out here in the United States, even though the campaign has significant support from HIV researchers, the National Institutes of Health, and the CDC.

According to data collected and examined by the Henry J. Kaiser Family Foundation, the U.S. lags behind Canada, Japan, the United Kingdom, Australia, France, Sweden, and many other developed countries in its HIV viral suppression rates. And these aren't small differences: Just 54 percent of Americans with HIV are receiving enough medical treatment for the virus to be considered "suppressed." In the United Kingdom and Switzerland, that number is 84 percent. New incidences of HIV infection had been falling for years in the United States, but that statistic has hit a plateau. About 38,500 Americans are still becoming infected annually. An estimated 15 percent of Americans who are infected do not know it.

Polling from Kaiser shows that there are significant gaps in the average American's awareness of advances in this space. People realize that fewer are dying of HIV-related illnesses and that treatment has improved, but many don't realize how much better it has gotten. In a poll from March, only 52 percent of respondents understood that drug therapy was effective in stopping people with HIV from infecting their partners. Only 42 percent knew that PrEP drugs even existed. But that's still an improvement, since just 14 percent knew about PrEP in 2014.

President Donald Trump announced in his State of the Union address in February that he wants to eliminate HIV in the United States within 10 years. State of the Union promises are often aspirational expressions of goals that may not exactly be realistic. This goal didn't come out of the blue, though. It was pushed up to the president by experts in public health. Is it actually achievable?

"Given the HIV treatments that we have as well as the prevention options that we have, theoretically, yes," responds Jennifer Kates, vice president and director of global health and HIV policy for the Kaiser Family Foundation. "Realistically, it's challenging. It's hard. The details are in proven public health interventions. It's building on years of knowledge and know-how. It's something we couldn't have said 10 or 15 years ago."

The true goal isn't complete elimination of HIV in the next decade, she says. Rather, it's to reduce new infections by 75 percent in five years and by 90 percent in 10 years. Trump's 2020 budget proposes $291 million for this effort, targeting areas where new infections are most notable.

Accomplishing that feat can't just involve targeting people whose sexual activity puts them at risk. Consider needle exchange programs, where intravenous drug users are able to replace the dirty tools they use to get high without worrying about getting arrested. Such programs were developed in the 1990s, despite the ramping up of the drug war at the time, because they served the important goal of reducing the spread of HIV. Yet needle exchange programs are still often attacked by those who believe they're encouraging drug use, which they don't like seeing in their neighborhoods.

The day after Trump's State of the Union address, the administration's commitment to reducing HIV was challenged from within when the U.S. attorney for the Eastern District of Pennsylvania filed a lawsuit to stop the city of Philadelphia from allowing a safe injection facility to be built. These sites are places where drug users can safely shoot up under the watchful eye of professionals who can quickly respond to overdoses and help those who are addicted seek treatment. Like needle exchange programs, they are harm reduction efforts that lower the risk of HIV transmission without trying to punish the underlying drug use. The United States doesn't have any of these facilities yet, and the Department of Justice is threatening legal action against any locality that tries to build one.

If the Trump administration is serious about advancing HIV prevention, it should rethink how it's using the opioid overdose crisis to breathe new life into the war on drugs. "Syringe access is an issue that's been politicized for many years," Kates says. "But study after study has shown it does work."

'This Depended on a Lot of Altruism'

While an increase in federal attention and spending is undeniably a part of the picture, the dramatic three-decade shift in the fate of those infected with HIV wasn't a top-down effort. Kates notes that community-level education and advocacy were at the tip of the spear. The fight against HIV also brought into focus the concept of the patient as an advocate for his or her own care, not just a passive recipient of outside treatment. People with HIV and AIDS became experts on their conditions and played a significant role in helping to push policy.

The medical advancements didn't just happen "out of the clear blue sky" or by government fiat, Cohen says. It took a lot of work, and a good chunk of it was philanthropy-driven. About a fifth of the funding for all disease treatment research and development comes from philanthropic sources, accounting for more than $650 million annually, according to data from the global health think tank Policy Cures Research. In 2017, about $144 million of that money was devoted to HIV research. That's nearly equal to the $149 million that the pharmaceutical industry itself spent researching HIV drugs in 2017.

"This depended on a lot of altruism from a lot of people, both infected and uninfected," Cohen says. "It's a great story, but it was decades in the making."

And the story is not over. Researchers are now working on an injected version of PrEP that would require only one shot every few weeks instead of a daily pill. Results of those tests are expected in 2021.

For somebody like me, whose entire early adulthood was framed by a fear that I might contract HIV and die, the looming end of this crisis is a triumph.

