Question: If treatment makes people with HIV non-infectious, could widespread treatment of HIV actually end the epidemic?
Paul Bellman: Well I think that the idea that treatment could potentially be prevention—because if someone is affectively treated they can’t pass on HIV—absolutely is powerfully important at this time where we don’t have a preventative vaccine and we don’t have a cure as actually the best path towards prevention. And Dr. Brian Williams of the World Health Organization who is one of their leading epidemiologists, has done some very careful modeling of the epidemiology of HIV in South Africa, which is incredibly hard-hit and he has calculated that if we could accelerate access to testing and effective treatment that we would dramatically reduce the incidence of new infection in the space of two decades—potentially even end the epidemic. But very early on it would translate into a dramatic reduction in new incidence of, not just HIV but infections that are associated with it like tuberculosis that are transmissible to non-HIV-positive people
Very recently, Dr. Ezekiel Emanuel who is Obama’s special advisor on AIDS had a blog in the Huffington Post which came out of the recent World AIDS conference in Vienna. And in this blog he was very critical of an activist who was critical of Obama’s current health plan in terms of budgeting for resources in the developing world. And, you know, so much so that he basically lambasted the activist and then went on to criticize Archbishop Desmond Tutu for similarly criticizing the Obama plan.
Now, these are really complex issues and certainly Dr. Ezekiel made some good points about how we have to try to make sure that the resources we’re spending are being well spent and I don’t think anyone would argue with that, but on the other hand he made a statement that I think really requires some scrutiny and should be the subject of real discussion and debate, and not just simply accepted. In this blog he said essentially that we can’t treat our way out of the epidemic and that is contrary to what many public health experts believe like Julio Montaner of Canada and Ronald Stahl of Pittsburgh who is a leading public health epidemiologist and it really is a matter of applying the resources and applying them wisely and correctly.
Recorded August 18, 2010
Interviewed by Max Miller