According to the latest BBC news, if spending on AIDS
increased then there is a possibility that the disease could be ended by 2030.
Yet the meaning of this statement is unclear. For example “end” could mean that
the disease will be eradicated globally or it could mean that the disease would
just be restricted to certain areas so that it would cease being an epidemic
and instead become an endemic viral disease. There is further obscurity in the
latter definition as the success of “ending” the disease in some areas would
depend on the size of the area, the population of the people living in these
areas, the lack of development in areas still suffering from AIDS. An example
of this would be if AIDS was eliminated in Britain yet the whole continent of
Africa still suffered from AIDS and didn’t even have access to palliative care
let alone a potential cure if Britain developed it. In this case the
declaration of “ending” AIDS in Britain would be still less important when we
account for global progress and the suffering of individuals. It is for this
reason why I shall consider the former interpretation that we can eradicate
AIDS altogether in order to set a clear target to be able to compare our
current progress to that needed.
Can it be done?
The figures are initially encouraging as in 2013, there were
38% fewer cases than in 2001 representing a decrease of 1.3 million cases
worldwide. This trend, if it continued at a current rate of decreasing by 1.3
million every 12 years would lead us to believe that AIDS could be eradicated in
19.38 years which arrives at an estimate of eradication at the year 2032.
However this is likely to be far too optimistic. This is because the rate of
decline is not likely to remain constant and instead is likely to plateau. This
is because the recent fall in AIDS related cases has primarily been in Western
Africa. Therefore as these areas become more developed and AIDS cases fall to a
minimum other areas of the world may not improve and so this may mean that, as
the rate of the fall is due to development, when development has been reached,
the rate of the fall will be less. The graph to the right also appears to suggest that although in some cases HIV is declining in proportion, it is only doing so at a very slow rate and that the actual number of infections is increasing, even if this increase is slowing down. Also we must consider the possible 15 year
delay when infected people are unaware they have AIDS. This means that any
increase in spending to make people more aware of the dangers of unprotected
sex will not be seen until 2029 at a maximum. Thus the effect of increased
spending is unlikely to influence the decline of AIDS in order to meet the 2030
“target”.
Nevertheless, AIDS related deaths have fallen by a fifth in
the last past three years and so this shows the rate of development of
healthcare as AIDS was first recorded in 1980 and so the proportion of the last
three years is 8.8% of the time we have known about AIDS. Thus if deaths have
fell by a fifth in this time, this would seem to suggest that medicine has accelerated
in regards to treating AIDS. Even so this assumption may not be accurate. For
example if deaths decreased by half in the previous from 2008-2011 then this
would suggest that medical development is slowing and although deaths are still
being reduced, this occurs at a much lower rate. Furthermore, this doesn’t give
us any information about the cases of infection or what proportion of people
with AIDS survive. In 2011 there were “6280 new diagnoses of HIV in the UK. At
the end of 2011 around 96,000 people were living with HIV”. Clearly if none of
these 96,000 people died then it would appear a massive success (which it would
be) and would seem to suggest that we can deal with AIDS, yet this ignores the
fact that these 96,000 people still have AIDS and still may endure a low quality
of life. Thus ending AIDS wouldn’t be much closer. Also the UK is more
developed than Africa say and so may represent the next stage of development
for Africa. Thus, if the UK still suffers from AIDS, then it is unlikely that
we will see the complete abolition of AIDS globally if even the developed
regions suffer. This is specifically shown in the pie chart in which high income countries still have a portion of the total number of AIDS sufferers, even if this portion is low. Hence, although death rates could show the level of medical
treatment and care, it cannot indicate how close we are to eradicating a
disease.
However, I must also consider the “trickledown effect” as it
can be called, in that improving healthcare (and hence reducing the death rate)
also allows development of knowledge. Hence if knowledge develops then we can
more easily analyse and develop methods of destroying HIV. In addition, more
knowledge of the disease can lead to more effective preventative campaigns
which may reduce the infection rate and so this would mean that a reduced death
rate could be an indicator that the number of cases of AIDS will decrease. In
addition, in the book “Hippocratic oaths”, Raymond Tallis states that increases
in life expectancy have not solely been gained through healthcare but also
education and nutrition. This may be similar in the battle against AIDS because
as poorer regions develop, education is likely to increase and so this will
also cause a reducing in the infection rate. Despite these issues, though, the
article still states that “there have been more achievements in the past five
years than in the preceding 23 years” which suggests that this rate of achievement
will continue to increase.
