Washington — Sub-Saharan African nations that have known the worst of the world's HIV/AIDS burden may be able to give birth to an AIDS-free generation in as little as three years.
U.S. Global AIDS Ambassador Eric Goosby offered that prediction November 30, a day after Secretary of State Hillary Rodham Clinton outlined a road map for communities and nations to rid themselves of full-blown, untreated AIDS.
"I think we have a real opportunity to aggressively move toward this AIDS-free generation within this three-to-five-year period," said Goosby in a teleconference, referring to countries such as Botswana, Namibia, Zambia and Zimbabwe where the number of people receiving treatment with antiretroviral drugs (ARV) exceeds the number of new infections recorded in 2011, according to data compiled by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).
That result is achieved with a multipronged prevention strategy and early administration of drug therapy, which preserves the health of an HIV-infected person and drops the ability to transmit the virus to others by up to 96 percent, the AIDS ambassador said.
Treatment also prevents the wasting and opportunistic diseases that occur when HIV overwhelms the body's immune system.
"We're talking about pre-empting the movement of HIV to a diagnosis of AIDS," Goosby said. "We're positioning ourselves so we have effectively blocked movement of the virus in the population better than the virus is moving in the population."
PEPFAR, which Goosby leads, has identified 16 sub-Saharan African countries where this "tipping point" is close to achievement and the three-to-five-year goal for containment of the disease is within reach.
Effective, aggressive prevention measures are also critical to this strategy, including:
• The prevention of virus transmission to infants through their pregnant mothers.
• Circumcision for males.
• Increased access to condoms, HIV testing and counseling.
The effectiveness of HIV prevention strategies was documented in the World AIDS Day report issued by the Joint United Nations Programme on HIV/AIDS (UNAIDS). It showed that the rate of new HIV infections has been reduced by more than 50 percent among people aged 15-49 years in 25 countries between 2001 and 2011.
Goosby said achievement of an AIDS-free generation also requires that partner countries provide leadership in identifying the greatest problems in the unique circumstances of their epidemic, addressing those needs, and devoting domestic resources to health care.
The disease has killed more than 30 million people since the epidemic began in the 1980s. Goosby has been involved since the first cases were seen in the United States more than 30 years ago. He reflected on the enormous human toll he has seen taken by AIDS.
"I have seen communities wobble and fall because of the number of individuals infected," he recalled. "I've seen villages disappear from the planet because people were so devastated with death from the virus, they just wrapped up and moved on."
In the early years in African countries, many people with HIV received their first medical attention when AIDS had reached a late stage and already ravished their bodies. Goosby remembers that and compares it to the standard of treatment today, which is mostly on an outpatient basis as patients lead normal lives with ARV treatment.
"That has been breathtaking," Goosby said. Only about 50,000 people in sub-Saharan Africa were receiving treatment eight years ago, and close to 6 million receive treatment today with U.S. funding. Other donor programs and domestic investments raise the total of people on ARVs to 8 million, according to the UNAIDS report.
Goosby said he is humbled and gratified that the U.S. commitment and country-level leadership have led to this opportunity for the birth of an AIDS-free generation.