A Bad Start with a Promising End: HIV and HPTN 052

When growing up, things seemed simple: eat, sleep, chores, play.  There was little to worry about and nothing besides the proverbial here-and-now mattered much.  I started elementary school in Central Florida, in a community that was exposed to HIV in unsettling ways.  At school, I remember playing "tag” during school recesses.  In the late 1980s, “tag” took on a different name.  Inspired by what we constantly saw on evening television, “tag” on the playground became known as the “AIDS game” where being tapped meant one had AIDS.  As children, we knew little about the disease and few parents, including my own, made efforts to further describe it.

People that we knew or “knew about” were gradually disappearing.  I often found myself reading their obituaries in the local newspaper--an odd yet intriguing pastime.   These obituaries revealed a lot about what was happening during this time.  Young faces--ages 16, 22, 24, 30—mostly male, hemophilic, and sometimes gay seemed to die in the same way.  “After a long fight with a terminal disease, he passed away from complications caused by pneumonia.”
 

The rumor mills were in full force to fill the gaps.  Eventually, rumor gave rise to fear and AIDS made its way from the obituaries to the front page.  In 1987, the house of local family with three HIV-positive sons was set ablaze.[1]  The news was shocking: How could anyone do this?  Was AIDS so feared that neighbor could be pitted against neighbor in blind efforts to control it?  The news made many of us doubt if AIDS could ever be viewed in the same light as other diseases as cancer and diabetes.

In 1996, good news came in the form of a group of medications called anti-retroviral therapy (ARVs).  This news gave hope to ending what was then considered the worst disease imaginable.  It gave optimism to people who were otherwise destined to die.  With ARVs, a diagnosis with HIV/AIDS could no longer be viewed as fatal, but rather a manageable, long-lasting illness.

Test and Treat?

Fast forward to May 12, 2011.  On this day, results of the HPTN 052 clinical trial announced that if a heterosexual, HIV-positive person continually takes their ARV medications, the risk of transmitting HIV to their sexual partner could be reduced by 96%.[2]  In other words, HIV-positive people taking ARVs were more than 20 times less likely to infect their partners than untreated people.   The study was groundbreaking.  In the words of UNAIDS executive director, Dr. Michele Sidebe, the HPTN 052 findings were a definite “game changer” in how we thought of HIV prevention.
 

Previously, doctors were reluctant to start people on treatment as soon as they tested positive.  They were often concerned with the costs of doing so and the harms that came with starting early treatment.  This study provided the first evidence from a clinical trial--the gold standard in medical research—that “test and treat” was actually effective in reducing HIV.

In spite of the study’s great news, we still have a long ways to go.   Right now, the money that we currently have for HIV/AIDS programs is very limited.  Many clinics in Sub-Saharan Africa are turning away patients who are not just infected but close to death.  In some states, the money provided by the Ryan White Care Act is running thin leaving poor uninsured people on waiting lists for medications.

The news of HPTN 052 brings new hope in the nearly 30 year fight against HIV.  Now, we can no longer think of AIDS an incurable disease and actually start imagining what an “AIDS free generation” could look like.  Still, we must not disregard the difficult days of 20 years ago.  We should be reminded of the images that plagued our newspapers and news broadcasts—images of young men dying from AIDS-related causes, children thoughtlessly assuming that AIDS was death, and communities turning against each other for fear of the disease.

Ray is a Doctoral Candidate in Health Policy and Management at Emory University.  He has previously worked with several multinational organizations in Zambia and Thailand on programs related to HIV and TB care/treatment.

---

 [1] "Arson Cause Of Fire At Rays -- Boys Start School Today" Orlando Sentinel, September 23, 1987

http://articles.orlandosentinel.com/1987-09-23/news/0150050182_1_andy-ray-ray-family-varnadore 

[2] “Prevention of HIV-1 infection with early antiretroviral therapy.” http://www.hptn.org/research_studies/hptn052.asp