National Institute of Allergy and Infectious Diseases, National Institutes of Health - Monday, Dec. 1, 2003
Anthony S. Fauci, M.D.

New estimates on the scope of the HIV/AIDS pandemic are profoundly sobering. An estimated 40 million people worldwide are living with HIV/AIDS, according to a newly released report from the Joint United Nations Programme on HIV/AIDS (UNAIDS). In 2003 alone, 5 million people worldwide were newly infected with HIV -- about 14,000 each day, more than 95 percent of whom live in low and middle income countries. In 2003, 3 million people worldwide with HIV/AIDS died. In the United States, nearly one million people are living with HIV/AIDS, and by the end of 2002, more than 500,000 people with HIV/AIDS had died, according to estimates of the Centers for Disease Control and Prevention (CDC).

As shocking as these numbers are, they do not begin to adequately reflect the physical and emotional devastation to individuals, families, and communities coping with HIV/AIDS, nor do they capture the huge deleterious impact of HIV/AIDS on the economies and security of nations, and indeed entire regions.

Even as the burden of HIV/AIDS continues to grow, recent developments provide some measure of optimism. Four new antiretroviral drugs were licensed in 2003 by the U.S. Food and Drug Administration (FDA), bringing the total of FDA-approved antiretroviral formulations to 23 and providing new hope to individuals who may have exhausted other treatment options. Novel approaches to HIV prevention are being studied and validated, and the pipeline of HIV vaccines is larger than it has ever been.

To help turn the tide of the global HIV/AIDS pandemic, the National Institute of Allergy and Infectious Diseases (NIAID) has established research collaborations with international colleagues in more than 50 countries to develop comprehensive approaches to the HIV pandemic, encompassing vaccine development and other prevention activities, therapeutics, and care of the HIV-infected person. These collaborations already have yielded important results, notably in developing methods to reduce mother-to-child transmission of HIV.

A rate-limiting factor in providing treatment for HIV/AIDS in developing countries has been a lack of funds for the purchase of antiretroviral drugs and for improving existing healthcare infrastructure. The President's Emergency Plan for AIDS Relief will help change this situation. The plan commits $15 billion over 5 years for HIV/AIDS prevention, treatment, and care in 14 countries in sub-Saharan Africa and the Caribbean. This lifesaving effort will not only reduce the suffering caused by HIV/AIDS in countries that account for about half of the world's HIV infections, but also will provide a framework for research efforts to develop new and improved tools for treatment and prevention. The President's Plan complements (and will contribute to) another significant effort, The Global Fund to Fight AIDS, Tuberculosis and Malaria.

I am further encouraged by the substantial reductions in the prices of anti-HIV medications recently announced, and by new national plans to fight HIV/AIDS, developed by countries seriously impacted by HIV/AIDS, notably South Africa, which has the most HIV-infected citizens of any country in the world.

In addition to robust international HIV/AIDS research efforts conducted by NIAID and many other organizations, we now can point to numerous examples of community programs in developing countries -- generally modest in scale -- that clearly demonstrate that HIV care and prevention services can successfully be delivered in resource-poor settings. The momentum provided by increased funding, political will, and the sustained commitment of AIDS fighters across the Globe suggest that we can "scale-up" such programs so that the availability of HIV treatment and prevention becomes the rule, not the exception, for all the citizens of the world, rich and poor alike. At the same time, it is critical that we accelerate efforts to develop the next generation of therapies and prevention tools that will improve upon our current armamentarium.

Let us not expend our energies in concern for reasons why these efforts might fail; rather, on the occasion of World AIDS Day, let us apply ourselves as a global team to assuring that such efforts do indeed succeed.

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Dr. Fauci is the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Maryland. The National Institutes of Health is an agency of the U.S. Department of Health and Human Services.
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