The world’s largest gathering of AIDS researchers, activists and policymakers will convene in the nation’s capital this weekend amid rising optimism that a vaccine for HIV, the virus that causes AIDS, is within reach, and as more of the world’s population gains access to testing and treatment.
However, the International AIDS Conference is also taking place in a city with a 3 percent HIV infection rate – equal to some of the world’s worst-affected countries – and in a nation where the disease has a disproportionate impact on poor and minority communities.
The conference, held every two years, will bring together science, medicine, public policy and advocacy in one place to brainstorm the response to a global pandemic that’s killed 30 million worldwide over three decades, including 600,000 Americans. New breakthroughs in research will be announced, as will new efforts by governments and organizations to reduce the spread of HIV, to treat those who have it, and to work, eventually, toward a vaccine and a cure.
“More than 5,000 people a day die of the disease. This is still an emergency,” said Michael Weinstein, the president of the AIDS Healthcare Foundation, a Los Angeles-based provider of HIV and AIDS treatment. “The war against AIDS has not been won.”
More than a million Americans live with HIV, according to the Centers for Disease Control and Prevention.
Worldwide, 34 million people lived with HIV last year, according to the United Nations, and 2.5 million people became newly infected. Though the toll has declined since the peak in 2005, 1.7 million people died of the disease last year.
Perhaps nowhere in the United States are those challenges more apparent than in the nation’s capital. The city’s rate of infection is twice the World Health Organization’s generalized definition of an epidemic.
Not far from the city’s convention center, where next week’s conference will take place, is Whitman-Walker Health, the nucleus of HIV prevention and treatment efforts in the District of Columbia for nearly three decades.
“D.C. still has hundreds of people die a year of AIDS complications. That’s way too many,” said Meghan Davies, the director of community health at Whitman-Walker, which provides HIV testing and treatment and education.
The district has a large concentration of groups most vulnerable to HIV and AIDS: young, gay, poor, black and uninsured. While infection rates have fallen in many categories in the past few years, according to a District Department of Health report last month, others have increased alarmingly. The infection rate among black women in the city’s poorest neighborhoods doubled to 12 percent between 2008 and 2010.
“We’re obviously doing something wrong,” Davies said. “Women think they’re not at risk for it.”
The first barrier is resistance to using condoms, which Davies said are 95 percent effective in preventing HIV transmission. The second barrier is getting tested. People who don’t know they have HIV are far more likely to pass it on to their sex partners. Davies said everyone should know their HIV status.
“People are petrified of knowing the answer,” she said. “Once you know, you have to deal with it.”
The third barrier is getting proper care to people with HIV. Antiretroviral treatments have proven 96 percent effective at making the virus undetectable in patients, and Davies said that helps reduce the transmission rate.
“We are so lucky that the treatment has gotten so good,” she said.
Until a cure is found, said Chris Collins, vice president and director of public policy for The Foundation for AIDS Research, known as Amfar, based in New York, it’s most important to get people the care that currently exists.
“To truly end the epidemic, we need a cure and a vaccine,” Collins said. “There is a growing sense we can achieve both in the years ahead. In the near term, we can use the tools we’ve got.”
The conference hasn’t been held in the United States since 1990, in part because of a longstanding ban on HIV-positive visitors from entering the country, a policy that was reversed two years ago under President Barack Obama. However, Obama will not attend the conference, disappointing some participants.
“We’re going to be in the president’s backyard on Sunday,” Weinstein said. “He could come and visit.”
In a statement earlier this week, the White House said that senior administration officials would attend the conference, including Secretary of State Hillary Clinton and Health and Human Services Secretary Kathleen Sebelius. Former Presidents Bill Clinton and George W. Bush, and former first lady Laura Bush, also are expected to participate. The event will draw other high-profile guests, including Bill Gates, Elton John and Whoopi Goldberg.
In a statement, Obama’s Republican challenger, former Massachusetts Gov. Mitt Romney, did not say whether he would appear at the conference, nor did he criticize Obama’s efforts. But he said that the U.S. "has been – and must continue to be – a beacon of hope for innovative research and support as we seek to overcome the global challenge of AIDS."
Obama will address the delegates in a brief video message welcoming them to Washington.
“I wish the president were coming,” Collins said. “I think the most important thing is, are the policies and funding in place?”
The global funding effort began under Bush, whose President’s Emergency Plan for AIDS Relief, or Pepfar, has extended lifesaving AIDS treatment to 4 million people worldwide, supported another 13 million with care and support, and supported counseling and testing for 40 million people in countries with the highest rates of HIV infections.
Collins called Pepfar “one of the most effective global health programs in history.”
Though Obama’s 2013 budget reduces funding for Pepfar by $214 million, the United States still would contribute more than $6 billion toward the global AIDS fight, more than any other country.
“This is not a good time to cut it,” Collins said. “I think Congress will not, in the end.”
Obama is committing more resources to domestic efforts. The national HIV/AIDS strategy began in 2009 with the goal of cutting the rate of new U.S. infections by 25 percent in five years. About one in five Americans who are HIV positive do not know it, and the White House effort emphasizes HIV testing and treatment, condoms, abstinence and needle exchanges. It focuses on the groups at highest risk for HIV infection, including young people, poor people, gay men and African American women.
Collins said that Obama’s health care law, if it succeeds in expanding coverage, would help bring treatment to those who are living with HIV and are currently uninsured.
“To bring HIV incidents down in this country, we’re going to have to increase testing, linking people into care and getting them the care they need,” Collins said.