World AIDS Day: What does the future hold?


Today is World AIDS Day. In the 30 years since the scourge emerged, more than 30 million people have died and twice as many have been infected with HIV. Dr. Richard Marlink, executive director of the AIDS Initiative at the Harvard School of Public Health, offered his perspective on what the future holds.

In many ways, he’s optimistic.

“We think the end of AIDS is coming about,” he said.

There’s reason to hope that the deadly pandemic can be halted, Marlink said, because the last decade has seen an explosion of new scientific and medical information with which to battle the virus. “It’s not a simple silver bullet, but really a repertoire of what we call combination prevention,” Marlink said in a phone conversation.

Thursday and Friday, in one of many commemorative events, several hundred global health leaders, elected officials, scientists and activists are convening at the AIDS@30 symposium in Boston to reflect the advances made in the field and how to use them to turn the epidemic around. (Visit the conference’ Facebook page for updates on what’s going on and being said.)


Scientists now know that antiretroviral treatment not only keeps the virus in check in those who are infected but also dramatically reduces the chances of transmitting the virus through sexual contact, Marlink said. That means routine and continuous treatment will not only help the person on the medication, but protect their partners as well. Marlink added that studies are being conducted on whether infections would be reduced even further if both partners take antiretroviral drugs instead of just the infected person.

“We can’t get rid of the infection yet, we don’t have the cure,” he said. “But we can suppress it so it’s not replicating itself and prevent it from causing damage to our immune system.”

Other studies conducted in Africa have shown that antiretroviral intervention when a woman infected with HIV or AIDS is pregnant or breastfeeding could reduce the possibility of infecting her child. Marlink, who is also a senior advisor for the Elizabeth Glaser Pediatric AIDS Foundation, said this could result in a virtual elimination of pediatric AIDS cases if implemented correctly.

“The end of AIDS is possible, but it all depends on the funding and treatment,” Marlink added. “We need to get the mothers into programs and keep their babies from getting infected. We’re maybe a little less than halfway there.”

There is a possibility of reducing the number of new infections by 95% in areas such as sub-Saharan Africa, Marlink said. The same goes for minority communities in the U.S., which Marlink said has a disproportionate amount of new infections. But the key to fighting the pandemic lies in maintaining – even growing – the amount of funding for treatment and prevention programs, Marlink said.

Expansion may not be an easy proposition. The Gobal Fund to Fight AIDS, Tuberculosis and Malaria, which funds the lion’s share of treatment programs for AIDS around the world, announced last week that it doesn’t have enough money to expand its current programs because of the economic downturn. According to the Global Fund, this year it spent $2.8 billion to pay for treatment for half the developing world’s AIDS sufferers.


Marlink says that much more needs to be done in the U.S. to fight the virus by making HIV testing as common as checking for blood pressure upon admittance to a hospital.

“We’re letting AIDS continue here,” he said. “The United States has seen 40,000 new infections a year for the past decade. It’s like accepting the Vietnam War’s number of deaths, but doing it every year. We’ve become complacent, and it’s unacceptable -- especially after we know how effective testing and treatment is.”

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