Will HIV 'cure' reach the people who need it most?
OPINION - The costs of these drugs and treatments tend to be prohibitive, making them inaccessible to most...
Last week the media was buzzing with the stunning news that a cure for HIV may have been found. More than three years after undergoing a stem cell transplant for leukemia, Timothy Ray Brown, an American man who was treated in Germany and is known as “the Berlin patient”, is still free from HIV. His donor stem cells came from an HIV resistant person.
The doctors involved in the case believe that this could be the first cure for HIV. Writing in the American Society of Hematology journal, they said: “Our results strongly suggest that the cure of HIV has been achieved in this patient.”
In addition to this possible cure, 2010 has also seen a number of important medical breakthroughs in the HIV/AIDS arena, particularly on the prevention side. Earlier this year, two rare human antibodies which destroy 90 percent of HIV strains were discovered. This is in addition to a topical gel that has been found to be effective in preventing HIV infection in women — who are overrepresented in HIV cases in Africa in general — in South Africa.
In the US, a recent study found that the risk of HIV infection for gay and bisexual men taking Truvada — a prescription anti-retroviral pill usually used to treat those infected with HIV — was reduced by up to 73 percent if they took it 90 percent of the time.
“These results represent a major advance in HIV prevention research,” stated Dr. Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention at the U.S. Centers for Disease Control and Prevention. “For the first time, we have evidence that a daily pill used to treat HIV is partially effective for preventing HIV among gay and bisexual men at high risk for infection, when combined with other prevention strategies. Given the heavy burden of HIV among gay and bisexual men, a new tool with potential additive benefit is exciting and welcome news.”
What does all of this mean for the African-American community, which is disproportionately affected by HIV? According to the CDC, at the end of 2007, black people — who make up 12 people of the US population — accounted for almost half (46 percent) of people living with a diagnosis of HIV infection. In 2010, while AIDS is the fourteenth leading cause of death for the general population, it is the leading cause of death in black males aged 25 to 44 and, and at all stages of the infection, African-Americans bear the biggest burden. Surely, these are the breakthroughs that everyone has been waiting for?
On the surface it would seem like the answer to that question is yes. However, even with all of these breakthroughs, there are deeper questions to be asked and issues to be addressed particularly when it comes to cost and access. These are the two biggest barriers to people of color being able to take advantage of these medical advances.
The costs of these drugs and treatments tend to be prohibitive, making them inaccessible to most. For example, it costs more than $10,000 per year for Truvada, the drug which has reportedly prevented infection in gay and bisexual men. Although there are other, cheaper generic versions available in some countries, they are not yet available in the U.S.Stem cell treatment is also highly expensive. Furthermore, being able to extrapolate from the singular case of the Berlin patient to the millions of people living with HIV, as well as turning the results of studies into real world experience requires a huge injection of government funding and outreach work.
Currently, federal funding for HIV/AIDS in the black community is low. Writing about the Obama administrations plans for HIV/AIDS funding, the board-chair of the Black Aids Institute said, “There is currently not enough funding for HIV/AIDS in this country. And those driving the strategy know this”. He also added that not only did African-Americans need to be “up front” in advocating for more funding but that it was unlikely that there would be any significant increase in HIV/AIDS funding for the black community.
The funding issue is particularly important and poignant in light of a CDC study this year which revealed a significant link between poverty and HIV. The CDC found that those in poorer neighborhoods were four times as likely to contract HIV than the national average, partially due to limited access to health care and higher rates of substance abuse and incarceration.
In a statement released at the time, Kevin Fenton,director of the CDC’s National Center for HIV/AIDS said:”In this country, HIV clearly strikes the economically disadvantaged in a devastating way.”
It is clear, then, that although such medical breakthroughs are to be celebrated, they may have little to no impact on the communities that most need them, particularly not African-Americans.
In addition, for every person treated for HIV, more are infected so while a cure is great, it still is not the answer to ending the HIV epidemic.
So where does this leave African-Americans? In a conversation with David Wilson, the World Bank’s Global Aids Program Director on World Aids Day, it was made clear to me that the countries such as Uganda which had had the most success in reducing HIV infections had done so through shifts in behavior and social norms. This is an area that is often not focused on so much as many scientists believe that it is hard to shift behavior. However it has been proven to work.
Uganda implemented an aggressive grassroots media campaign which really used the power of communication to reach people, as well as involving the church and faith-based organizations. According to research into Uganda’s success in this area “spreading the word involved not just information and education, but, in addition, a fundamental behavior change-based approach to communicating and motivating.”
Medical breakthroughs are only going to be effective for those who can afford them and who have access. For those who can’t and don’t, there are still other options — but these start with people and with using the current tools we already have to implement contextual and paradigm-centered shifts in how people think about and view themselves and the disease.
This is perhaps where both our prevention and our cure lies.
