AAAS Day 3: Saturday 17 Feb 2007

An important ‘topical lecture’ was given by Anthony Fauci, Director of the US National Institute of Allergy and Infectious Disease (NIAID), on ‘HIV/AIDS: 25 Years and Counting.” Fauci noted that despite an increasing US federal research budget and more powerful drugs have led to great progress in combating the HIV epidemic in the United States, the annual rate of new infections has remained steady at 40,000 for more than 10 years.
Addressing this troubling statistic, he urged scientists and politicians to pay more attention to strategies that raise awareness about actions that increase the risk of contracting the virus and encouraging those in high-risk populations to get tested regularly.

“Twenty-five percent of all people infected do not know that they are infected,” Fauci said. “With the vast majority of HIV infection transfers coming from people who do not know that they are HIV positive, we clearly are not getting to the people that we need to be getting to.”

Fauci provided an overview of past and current HIV research, and spoke about the future of medicine and political initiatives in the global fight against HIV. Citing a $2.9 billion dollar National Institutes of Health budget for HIV research in 2006, $190 billion federal cumulative dollars spent on HIV research from 1981 to 2007, and 207,572 HIV-related papers in PubMed Database (a directory of biomedical research), Fauci contended that HIV/AIDS is the most studied pathogen in human history. He also pointed out that the U.S. Food and Drug Administration has approved more HIV/AIDS anti-viral medicines that all other anti-virals combined. “HIV/AIDS is the most studied pathogen for good reason – last year it overtook tuberculosis as the leading cause of infectious death in the world,” said Fauci.

Appointed director of NIAID in 1986, Fauci remembers reading the startling news story in 1981 that five gay men has contracted pneumocystis pneumonia, a relatively rare illness with symptoms of coughing, fever, and shortness of breath. Soon after, newspapers around the country began reporting similarly rare illnesses in populations of Haitians, haemophiliacs, people who had received blood transfusions, infants of HIV-infected mothers and partners of heterosexual men.

Building on the Nobel Prize-winning research on reverse transcriptase by David Baltimore (1975), the discovery of HIV as the cause of AIDS (1984), a blood test that could protect blood supplies and provide diagnoses (1985) and epidemiological studies, experts were able to fight back. “With each new infected demographic and the scientific breakthroughs, we learned important information about how the virus travelled, who was at risk, and how to respond,” Fauci recalled. In addition to robust federal funding of research, Fauci believes that the United States needs to continue strong prevention programmes that address issues that some communities find difficult: “While there is blame to be passed around to almost everyone, I think the fact that the African-American community, especially its clergy, did not get involved with issues of its gay men hurt our efforts.”

An advisor to four U.S. presidents beginning with Ronald Reagan, Fauci believes that HIV epidemic was complicated by the fact that scientists did not understand the social implications of the communities affected by HIV. “Reagan never came out strong enough in combating HIV – I call it the dark years,” said Fauci. “Some think he didn’t respond strong enough because it was a disease of ‘gays, drug addicts, and bath houses’.”

In addition, Fauci believes that in the 1980s, public health officials did not work hard enough on prevention for fear of stigmatising the very people who were most in danger. “We were overly ambitious on finding the miracle cure, as opposed to immediately addressing prevention,” Fauci said. “We did not want to isolate a community that had just gained expressive freedoms.”

As the current president’s lead advisor on HIV/AIDS, Fauci has travelled with former Secretary of Health and Human Services Secretary Tommy Thompson to 11 Sub-Saharan African nations and Haiti. While in Haiti, he met with several people who had benefited from anti-viral medications. In January 2003, George Bush announced the Presidential Emergency Plan for AIDS Relief (PEPFAR), a five-year, $15 billion dollar, multifaceted approach to combating the disease around the world. Through the plan, the U.S. Government pledged to work with international, national, and local leaders in supporting an integrated prevention, treatment, and care programme. “With this muscular response from the Bush Administration, along with the recent money from the Clinton Foundation and the Gates Foundation, I think that we are moving the right directions to find a safe vaccine for HIV,” Fauci said.

While some may dispute these claims, including the accuracy of PEPFAR reporting, it is clear that there are significant new resources available for battling this dreadful disease. For those wishing to learn more about recent STEPS-related research on HIV/AIDS, check out the work of Institute of Development Studies

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