What should be done?
If we are to meet this target then, what should the areas of
interest be? Fewer than 40% of HIV sufferers receive antiretroviral therapy, a
treatment that is often lifesaving. If we focus on the wider circulation of
this treatment then we should focus on getting these countries more independent
and not reliant on foreign aid. This is because, whilst foreign aid can allow
undeveloped areas to access high quality care, it doesn’t give these countries
the flexibility that they need. For example, they may not be easily able to
increase production. Also, because AIDS is less of an issue in developed regions
then these countries may not produce these drugs on a large enough scale. In
addition, drugs companies may exploit the reliance of undeveloped countries on
their drugs by charging higher prices.
Another area of importance will be ensuring that a “final
push” is made as AIDS becomes less common. This is particularly significant with
disease as if complacency is allowed to grow then fewer people will acknowledge
the issue which could lead to many people being put at risk without knowing. A
similar case has been seen in vaccination which produces a cyclical pattern as
people get vaccinated so herd immunity increases causing people to perceive the
risk as lower as it is less likely to spread. This lowers the vaccination rate
and so can cause mass infection which causes vaccinations to again rise. A
similar, although not identical, pattern could be seen if complacency towards
AIDS is developed
Drug resistant HIV strains could further complicate the
issue as they may slow drug development. Methods of resistance could therefore
mean that any cure is limited in the long-term as it is probable that HIV
strains may mutate and hence render any treatment less effective than
originally planned. This means that medical development will be sure to slow if
the virus changes even as slightly as to cause a slight change in the success
rate of treatment. However, this is already being tackled as in July 2006, a
single-pill, once-a-day AIDS treatment (Atripla) was approved by the FDA which
avoided the “cocktail” of drugs that is often used to manage the disease. By
avoiding many drugs, this means that regular treatment can be given and so this
will ensure that the AIDS virus cannot easily mutate as it will be regularly ‘attacked’
as opposed to previously where it could be given time to mutate and develop resistance
to a drug which reduced the success of treatment hence leading to more prevalent
HIV strains which increased the rate at which resistance to the other drugs
could be achieved.
My Verdict
Ultimately, we could compare this attempt to eradicate AIDS
to the eradication of smallpox which, so far is “the only infectious disease of
humans, to be eradicated by deliberate intervention”. Hence any attempt to
eradicate AIDS will require community effort and global interaction such
as the AIDS meeting which recently took place in Australia in 2014. The method
used to eradicate small pox was a mixture of focused surveillance to identify
the smallpox virus, followed by “ring vaccination” which involved a series of
quick vaccinations to increase herd immunity. However this is unlikely to be
used in the war against AIDS as infections cannot easily be seen. Furthermore,
when two sexual partners suddenly develop AIDS then it can be suggested that
one must have breach monogamy. This is unpredictable and so it is difficult to
prevent the spread of AIDS if people do not take personal responsibility, compared
to small pox when it could easily be predicted when someone may develop
symptoms (i.e. relatives may be more at risk). Hence, I don’t believe that the
target to defeat AIDS by 2030 is realistic in the present day, but I do believe that we can beat
AIDS if we introduce a more coherent and direct plan combining international
collaboration in medical research with education programmes to allow “ring”
approaches to be made.
Sources
http://www.rosehillnazarene.org/herald/hiv.bmphttp://www.nhs.uk/Livewell/STIs/Pages/HIV.aspx
http://www.wecanendaids.org/
http://www.infoplease.com/ipa/A0106323.html
http://en.wikipedia.org/wiki/Eradication_of_infectious_diseases
http://www.historyofvaccines.org/content/articles/disease-eradication
http://www.newscientist.com/data/images/ns/cms/dn9244/dn9244-1_700.jpg
Raymond Tallis - Hippocratic Oaths
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