NEXT: Hong Kong Protesters Use Umbrellas, Lasers, and Respirators to Evade Surveillance and Tear Gas

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  1. So White’s lawsuit became a rallying point for society taking seriously the risk by seeking to prevent society from taking a measure to mitigate a then unknown risk? That seems a bit contradictory.

    1. I remember the period during which the lawsuit took place. At that time it was already known that AIDS was transmitted only through serious body-fluid exchange. Blood transfusions, serious tonsil hockey, or sex. Period. The chances of contracting AIDS from casual contact with a carrier are lower than the chances of getting killed by a meteor.

      That said, some elements of the Gay community did some awfully stupid things in the early days of the disease. While it CAN be transmitted in other ways the primary vector has always been unprotected anal sex with relative strangers. The people who opposed closing the bath houses, or screening for AIDS in the blood supply really need to be struck briskly with ball-peen hammers.

      1. I agree up to the ball-peen hammer part (unless that’s a euphemism for civil liability applied through due process).

        Anyway, I’m glad you said it instead of me – when I say it people seem to hear “it’s OK for the police to assault and terrorize gay people.”

        If they’ve found a cure or a way to eliminate the symptoms then that is simply wonderful.

        1. Considering the damage they did, both to society at large and to the Gay subculture in particular, I think at least making them run a gauntlet is entirely justified,mso long as the gauntlet is made up of Gay people who lost friends, rather than Gay basher wannabes.

          I’ll accept civil liability.

      2. If cured, Tony will be back to the bath houses where he can be the pass around pack he’s always to be.

        1. Tony was big with bug chasers. What’ll his hook be now?

          1. I still think the ‘Bug Chasers’ story was the result of a few Gay jokers playing with an unusually credulous reporter. It has all the earmarks of hoax.

          2. Hamster insertion?

      3. Did the fact that White was a hemophiliac contribute to the fear of having him in school? That is, fear that any little cut or scrape could cause him to leak infected blood around the place?

  2. “…but at the time, most of American culture thought of HIV and AIDS as something that only afflicted gay men and those who injected street drugs.

    Its still mostly was. Someone infected with AIDS donated that blood. Odds are the blood was collected from a person who needed to sell blood in an inner city, like a drug addict or gay man who needed money.

    Its why blood donations screen out high risk gay male behavior.

    1. Shackford, you didn’t link to the “stury”. Did these couples couple’s regularly use condoms to prevent the spread of the disease?

      Also, HIV is still almost exclusively a homosexual and druggie disease. If you never have homosexual sex (or in the case of women never have sex with men who do that) and never inject drugs, you can almost be guaranteed to never get it today.

      1. You’re either ignorant about HIV epidemiology today, or the meaning of the words “almost” and “exclusively”.

    2. Although I wonder why someone with a terminal illness would want to attend high school.

      1. Because all their friends are, and otherwise they spend the middle of the day alone?

      2. Well, there was always a chance that the illness WOULDN’T be terminal, and what’s he going to do anyway? Watch ‘Genital Hospital’ and cultivate bedsores?

    3. AIDS used to be called GRID (Gay Related Immune Deficiency). But the homos bitched and whined about that and got the name changed.

      1. “Anally inflicted death sentence, A.I.D.S.”

        That billy Milano could write a humorous song. Haha

      2. Or, you know, the medical community decided “gay related” was no longer accurate when it began appearing in heterosexual populations.

  3. Even if gay men dont have to worry about AIDS, there are a host of other diseases associated with high risk gay men anal sex/outercourse.

    The MSM wont cover it but evidently parasite worms are making rounds in the male gay community.
    Entamoeba histolytica, as it turns out, is another parasite common in developing countries spread through contaminated drinking water, poor hygiene when handling food, and…rimming.

    1. Giardiasis is also called “beaver fever.”

      Jokes… go forth and write yourselves!

      1. Tony gets more Giardia from a man’s ass rim than a toilet rim.


      2. A clean beaver is a happy beaver.

      3. Nice to meet you, Harry Beaver.

      4. Leave it to Beaver.

        Was a real TV show.

        1. Yes I remember it.

          Leading to the old joke.

          “Ward, I think you were little hard on the beaver last night”

      5. Beaver fever? Sounds like you’re taking too big of a bite.

      6. Giardia? ‘taint too hard to avoid.

      7. Wynona had a big grown beaver…

    2. Bingo! AIDS appeared because behavior created the perfect population for a disease like that to spread through. Without any change in the behavior, another disease will come along to exploit that niche, then another, then another.

