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Getting to Zero: The Next Chapter of HIV

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30 years after the first cases of what would turn out to be AIDS were described in the USA HIV remains an incurable disease.

But the epidemic is at a tipping point. In many countries new HIV infections are in decline. Life expectancy, if you are diagnosed and have access to treatment, is almost as good as that of HIV negative people. For many, living long-term with a chronic disease now poses more day-to-day challenges than HIV-related illness.

At this historic moment in the course of the epidemic the world appears to be realising the powerful drugs that people living with HIV have taken for the past 15 years are probably the best tool we have to reduce HIV transmission.

This past summer a truly momentous piece of research showed HIV treatment was able to reduce HIV transmission between heterosexual regular partners by 96%.

The benefit to an individual of starting HIV therapy is unambiguous.

These latest findings are also a powerful tool, which could de-stigmatise HIV, and alleviate the internal stigma many people living with HIV feel post diagnosis.

With growing numbers of people accessing HIV treatment around the world some commentators have feared that investment in prevention programmes would falter as the bill for HIV drugs increased; particularly in times of global financial instability.

But with treatment now firmly being seen AS prevention there is an unprecedented momentum to test and treat people, not just for their own benefit but also in an attempt to alter the course of the HIV epidemic.

This would be most likely achieved with early diagnosis and treatment and would require high levels of adherence to HIV treatment.

Most HIV transmissions occur from people who don't know they are HIV positive.

The US government has recently confronted these remaining challenges head on.

Having funded the lion's share of global HIV treatment programmes and prevention research they have recently demonstrated leadership by committing to facilitate an 'AIDS-free generation.'

Researchers have long argued that using a "combination of prevention approaches" - that is, testing and treating people, offering male circumcision and providing mothers with medicines to reduce the likelihood of HIV transmission to their babies alongside proven strategies like condoms - will give us the best bang for our buck.

But until the world's politicians grasp the concept and put more money and manpower behind the programmes, the approach could be regarded as rhetoric confined to conference halls.

By recognising the extraordinary opportunity a 'combination prevention/ approach represents the US government has grasped this concept. Hopefully other governments will follow.

Most importantly any strategy that firmly backs the further rollout of HIV drugs will save millions of lives.

UNAIDS has set a goal that 15 million people will have access to effective HIV drugs by 2015. By then over half of all people living with HIV will be over 50.

Whilst research is now really focusing on a cure, it may be decades away.

And people living with HIV are ageing, some would argue, at an accelerated rate compared with the HIV negative population.

Here in the UK HIV is fastest rising in the over fifties and it's the diseases prevalent with ageing that are the ones complicating the lives of people with what is now a very treatable infection.

Taking HIV treatment long-term appears the surest way to ward off illness caused by HIV.

But heart disease, stroke, diabetes are all more common among people with HIV. So too is lung, liver, and anal cancer and a whole heap more. Perhaps earlier screening for cancer among people with HIV will be the norm in the coming decade.

Simple health promotion messages apply to people living with HIV as well as they do to the general population. Stopping smoking, moderating alcohol intake, getting regular exercise, leading an active life are the keys to a long life with HIV, if you take your tablets.

Increasingly it's complications of living long-term with HIV and some of its treatments that pose people living with HIV the biggest challenge.

If, in the future, we get to zero infections, there will be millions of people with HIV who have led long, hopefully fulfilling, lives but who are facing a number of challenges brought about by competing health issues as they age.

Let's hope the cure comes sooner rather than later.