Each year on December 1, I pause for World AIDS Day to commemorate the lives of the more than 36 million people worldwide who have died from HIV/AIDS. It’s also a time for me to celebrate how far science has come in the 40 years since HIV was first officially reported.
Like many diseases, HIV was first recognized among disenfranchised populations who later became even more stigmatized. The 1980s and into the 1990s were frightful times for gay and bisexual men. It was not unusual even in the smaller populations in the Midwest to hear of yet another funeral for a beloved community member every month. In big cities, the toll was, of course, much larger.
Here in Indiana, many folks know the disease also affected vulnerable children and adults who lived with hemophilia. One of the pandemic’s best known and longest enduring medical treatment and prevention programs is named after Ryan White, a youngster from Kokomo who was not allowed to attend school with his friends because he had AIDS. In 2020, the federal Ryan White HIV/AIDS Program allocated $2.39 billion for low-income people to received medical care, support services and medications.
Even among healthcare and social service providers who take oaths to protect the vulnerable and safeguard the ethical pillars of of patient autonomy, beneficence, nonmaleficence, and social justice, there has been a great deal of stigma of patients who were HIV-positive. In part, this arose from the early days of HIV and not knowing how it was transmitted. Despite the scientific advances of knowing occupational exposure was very unlikely when universal health precautions are taken in medical settings, stigma persisted in health care settings because HIV is most often transmitted sexually or by sharing needles. Health care professionals themselves have also been stigmatized for their dedication to working with people living with the disease.
The mid 1990s brought in a new class of drugs to keep HIV at bay within an infected person’s body. There was literally a Lazarus effect where people at the brink of death were brought back to vitality through the wonders of pharmaceutical advances. Instead of dying from AIDS, people began living with HIV.
Equally wondrous were the scientific and pharmaceutical successes in the 1990s vastly reducing mother-to-child transmission of HIV in-utero, during birth, or through breastmilk.
Most recently, advances have been made in HIV prevention through Pre-Exposure Prophylaxis, commonly known as PrEP. Individuals at higher risk of being infected by HIV through sex or injecting drugs can take medication regularly to greatly reduce their chances of being infected if condoms fail.
What’s most exciting, though, is that medications have become even better at reducing the levels of HIV within an infected person’s body to being undetectable. Persons who are adherent to their daily medicine can achieve and maintain an undetectable viral load and not transmit the virus. This has is known as Treatment as Prevention or Undetectable=Untransmittable.
It’s not over yet. Despite all these marvels of scientific advancement, the HIV/AIDS pandemic continues. Although science has been enormously successful in advancing treatment and by extension prevention of HIV/AIDS, there is not yet a vaccine. This calls to the importance of practicing safer sex by using condoms and not sharing needles as well as getting regular HIV tests. And, if infected, getting on and taking medications faithfully is obviously critical. Finally, and perhaps most importantly, no one should be kept away from treatment through stigma or because they don’t have access to healthcare.
On this day, December 1, 2021, I remember and celebrate the lives of too many friends who died, rejoice that there are so many treatment options for the more than 37 million people living with HIV today, and look forward to the day when a vaccine is developed and universally available.
If you want information about HIV testing, prevention or treatment, it’s available through Ball State University Health Promotion and Advocacy, the Centers for Disease Control and Prevention, or UNAIDS.