The Eradication of HIV

The eradication of infectious diseases, the noble quest to reduce global carriers to 0, has effectively been in progress for more than 100 years.  The most notable example is smallpox, which has been completely wiped out thanks to aggressive vaccination policies worldwide.  Similarly, polio and malaria are nearing eradication thanks to effective and widely available vaccines as well as the dedication and hard work of organizations such as the Gates Foundation.

As probably the most gripping disease outbreak in recent memory, HIV presents an interesting question for eradication.  Though the disease’s spread has slowed, infection rates are still unacceptably high across the globe, and thorough solutions seem to be in short supply.  Despite the recurring (if sporadic) news stories about the attempt to create an HIV vaccination, efforts have been largely unsuccessful.  This leaves prevention up to education, which presents problems around dependable and consistent behavior – it only takes one misstep for a new infection to occur.

Thus far in history, vaccines have played a central role in disease eradication.  With the lack of an HIV vaccine, the question is whether a new path to eradication can be created.  Last week I met with an HIV expert at the Maryland Department of Public Health, and left with a feeling that yes, it can.  As this expert explained to me, the key is to think of treatment as prevention.

Treatment as prevention might not be such a radical thought, but it was a lightbulb moment for me as it broke the traditional separation of the two camps.  Too often we separate the two and fail to see the ways in which they might beneficially intersect.  We have an effective treatment for HIV; we do not have an effective prevention.  So why should we not capitalize on that treatment, rather than continue to spend money and time on the search for prevention?

The nature of HIV may actually lend itself to treatment-as-prevention, but it will require a shift in focus, and perhaps more perturbing, funding.  If that can be successfully accomplished, we might just see the elimination of AIDS in our lifetime.


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