      The real problem wasn’t a virus. It was the behavior. They just don’t want to admit that.

    3. Don’t you have some beets to mash with your feet or whatever it is you primitives to do make your soup?

      1. Tony, you’re lucky you don’t have full blown GRID, given your proclivities as a sloppy bottom.

      2. Actually, I use an immersion blender.

      3. Don’t you have another sock puppet to stupidly reveal in a self-own while praising your gigantic clock? Or are you too busy cramming 50 diseased clocks up your ass, you retarded inbred Okie?

  4. I wasn’t around in the 1980s, but I heard the spread of AIDS in that decade was largely Ronald Reagan’s fault.

    1. People these days tend to forget that back in the 1980’s, EVERYTHING was Ronald Reagan’s fault. Liberals only like him now because of nostalgia, and he’s dead.

    2. I was around at that time. There was a significant amount of fear that breed hatred. C. Everett Koop was Ronald Regan’s Surgeon General and he took AIDS very seriously. Many conservative religious leader painted AIDS as a moral failing and as God’s retribution. The Regan Administration was reluctant to step into the fray. But Dr. Koop was not and unlike some Republicans today, he let science guide his decisions. He was true to his profession even when others put road blocks in his way.

      1. “painted AIDS as a moral failing”
        It was spread largely by buggery and shooting up in the West, and rapists spread it to women and children in Africa.
        It was a moral failing.

        1. Should have kept calling it GRID

        2. There is no moral component to consensual “buggery” or shooting up.

      2. Koop was one of the good ones.

      3. Leftists often blame Reagan for the spread of AIDS, but the reality is that AIDS was introduced and began its spread in America during the Carter administration and was completely ignored.

        Under Reagan however, the divisions of HHS assigned to deal with the AIDS epidemic saw no less than an 80% increase in their budget every single year during Reagan’s tenure (one year they had over a 1000% budget hike), so there’s no truth at all to the story that Reagan hated gays and let AIDS spread out of some personal malice towards homosexuals.

        1. The most that can be said is that he didn’t respond to the crisis as quickly as many would have liked, but government has never been an institution with a great record of preventing catastrophes…the best they can usually do is help clean up after the catastrophe happens, which they did when they realized how far AIDS had spread. Reagan was many things, but a psychic he was not.

        2. “no truth at all to the story that Reagan hated gays”

          Of course there is no truth to this story. Ronald Reagan began his career as an actor and new a number of his fellow actors were gay. He did not let that stand in the way of friendship or respect for their talents. I noted one of these men sitting a watch on his casket as it lay in state before President Reagan’s funeral. He was a man of a generation that considered a person’s sexual orientation a private matter.

  5. To what extent is society obligated in the name of public health to help people indulge their vices safely because those people will not prioritize their health over their vices on their own?

    1. Yes, you’re right. Let’s make sure that all cures to sexually transmitted diseases are made illegal or very costly. That way, only man-whores and sluts will suffer from STDs, and all of us virgin-until-married libertarians will be safe from it.

      1. Hey, I’m a libertarian, and I only sleep with sluts.

        It’s like fast food. Why put in the effort when it can be easy?

  6. Well if they cure it we might get to see the sexual revolution go off on full steam again like it was in the 1970’s. Not that would be a all good thing, but I would like to see what it would do to the left side of the PC crowd now that they are against it.

    1. I do think it’s interesting that AIDS and Hepatitis C have ripped through the Boomer Generation who seemed to think sex had no consequences.

      1. The only dick a libertarian should police is his own.

        I do hate stating the obvious.

        1. But you expect federal funding to fix the issues of shoving your phallus into assorted orifices.

          1. I expect libertarians to accept that not policing people’s orifices comes with consequences to public health.

            Or don’t you believe in not using the feds to stick their business up people’s holes?

            1. Hey, if I don’t have to spend a red penny for you sticking your phallus into assorted orifices, then fine. Gay sex is hardly impressive or interesting. Couldn’t conceivably care less who you desire to thrust into.

              1. That’s totally what someone who doesn’t think about gay sex would say.

                1. Tony, I’m ok with your faggotry, as long as youplay for your own AIDS treatment after the many many loads you take at the bath house.

        2. The obvious that you’re an illiterate retarded faggot douchebag?

  7. 1. Truvada comes with non-negligible potential side effects
    2. Truvada use has led to a significant increase in other STDs in large cities
    3. Undetectable is only as good as your last dose of meds, taken as prescribed. People forget, people are busy and don’t reorder in time, etc with just about every med not given out in a hospital.
    4. The ‘undetectable=no risk’ studies are still small sample sizes. Should people gamble that there are no tail risks? No black swans?

