40-year-old AIDS: Preparing for the End of the Global Catastrophe | News

June 3, 2021 – June 5, 1981, CDC It was published First official report of the disease becoming known as AIDSIn a recent interview, four researchers at Harvard TH Chan School of Public Health looked back on the successes and failures of the global response and the work left to finally end the illness.

Lessons from global illness
Philis Kanki, Professor of Health Sciences, Mary Woodard Lasker

I have spent most of my career treating HIV. I started when I was a graduate student right after the virus was discovered. The disease is unique in that it has affected the world and has different biology and epidemiology in different parts of the world. While certain populations were at risk in the United States, there were actually different populations in Africa and Asia. The response has provided many valuable public health lessons. How the stigma of illness affects an individual’s health and social response. Differences in regional and global health inequalities. The importance of the government leaders involved in influencing policy. The role of the community in useful interventions.

The world has vast population segments and geographic regions, most of which are poor, have the highest disease burden, and were inaccessible when treatments became available. We are pleased to be able to participate in the response that provided treatment and helped save the lives of millions of people.I’m at school pepper (President’s Emergency Plan for AIDS Relief) Program in Botswana, Nigeria and Tanzania. In these countries, we formed independent non-governmental organizations and took over the program when school grants ended. Botswana Harvard Partnership, Nigeria’s AIDS Prevention Initiative (APIN), And MDH (Health Management and Development), In Tanzania. I still work with APIN and am very proud of their achievements. They operate more than 570 clinics in Nigeria and have provided treatment and prevention to more than 250,000 patients. Their scientists are also involved in important operations research that is useful in this area.

The HIV / AIDS epidemic is nearing its end, but not yet. We need to remain committed to achieving our preventive and therapeutic goals and ensure that they are not by our side forever. Ten years from now, the disease will become a very rare and rare disease, and everyone with the disease will have access to effective medicines to improve their quality of life. I hope. Vaccines may appear and decrease in number, but it is likely that some people are still being treated. Therefore, we need to continue to improve our treatments to make them more tolerable and effective.

“On the rope”
Roger Shapiro, Associate Professor of Immunology and Infectious Diseases

When I started working on HIV / AIDS in the mid-1990s, the problem was so great that it was difficult to think about how to end it. We could see all the challenges, but could only imagine a scientific breakthrough in treatment. Many experts have antiretroviral therapy (ART) across developing countries. I predicted that it would not be possible to distribute it on a large scale. Instead, I am grateful every day that ART has helped change the trend. Currently, more than 25 million people living with HIV are receiving ART. This is a three-fold increase over 2009. Even high-infection countries, such as Botswana, where I work, have achieved treatment goals. But we still need to improve. I thought prevention and vaccine efforts would be showing more progress than ever before, but I’m dissatisfied with the fact that a new generation affected by HIV is still being seen.

Over the last 40 years, HIV / AIDS has changed public health. Community voices that attracted attention in the early stages of the epidemic accelerated the entire process of conducting clinical trials during the epidemic and shortening the schedule while maintaining scientific integrity. The legacy of this activity, to date, can be seen in the quicker response to conducting research during the COVID-19 pandemic.

Over the next decade, new long-acting antiretroviral drugs have the potential to improve both treatment and prevention, and their strategic application can make a big difference. To break the cycle of infection to the next generation, PrEP (pre-exposure prophylaxis) with long-acting drugs should be targeted at 16 to 24 years of age. Also, accelerating research into the use of long-acting drugs in pregnant and lactating women can dramatically reduce HIV in children. In some cases, it can also be used as a preventive drug for babies. I don’t think HIV / AIDS will be gone in 2031, but you can ride the rope.

Science-policy gap
Kunjar Patel, SD ’06, Senior Research Scientist, Faculty of Epidemiology

I moved to the United States in 1985 when I was in the third grade from Zambia. The first time I heard about HIV / AIDS was in a high school health class. When I was attending the MPH program at Yale University, I began to learn more about this and was fascinated. In the case of infectious diseases, it was necessary to understand the cross-cutting areas of health sciences such as transmission dynamics, prevention, treatment, adherence, social sciences and behavioral sciences of infectious diseases. As an epidemiologist, I thought this was a treasure trove. Then I attended a lecture by epidemiologist Sir Richard Doll. He lamented that science often did not lead to effective policies. One of the things he mentioned is that many studies have shown that needle exchange programs are very effective in reducing HIV infection in injection users. But still, the federal program does not fund them. It made me very angry. From bench science to policy, I found that there was still a lot to do. Thanks to that, my interest in confronting this epidemic has solidified.

At Harvard Chan School George Siege As a mentor for my PhD. Thanks to him, I started working on childhood HIV and was able to contribute to the development of the world. Pediatric HIV / AIDS Cohort Study (PHACS). Currently, I am leading a senior epidemiologist on the research team for this and other pediatric HIV cohort studies as a whole. This task informs perinatal and pediatric guidelines for people living with HIV and will continue to notify them as the population ages. We work very closely with the community of participants and caregivers to ensure that they really understand the actual experience of the participants we are studying. , Many things are happening besides the treatment results. Their HIV does not define them.

I think it’s amazing that HIV has changed from a death sentence to a chronic illness in the last 40 years. When it comes to prevention and treatment, the toolbox has great tools. But implementing them is still a problem. Part of dealing with this is to better meet people, especially those who may be distrustful of the health care system, especially those who are there. This final step is the most difficult part of the fight to eradicate HIV. We need to be more creative and innovative.

Overcome fear
Anton Castellanos Ushiguri, DrPH ’22, Chen Fellow

I don’t remember exactly when I first heard about HIV. But I remember growing up as a gay teenager and being afraid of it, even if it was safe. For many men who have sex with men, this fear shapes their first sexual experience. Unfortunately, many sex educations use fear and shame to motivate behavior, creating more stigma for those who already have stigma.

When I was a teenager, I got angry with this and started advocating comprehensive sex education at a high school in Mexico. This is the first step in a later career. Currently, my public health work focuses on helping the community access quality sexual health services. When I was working in a Brooklyn hospital a few years ago, I was asked to help take a young gay or bisexual man to the clinic for HIV / STI testing and pre-exposure prophylaxis (PrEP). I did. [HIV prevention medication]Traditional outreach methods didn’t work, so I decided to reach out to a space where men could discuss sex, a dating app. And it worked. This approach attracted about 100 new clients each year. I am currently working to extend this initiative to other situations throughout the United States.

I am very grateful to the generation of HIV / AIDS activists who fought in the 80s and 90s for access to life-saving drugs, demanding that the government address the epidemics and homophobia that are causing silence and prejudice. .. They are truly a unique example of a global health exercise. There was passion and strength that the community could draw from itself. Many public health programs tend to think about how the negative things people face affect their health. But we rarely talk about the strengths of the community. In the early days of the HIV epidemic, I think it really reflects the importance of the social support we can give each other.

Of course, the situation has changed significantly since the beginning of the epidemic. But there is still a lot to do. We need to innovate further and increase access to sexual health services and education. We need to listen to people and have honest and positive conversations about connecting sexual pleasure and safety. And we must move away from the fear-based approach to sex education.

– – Amy Loader

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