What can one life tell us about the fight against HIV?

Hindsight A series of Headway teams that look back on predictions and promises from the past.

The story of the last 20 years of the fight against HIV can be told throughout the life of Juliet Auor Otierno. She was 18 years old, lived in Nairobi, Kenya in 2001 and learned that she was pregnant.She was tested for HIV when she visited the doctor

“The results came out on a receipt-like paper stamped with’POSITIVE’,” she recalled. “I cried for 30 minutes. People didn’t want to be HIV related I didn’t want to be HIV related either.”

That year, the United Nations predicts that by 2021, 150 million people around the world would have been infected with HIV. But that dire fate did not come true. The Joint United Nations Program on HIV / AIDS, known as UNAIDS, estimates that approximately 79 million people have been infected with HIV since the outbreak began. This is still a disastrous number, but just over half of the feared total.

How did the turnaround begin?

In Kenya in 2001, as in many parts of the world, the diagnosis of HIV was accompanied by imminent death anxiety. Antiretroviral therapy, or ART-a daily regimen that prevents the virus from multiplying in the body-provided its general effectiveness, but was costly.According to Doctors Without Borders, 2000 is equivalent to a year’s worth of treatment It costs money One patient costs $ 10,000 to $ 15,000.

Advocate of reproductive health, Otierno took the antibiotic sceptrin to avoid opportunistic infections associated with HIV. She was ashamed of being HIV positive and was afraid that her family would know her identity, so she dumped most of her septrine in the trash. Her boy, born in 2002, probably got HIV from her and died of pneumonia at the age of five months. The following year she developed toxoplasmosis, a parasitic infection. Her right side is still partially paralyzed.

During this dire time for Otieno, HIV / AIDS quickly gained attention as a global human rights issue and embarked on a shift in movement that began to turn around the world and Otieno’s own HIV pandemic.Activist Pressured Pharmaceutical company lifts patent protection for antiretroviral drugs Lower drug prices We called on generic drug manufacturers to create affordable versions. In 2003, a year of treatment cost $ 1,200 for patients in low- or middle-income countries. By 2018, the cost will be less than $ 100.

Governments and international organizations have taken seriously the fight against HIV / AIDS. In January 2002, the World Fund for the Fight against AIDS, Tuberculosis and Malaria was established with a $ 1.9 billion pledge from a group of eight countries. The following year, President George W. Bush announced the creation of the President’s Emergency Plan for AIDS (PEPFAR). It begins with a budget of $ 15 billion over five years and aims to enhance treatment and prevention in the most devastated countries. Especially in sub-Saharan Africa. In 2003, the World Health Organization announced a “3 by 5” initiative aimed at receiving 3 million anti-retrovirus treatments by 2005 (the goal was not achieved, but the actions of international organizations). Helped to spur).

“PEPFAR has changed the status of HIV services and brought treatment to the burdened areas,” said Annette Reinish, senior disease adviser to the Global Fund.

Lucy Kluber, a researcher specializing in HIV and children at Oxford University and the University of Cape Town, said: “You need to get the pills from a pharmaceutical company to a small clinic on the hill and get someone who is well-informed and can interact with those who need to take it daily. All of these. Logistics and procurement processes, all this stigma. These achievements reflect a level of complexity that can be daunting to think about. “

Within 10 years of the UN warning, HIV, a deadly infectious disease for millions of people around the world, has become a manageable chronic disease for many.

In January 2005, at the Doctors Without Borders clinic in the slums of Nairobi, Otierno learned that anti-retrovirus treatment was available in Kenya. The counselor warned her that the drug could cause side effects such as rashes and vomiting, and that if she skipped taking it, she could develop a worse infection. Support from loved ones was extremely important. Otierno realized that he had a second chance in his life and decided to take treatment seriously. After years of keeping her position secret, she revealed the truth to her mother.

Are you winning the battle today?

The global battle against HIV / AIDS continues. In 2011, UNAIDS announced the following ambitious campaigns: Reach zero.. Public health authorities are working on the goal of zero new infections, discrimination and AIDS-related deaths by 2030.

However, as the world has learned from Covid-19, deadly viruses have many ways to counterattack. In contrast to efforts to fight the virus that causes Covid, HIV vaccines have escaped decades of effort.Many experts Ambitious new target The virus still carries a tremendous stigma, especially where there are laws that limit homosexuality and policies that promote abstinence.Childhood HIV Difficult challenge..I also have Covid Diverted resources From the treatment and prevention of HIV.

In July 2021, Otierno gave birth to a healthy boy. She continues to control the virus through ART. Looking to the future, she says her job is focused on maintaining funding for HIV services so that people can continue to receive treatment. If millions of people living with HIV as a chronic illness cannot maintain long-term care at an affordable price, many can drop out of ART and become more infectious. Proponents are also pushing ahead with advances in pre-exposure prophylaxis, or preventative measures such as PrEP, which is a daily pill to prevent infection, and seek to eradicate the stigma of HIV.

“We can’t win,” said Kluber. “It’s a mistake to say we’re winning, but we’ve made a considerable intrusion into reducing what could be worse.”

Operation interval An initiative from the New York Times to explore the world’s challenges through the lens of progress.

The Headway Initiative is funded by grants from the Ford Foundation, William and Flora Hewlett Foundation, and Stavros Nialcos Foundation (SNF), with Rockefeller Philanthropy Advisor as financial supporter. The Woodcock Foundation is a funder of Headway’s Public Square.