  8. Great but… the Flu Killed 80,000 last year alone and that is not transmitted by “personal conduct”. Do not take this wrong but the list is long for viruses that kill people around the world in vast numbers. Some of which actually have vaccines. A quick search of the word “Pandemic” will give you some information on the topic. Then again I can only hope there are actually people who are out there working to end these threats but they are get little press… Then there is the cost. Most modern countries cannot even take care of their own people so unless the African counties that have the bulk of the aids problem can pay for it, we may not see much change. After all we are talking about places that do not have functioning governments, have peasants, no roads, no electricity, water or sewers and that is not going to change for another 100 years…..

    1. Because influenza is a very slippery bug. It keeps shifting its genome. There is no vaccine for HIV but the good news is the combination antiretroviral meds are so effective that they can prevent transmission.

      The logistical problem you pointed out is correct. It is difficult to get people even in the best of circumstances to get the pill and take it every day. But what if you had a delivery system that worked for a month or a year and was affordable? Then you have something where a public health system with global effort could manage. In a generation you could drop the number of cases by 80-90%. It is now that much cheaper and easier to manage.

      Eventually you at worst have a rare disease with local outbreaks easily contained.

      You also already have a drug that nearly cures those with the virus who can live a normal life which is a spectacular accomplishment when people were dying a horrible death within a few years just decades ago.

      Besides we don’t know what will come next, perhaps something better.

      The only sad part comes from reading through some of the juvenile comments here.

  9. Too bad the same effort couldn’t have been made for diabetes…

    1. The islet cell transplant idea is promising and has demonstrated some success. Was thinking that with the advances in gene editing and cell culture techniques that could be very viable. Then you don’t need to harvest cells from donors. Don’t know where it is at currently.

  10. I still remember when nobody knew what caused this new disease as an undergraduate in biology. I have seen the entire transformation in advances throughout my career. It is just astonishing. Of the dozens of complications we saw on a regular basis and learned about one never or rarely encounters them today.

    It is the most significant accomplishment in medical science in the past 30 years and I expect to see this disease eradicated, or nearly so in my lifetime. Having the treatment available in a long acting injectable form would be a big step forward as compliance with daily meds can be an issue.

    Great article and thank you for keeping readers up on the latest advancements.

  11. There’s already been cases of Truvada resistant strains appearing. True, they’re not yet known to be in the double digits, but the lazier people get while taking the drugs, which will happen because humans are humans, the more likely the resistance starts to spread. Once that happens you’re back to square one. Pretending that this will be a cure on the order of smallpox is absurd to say the least.

    1. Have a little faith ravenshrike.

      Used to do a lot of backpacking . Would be toiling up the mountain, plodding one foot in front of the other and almost ready to give up. Then you would come to a break in the trees and see the valley now so far below. Take a drink of water and keep on going.

      1. I’m imagining that exact comment, but from Tony. Which has a different connotation.

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  13. Facing Facts

    “The single biggest threat to man’s continued dominance on the planet is the virus.” -Joshua Lederberg, PhD (1925-2008)

    The fact is that the two, primary, demographic groups infected with HIV and infecting others are drug-abusers and homosexuals.

    The fact is that not all Americans harbor sympathy towards drug-abusers and homosexuals, Big Media notwithstanding.

    The fact is that, like Ebola, HIV is an RNA-virus.

    The fact is that RNA-viruses tend to mutate. Fortunately, most mutations are lethal to the virus.

    The fact is that pathological microörganisms tend to develop resistance to anti-microbial drugs, feel-good articles notwithstanding. Think Staphylococcus, tuberculosis, and a host of other, lethal diseases. HIV still can do so.

    The fact is that in the early 1980s after the initial discovery of AIDS, homosexuals essentially went into hiding for fear of retribution from a panic-stricken public. Should the virus mutate to become airborne or mosquito-borne, they will have reason to do so again.

    The fact is that microbiologists tell us that we humans are facing a global pandemic of some sort. They refer to it as “Disease X”, given that thy cannot predict the lethal agent — probably a virus.

    The fact is — as posed in the novel, Retribution Fever — a question arises for the survivors. What then?

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  15. Article? Good.

    Comment section? Exhibit A in “why no one is sympathetic to libertarians”.

  16. Sad. I’ve been cheering AIDS as a population control in Africa, etc.

  17. Wow this is the best news I’ve heard today!

  18. Nice and informative write-up

  19. Nice site, thanks for shareing situs 24 jam

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