Mitchell Warren, the executive director of the AVAC global advocacy group for HIV prevention, says the world has begun to talk about something that would have been unimaginable even two years ago — an end to the global AIDS epidemic. Warren spoke to RFE/RL correspondent Daisy Sindelar about some of the most important advances in AIDS treatment and prevention as the globe marked World AIDS Day on December 1.
RFE/RL: As we mark World AIDS Day, it seems there’s some reason for optimism. UNAIDS is talking about “getting to zero.” Your own organization, AVAC, has spoken of a tipping point in the battle against AIDS. What are some of the advances?
Mitchell Warren: First and foremost, the fact that we talk about AIDS as openly as we do is progress. We still have huge challenges in terms of stigma and discrimination, but a decade ago it wasn’t even in the newspaper anymore. And [now] we’re seeing a lot of robust, good, accurate reporting, good conversation. So the fact that we’re even talking about the epidemic is a good thing.
RFE/RL: In November 2011, U.S. Secretary of State Hillary Clinton said an “AIDS-free generation” was possible. What did she mean?
Warren: The “AIDS-free generation” is very much around this idea of eliminating any new pediatric infections. And that’s a winnable battle. In the U.S., in fact, there are hardly any babies that get infected through vertical transmission.
Through treatment of pregnant women who are HIV-infected, we have seen this incredible decline, and we need to now make sure that happens globally. 2015 is a global target to really eliminate pediatric transmission, and that would conceptually give us an AIDS-free generation.
RFE/RL: You’ve said that the development of antiretroviral drugs is possibly the greatest achievement in the AIDS battle in the past decade. Those drugs were obviously used in the treatment of people infected with HIV. But last year, the U.S. National Institutes of Health began looking at using treatment as a form of prevention. Can you explain?
Warren: The results were released in the middle of 2011. And they basically confirmed what some people [already] thought — that treatment not only helped the person who was infected, in terms of keeping them healthy and sustaining their lives, but it actually provided a prevention benefit. And that trial found actually that it provided as much as a 96-percent protective benefit in terms of preventing onward transmission.
RFE/RL: So there are steps that HIV-positive people can take to prevent transmitting the infection. But what about people who are HIV-negative? Are there new ways for them to protect themselves?
Warren: Just a few months ago in the U.S., the Food and Drug Administration approved the first-ever antiretroviral for prevention — for HIV-negative men and women to take this pill in advance of potential exposure. And it was shown in clinical trials to reduce the risk of infection by as much as 60 or 70 percent, depending on the individual’s adherence to the pill-taking.
And the other big thing in the last five years has been the evidence that providing voluntary medical male circumcision can reduce a man’s risk of infection by as much as 60 percent, and over time can also provide protection to their female partners.
RFE/RL: How close are we to having a vaccine?
Warren: Three years ago, in 2009, we had the first evidence ever that an HIV vaccine could reduce the risk of [HIV] infection. Only by 30 percent, which is too low to see that vaccine licensed. But it was the first evidence that a vaccine could actually provide protection. And now there’s a lot of effort going into making that effectiveness even higher.
RFE/RL: Without a vaccine, is it really realistic to talk about an end to the AIDS crisis?
Warren: Historically, at least, epidemics have only been ended when we’ve had a vaccine. So ending the epidemic is a long-term prospect. It will take time; it is not necessarily around the corner. And it’s why at least we and others are talking a lot about “beginning to end” [the crisis] — and that gets us to this idea of a tipping point.