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NIH reflects on the reality of an AIDS-free generation — updated

After 22 years, the International AIDS Conference returns to the United States after a 1992 ban intended to prevent HIV-infected people from entering the country was lifted in 2010. This fact suits the optimistic tagline for the meeting — “Turning the tide on the HIV epidemic” — and Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases (NIAID) seemed jovial as he discussed the strides made since he attended the first meeting held in Atlanta, Georgia, in 1985.

“We had no idea what we were dealing with and how to intervene,” he says. That’s no longer the case. “Science — a lot of which was funded by the NIH [National Institutes of Health] — has really brought us to the point where we can be bold enough to consider the possibility of an AIDS-free generation,” he says.

Fauci and NIH Director Francis Collins reflect on strides made in HIV research, such as a garden of therapies in development and the pharmacological prevention of HIV approved last week. NIH grants have adapted in response to the advances. For example, half of the NIAID’s budget went towards therapeutics in 1994, when there were few antiretroviral drugs available, compared to a quarter of their much larger budget this year (pie charts below).

However, Nora Volkow, director of the National Institute on Drug Abuse (NIDA), focused instead on challenges that lie ahead. Since the beginning of the AIDS epidemic, Volkow says 32.6% of cases have been attributable to injection-drug users. The reality of how little care marginalized populations receive is grim. One study found that 70% of US doctors fail to offer antiretroviral therapies to people who inject drugs daily, says Volkow, probably because many drug users fail to remain on the treatments without treating their addictions. Putting these patients in programmes to rid them of heroin habits improves the outcome of antiretroviral therapy, she says. In response, NIDA supports research on long-lasting addiction medications that might improve antiretroviral compliance, as well as research on addiction vaccines. Still, Volkow requests help in implementing scientific advances. She warns, “If we don’t address the substance-abuse population, we will not succeed in creating an AIDS-free generation.”

UPDATE: July 23 2012, 11 am

US Secretary of State Hillary Clinton praised the NIH in her plenary address. “The ability to prevent and treat the disease has advanced beyond what people imagined 20 years ago,Clinton said, attributing advances in part to the scientists and doctors at AIDS2012. Clinton defined what an AIDS-free generation would look like. “No child anywhere will be born with the virus, as teenagers become adults they will be a significantly lower risk of acquiring HIV, and adults who catch the virus will receive the treatment they need,” so that they do not progress to AIDS.

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