A look at how far we’ve come since the first World AIDS Day was observed in 1988.
By Scott A. Kramer, LCSW-R
As we mark the 27th World AIDS Day on December 1, it’s worth noting that the landscape of HIV and AIDS is almost unrecognizable now compared with the early days of the epidemic. In NYC, St. Vincent’s Hospital — once ground zero for AIDS medical care in the U.S. — is being converted into luxury residential towers. The biggest and best change is that people are truly living with (rather than dying from) HIV. Let’s look at other changes since then, including what’s getting better and what’s not.
Treatment and Prevention
Treatment options today are extraordinarily better than they were in the ‘80s and ‘90s and continue to improve. Once, the standard of care was the dreaded, toxic, every-4-hour dosing schedule of AZT. Other medications were helpful in treating the opportunistic infections that accompanied waning immune systems, but AZT essentially didn’t work and people got sick just from taking it. When protease inhibitors were made available in 1995 and combination therapy became the standard, people started becoming healthier in a matter of weeks. Kaposi’s sarcoma (KS) lesions, once a tell-tale sign that someone was battling AIDS, started disappearing, allowing people to go back to work and live fuller and richer lives. Today, medications can help a person living with HIV control the virus so effectively that it becomes undetectable in their blood. Plus, we are constantly receiving news about new treatments that work even better and with fewer side effects; there are more options available when it’s time to consider switching meds; and we can expect the development of continually less toxic treatments as many people expect to be on them for the rest of long and fulfilling lives.
In the early 1980s when HIV hadn’t yet been discovered, there was no way to know what to prevent. A few years later we found the virus and identified that it was spread through blood, semen, vaginal fluids and breast milk. Only then could we pinpoint ways to truly protect ourselves and prevent transmission. With sex, methods like condoms or abstinence were the gold standard. While those options continue to work today, they aren’t completely effective, primarily because people simply choose not to use them.
But now there are new tools: One is the much-discussed PrEP — administering HIV medicine to people who are HIV negative as prevention. Even the World Health Organization recommends that anyone “at substantial risk of HIV should be offered preventive antiretroviral treatment.”
The other is TasP, which stands for Treatment as Prevention. Essentially, this means when you treat people with HIV so effectively that it brings their viral loads to undetectable levels, they can no longer spread the virus. In the initial results of the PARTNER study (which looks for HIV transmission in mixed-status couples), there were zero cases of transmission from a person with an undetectable viral load.
In some ways, HIV-related stigma in the gay community is worsening. In the early days of the epidemic, although there was fear, there was also a feeling of, “We’ll get through this together.”Gay people gathered to support each other in ways not seen before or since. Today, people with HIV are likely to face new kinds of moral judgment. Notice how many times ddf (drugs and disease free) appears on hook-up apps or dating sites. This can leave people living with HIV feeling fear, anxiety and depression — blaming
themselves for “not knowing better” and isolating themselves for “being diseased.”
Here, too, there is sad news. According to the Sero Project, “People with HIV may be prosecuted for not disclosing their HIV statuses to their sexual partners — even if transmission risk was minimal or nonexistent. They often face more severe charges and sentencing for assault, sex work, or other crimes just because they have HIV.” Where people were once portrayed in the media as “AIDS victims” and viewers were offered sympathetic images of them wasting away, today — all too often — the media reports on people with HIV as though they were predators intent on spreading the virus to others, and the legal system is more likely to punish them unfairly.
The global numbers are staggering: Since the beginning of the epidemic, almost 78 million people have been infected with the HIV virus, about 39 million people have died of HIV, and 35 million people were still living with HIV as of the end of 2013. But there is still plenty of reason to hope as we continue to see people living longer and healthier lives. And although the rate of infection in the U.S. is still about 50,000 new cases per year, we hope that — with the advent of PrEP and TasP — we’ll see that number fall.
Last modified: June 22, 2017