BEIJING, March 5 (Xinhua) — In his State of the Union address in February, U.S. President Donald Trump reaffirmed his pledge a year ago that the United States would end the AIDS epidemic and spread by 2030. Given the Administration’s attempts to cut AIDS-related programs and public health priorities, this general commitment seems a little untrue.
However, many public health experts believe that the chances of effective lying out AIDS by 2030 are considerable, both in the United States and around the world. It takes a lot of work, and we didn’t get off to a good start.
AIDS became more than 40 years ago. It is estimated that there are approximately 37.9 million people living with HIV worldwide, and that the disease will accompany them throughout their lives. For decades, we have had antiretroviral drugs that significantly reduce viral levels in the human body and prevent the last, often fatal, stage of infection, the onset stage. At this stage, HIV destroys the immune system and officially enters the acquired immunodeficiency syndrome (AIDS), or AIDS. As a result, under today’s medical conditions, the average life expectancy of people who begin treatment for AIDS early is close to normal;
In recent years, scientists have been refining AIDS drugs for cocktail therapy as a “pre-exposure prophylaxis” (PrEP) to reduce the risk of contracting the blood-borne and sexually transmitted virus in high-risk groups. People who take pre-exposure prophylaxis are not completely free of HIV infection, and this treatment is not affordable for everyone. However, if taken daily according to the recommended regimen, the risk of sexually transmitted infections can be reduced by 99%. In addition to PrEP drugs, both male and female condoms can also prevent AIDS, or other sexually transmitted diseases that make people more susceptible to HIV infection.
In addition, there is a “injector replacement program” that provides sterile needles to people who use intravenous drugs to reduce the risk of infection. These replacement programmes not only reduce the probability of HIV transmission in the community, but also help people who use drugs to integrate into the health-care system, enabling them to be screened for HIV and, where necessary, receive antiretroviral treatment.
These new and old interventions have led to the establishment of a strong strategy to reduce the spread of pandemic diseases since the 1990s. This strategy is primarily through screening for hidden HIV cases, especially among high-risk groups;
In 2016, the United Nations issued a report outlining the goal of eliminating HIV as a global public health threat by 2030. To do so, the authors estimate, there will be fewer than 200,000 new infections each year, 95 percent of whom need to know their HIV status; 95 percent of hiv-positive people need treatment, and 95 percent of those who receive treatment are completely able to suppress the virus.
In places like New York, AIDS is accelerating. In 2014, the New York state government announced the End of the Epidemic Program, setting a timetable for eradicating AIDS by 2020. Keosha Bond, a public health expert at the New York School of Medicine who studies AIDS, says the program appears to be working. “Over time, I’ve been able to see the changes that are taking place in our cities, and their new initiatives have had a huge impact on the incidence of AIDS in our communities,” said Keosa Bond, who worked for the New York City Health Department. “
New York City’s success has come from increasing Medicaid funding to make pre-exposure prophylaxis more accessible and affordable, and to giving registered nurses the ability to check people for sexually transmitted diseases and funding clinics that can provide low-cost or cost-free testing and treatment services. These measures target people of color at higher risk of HIV infection, such as men who have sex with same-sex people, and communities of color that researchers such as Kaisa Bond are concerned about.
According to the End-of-The Disease Program,”s 2018 target, the program is expected to meet its target by 2020: 65,000 New Yorkers taking PrEP drugs;
Keosa Bond believes that New York’s success will surely happen across the country, and that we can do more to help the marginalized. “I think these are strategies that other communities in our country can replicate. Their approach focuses on the continuum of CARE as a whole, not just on one aspect of AIDS prevention,” she said. So how do we reach those most affected by HIV? We know this approach works, but we still face challenges in how to make these services available to people. “
Despite the success of New York City, we also have reason to be concerned about recent EFFORTs to prevent AIDS. Trump’s 2030 action plan, which has only recently begun to be implemented, has set aside about $291 million. At the same time, the Trump administration has weakened its influence elsewhere, such as cutting programs aimed at helping the global fight against AIDS and making housing more affordable for people living with HIV. The Trump administration has also succeeded in cutting funding for Title X clinics that provide family planning services, including contraception, because they provide abortion services or introduce women to other places where abortion sits. The Trump administration has also paved the way for states to cut Medicaid, the most common source of insurance for people with AIDS.
“Trump is interested in ending AIDS. However, he came up with a budget proposal that would slash the many scientific funding sources for AIDS research,” said Rowena Johnston, vice president and head of research at amfAR, a non-profit organization. It’s a little confusing and complicated. “amfAR is a foundation dedicated to AIDS research.
Overall, the U.S. health care system is also less than satisfactory in caring for people living with HIV. Britain and Canada are almost as rich as the United States, but provide universal health care. Compared with these two countries, AIDS patients in the United States have a lower rate of viral suppression after treatment.
