A forty year journey from fear to hope
By Robert Hopwood
After 40 years, public health officials and activists see a pathway to end the AIDS epidemic. It starts with treatment.
With proper medical care, those living with HIV can reduce the viral load in their blood to an undetectable level. When HIV can’t be detected it can’t be transmitted, according to the California Department of Public Health.
Health officials and activists are now championing the message that undetectable equals un-transmittable, or U=U.
“The concept of U=U is the foundation of being able to end the epidemic,” Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said in 2019.
The U=U campaign also aims to end the stigma around HIV. That stigma keeps too many people from getting tested for HIV or obtaining the care they need to stay healthy. The result of 40 years of research is that people living with HIV can suppress the virus and live long lives with medication.
“They can have sex, babies, love—all with no risk,” says HIV activist Bruce Richman, who founded the Prevention Access Campaign, which started the U=U message.
But if a person doesn’t know they have HIV, that person won’t get access to the medication to stay un-transmittable, Richman says.
“If we really want to end the epidemic and save lives, we’re going to make sure that we invest in the wellbeing of people living with HIV, so they can stay healthy and prevent new transmissions,” Richman says.
DAP Health’s integrated model of services supports those people living with HIV on their journey to U=U, says C.J. Tobe, DAP Health’s director of Community Health.
“At DAP Health we learned through the AIDS crisis that becoming undetectable is more than taking daily medication,” Tobe says. “It is a combination of factors such as a roof over your head, food in your belly, staying on top of your mental health, and following through on routine oral health exams.”
It’s been 40 years since the AIDS crisis began.
In 1981, Dr. Michael S. Gottlieb, an assistant professor at the University of California, Los Angeles, wrote about a new syndrome that was causing rare infections in otherwise healthy gay men. The piece, published in the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, was the first official report about what would become known as HIV and AIDS.
Following that report, the media started to write about the mysterious illness. No one knew what to call it or how it spread. In 1982, the CDC named it AIDS.
The following year, playwright, author and film producer Larry Kramer called the disease “terrifying” in a screed he wrote for the New York Native, a gay newspaper. Kramer, who founded the advocacy group ACT UP, blamed the health care community and politicians of ignoring the epidemic.
“If this article doesn’t rouse you to anger, fury, rage, and action, gay men may have no future on this earth,” Kramer wrote. His screed encapsulated the fear and anger of many as AIDS continued to spread.
It was “an ugly time in America,” actress and singer Sheryl Lee Ralph recalled at the Steve Chase Humanitarian Awards 2021. She says the disease “blew out the flame of creativity up and down Broadway.”
The cause of AIDS was found in 1984. It came from a retrovirus.
Only two people are known to have been cured of HIV. In 2007, the “Berlin Patient” had no detectable HIV infection following a bone marrow transplant. And in 2019, the “London Patient” became second person cured through the same method.
Despite a prediction in 1984 by Health and Human Services Secretary Margaret Heckler that an HIV vaccine would be ready within two years, none have been created despite many attempts.
However, breakthrough drugs developed since the 1980s have turned HIV into a treatable disease. They have made viral loads undetectable. And they’ve made HIV un-transmittable. One of those drugs, Truvada, was approved by the FDA in 2011 for pre-exposure prophylaxis, or PrEP. According to the CDC, the daily pill cuts the risk of getting HIV from sex by about 99 percent. Among those who inject drugs, the risk falls by at least 74 percent if taken daily.
Between U=U and PrEP, we are starting to turn the tide on new infections, and HIV numbers across the country are going down for the first time in many years, Tobe says.
“We have the tools to help end HIV in our community—but only if we resist the urge to forget just how deadly it has been in our community for decades,” Tobe says.