I've never had to knock on wood and I'm glad I haven't yet

Taking a break from the usual b*tching and ranting and randomness, let me start by pointing out that today is World AIDS day. There is a lot of information about the current state of the AIDS epidemic at the UNAIDS and WHO sites today. Last week, the 2005 AIDS epidemic update was reported, and the news is definitely not going to send any agencies cheering for victory.

Let me throw some numbers out there, as a start. Here are some interesting findings about HIV/AIDS in the United States:

• About 1.1 million people have HIV. About 25% of those people are women.
  
• But African-Americans make up 50% of all new HIV cases.
  
• And African-American women make up 72% of all new HIV diagnoses in women.

Now consider this: worldwide, it is estimated that 40.3 million people have HIV. It is also estimated that >25 million people have died from AIDS since 1981. For all our fears about avian influenza, note that AIDS has killed just nearly the same number as the 1918 Spanish influenza. Now, let's look at Sub-Saharan Africa:

• where an estimated 25.8 million people have HIV
  
• and 17.8 million of those people are women. In fact, this number accounts for 77% of the world's HIV-infected women.
  
• where 64% of all new cases of HIV occur.

Now that you have those numbers before you, check out the ambitious program called "3 by 5." The idea was to get anti-retroviral therapy in the hands of 3 million people in low- and middle-income countries by the end of 2005. I'm not being sarcastic when I call it ambitious. In fact, it was so ambitious that it wound up missing its target, by more than 1 million people.

It's true that global prevention strategies are necessary to get this epidemic under some semblance of control. However, getting access to anti-retroviral therapy (ART) cannot be underscored. It's easy to forget that HIV has a 100% mortality rate, unlike an avian influenza or many other viruses. Just this week, NEJM published their results (should be free for viewing) of a study conducted in Haiti. Previously the 1-year survival for Haitians with AIDS has been about 30%, since access to ARTs has been pretty much zilch. Some have argued that the ARTs we use in the US wouldn't be as effective in the developing world anyway, given that there is a high rate of coinfection with all sorts of other diseases in those countries. However, the NEJM article shows that patients that were followed after introduction of ARTs showed 1-year survival of 87% in adults/adolescents, and 98% in children.

It is easy to dismiss HIV as an area that already gets plenty of research dollars, and that it is overhyped, because of the way it manifests in this country in 2005. In the US, it tends to affect poor minorities, homosexuals, and IV drug users. And even though we need to get that under control, people can live with HIV here, thanks to the availability of life-saving therapies. But we have to figure out how to get these therapies into the hands of the rest of the world. Morevoer, we have to seek out the holy grail- an AIDS vaccine. Though it's nearly impossible to develop, we have to try. I have heard people remark that HIV infection is preventable. This is true in theory, but when you have the kind of transmission happening in Sub-Saharan Africa and Southeast Asia, it sure doesn't feel preventable.

When it comes to prevention, I salute South African Bishop Kevin Dowling, who went against the church, and started advocating the use of condoms in South Africa. In South Africa, where AIDS is currently the leading killer of adults and young children, this is just the kind of sanity that is needed.

Oh, and instead of making snarky remarks about Lost, I'll just point you to a synopsis that could beat anything I could come up with by a mile.