One of the main reasons for such a low rate of inhibition is that AIDS treatment in the United States is much more expensive than in other countries. The U.S. Centers for Disease Control and Prevention estimates that the lifetime cost of a single HIV carrier is about $485,500. Much of the financial burden falls on insurance companies and aid programs, but in the U.S., higher upfront costs have led to an increase in out-of-pocket costs, which will inevitably force some people to stop taking drugs quantitatively or completely. A December 2019 study found that 7 percent of people with AIDS had difficulty taking medication because of cost, while 14 percent had to resort to drug-saving methods.
In addition, the drugs needed to keep people living with AIDS healthy have not become cheaper. A study published in February 2019 found that the initial cost of antiretroviral drugs in the United States had been steadily increasing between 2012 and 2018, even above inflation levels. This means that companies raise prices to make more money, not because they have to.
There are also high prices for PrEP drugs that hinder THE prevention and treatment of AIDS. Gilead Sciences’ drug Truvada, or Engotin/Tinoforwe, currently the only PrEP drug recommended by a health organization, is priced at about $2,000 a month. Even with insurance, taking PrEP drugs can force patients to pay high out-of-pocket and deductibles, making them unaffordable in the long term. High market prices have also affected publicly funded programs such as Medicaid, which have formed their own form of rationing. Wealthier cities such as New York City are better able to afford these costs and fund other aspects of HIV prevention and treatment, such as screening, but not in other parts of the United States, especially in rural areas.
Some reforms are under way. According to a recommendation last year by a U.S. government-appointed advisory board, PrEP drugs should be widely available prevention services by 2021, and insurers would have to pay for PrEP drugs without sharing any high-risk patient costs. Gilead will be forced to release a generic drug for Truvada later this year after a failed legal battle with the U.S. government over Truvada’s patent rights. In a “single-payer” universal health-care system, the government will provide basic coverage for everyone and will be able to significantly lower drug prices, which will almost certainly increase the cost of PrEP drugs and reduce the cost of antiretroviral treatment.
Worldwide, the eradication of AIDS has also encountered some difficulties. Since the beginning of the 20th century, new infections and AIDS-related deaths have decreased significantly, particularly in Africa, but over time these numbers have decreased by less. According to a 2019 United Nations report, we are likely to fail to fully meet the United Nations global AIDS targets by 2020 and end the AIDS epidemic by 2030. According to the World Health Organization (WHO), 1.1 million people were newly infected with HIV in 2018.
The lack of funds has frustrated efforts to eradicate AIDS. The United Nations has asked member states to commit $26 billion a year to its projects by 2020, but received only $19 billion in 2018, $1 billion less than the previous year. Such short-sighted funding would not only hinder saving lives, but could also cause economic losses to the world. For every dollar of the AIDS epidemic that is used to end the AIDS epidemic faster, there will be a $2 to $6 economic return in the future, according to research cited in the U.N. report.
When it comes to the virus itself, there are other worrying issues. In many countries, HIV, which is resistant to treatment, has begun to emerge. A 2018 WHO report found that at least 10 per cent of HIV-positive people in 12 countries in Africa, Asia and the Americas are resistant to two common first-line drugs. This threshold makes it dangerous to continue to supply these two drugs to other parts of these countries. Doctors can also treat these cases with other AIDS drugs, but they can seriously hamper future treatment.
Ideally, the best way to permanently address AIDS is to find a cure or a vaccine, but the elusive nature of the virus has long puzzled scientists. During treatment, HIV is hidden in the body’s “storage” and quickly re-emerges when the patient stops taking the drug. Promising research areas, such as the “shock-kill” strategy of waking up dormant HIV particles and then eliminating them, have not worked as we would like. Not long ago, a clinical trial of a candidate vaccine in Africa ended prematurely in “extremely disappointing” circumstances.
“What struck me was that from every new piece of information about HIV, we’ve been finding so many weapons that HIV has, so at every turning point, HIV is able to protect itself from any harm we can do to it,” says Rowena Johnston.
Johnston is hopeful of developing other strategies to combat AIDS in the future, such as gene editing techniques such as CRISPR. These new technologies can track the virus itself, or indirectly strengthen the immune cells that HIV is trying to infect. Researchers are also developing more durable antiretroviral therapies that they hope will be taken in weeks or months. As of 2019, at least one Phase III clinical trial is under way. These treatments will make it easier for people to suppress HIV while reducing the risk of developing drug resistance.
The cure or vaccine for AIDS is sure to be a huge achievement, but they may not play an important role in time for the next decade. Fortunately, we don’t necessarily need to stop the spread of AIDS. Keosha Bond says we still need to think about new ways to help those most at risk of BEING affected by HIV.
“I recently gave a lecture on sexual health fairness in class and told everyone that the ‘one size fits all’ model doesn’t work,” she said. “
The greatest challenge to the eradication of AIDS remains man-made factors. Some important public health interventions, such as the Syringe Replacement Program in the United States, have not been fully implemented and are demonized by some. Fear of stigma and misconceptions about HIV continue to discourage people from being tested. Poverty and drug greed continue to keep people away from real life-saving drugs.
It is not easy to get rid of HIV forever, but it is possible to build a better world. In this world, the current epidemic of epidemics can be completely eliminated only if the majority unite.