Research: treating and preventing HIV and AIDS

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Among the findings being presented and discussed this week at the 18th International AIDS Conference being held in Vienna are data suggesting that more HIV patients are taking anti-retroviral medications, study results indicating that proper, routine use of a vaginal gel before and after sex may cut infection HIV-infection rates by as much as 54% and research suggesting a strong link between urban poverty and risk for HIV infection.

According to new data released today by the World Health Organization, the number of HIV patients taking anti-retroviral medication increased dramatically — by 12 times — between 2003 and 2010, and from 2008 to 2009 an additional 1.2 million patients began the drug regimes. The surge means that, as of 2009, some 5.2 million patients around the world were taking the AIDS drugs, the Associated Press reports.

Yet while health officials and politicians lauded the news, celebration of progress was tempered by knowledge that much more needs to be done — and more money raised — and even worry that success could breed complacency. As former U.S. president Bill Clinton said in a keynote speech at the Vienna conference:

“Five million people on treatment is a lot compared to where we started — but still a third of those who need treatment today… We cannot get to the end of this epidemic without both more money and real changes in the way we spend it.”

A development that is being met with perhaps less restrained enthusiasm, however, is the finding that an antiretroviral vaginal gel may significantly cut the risk of HIV transmission for women. The study, which will be published in the journal Science, included 900 women from South Africa who were given a gel containing the anti-retroviral drug tenofovir to use before and after sexual intercourse. The researchers found that, at the end of the study, use of the gel cut infection rates by 39% overall — but that, among women who used the gel consistently and as directed, infection rates were cut by 54%.

As the Washington Post reports, news of the findings prompted enthusiastic responses in the AIDS research community, particularly in light of previous unsuccessful attempts to develop a gel that women could use to cut infection risk. As Dr. Bruce Walker, who researches HIV and AIDS at Harvard Medical School, told the Post:

“We have never had any kind of tool that has effectively allowed women to protect themselves… This is really a game changer.”

Amid news of exciting steps forward in AIDS research was a less celebratory report from the Centers for Disease Control and Prevention that may shed light on the relationship between urban poverty and HIV and AIDS among heterosexuals in the U.S. As the AP reports, the new CDC study of 9,000 heterosexual adults from predominately poor urban areas found that, contrary to previous findings, HIV infection in this sub-population was not concentrated by race — in fact, federal researchers noted no difference in infection rates among blacks, Hispanics or whites — but that it is often clustered in certain impoverished neighborhoods. What’s more, even within poorer communities where overall HIV rates are higher than in other communities, economic disparities were evident — that is, as the AP explains: “poor heterosexuals in those neighborhoods were twice as likely to be infected as heterosexuals who lived in the same community but had more money.”

The findings suggest the need to analyze HIV and AIDS in a different light, according to Dr. Carlos del Rio, chair of global health studies at Emory University’s school of public health. As del Rio told the AP:

“You talk about ‘Can we decrease the HIV burden in the United States?’ I would say, ‘What can we do to decrease poverty in the United States?'”

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