Over the past 10 years, the burden of living with HIV has eased considerably. What's made much of the difference is combination therapy, or having several choices of HIV medications that can be used together, to keep the virus at lower and safer levels in the body.
I hope someday soon, we'll also have a medical breakthrough to help prevent HIV infection. As it stands now, the only proven method is to pay close attention to how we live our lives: using condoms, getting regular STD screenings, and avoiding high-risk activities.
However, with 14,000 people becoming infected every day around the world, we clearly need more HIV prevention tools. Several strategies are under investigation but our best long-term hope to stop the global spread of this disease is finding a safe, effective vaccine. In fact, vaccines are the only way that a viral epidemic – like smallpox – has ever been successfully stopped.
While the ultimate goal of HIV prevention research is a vaccine that would eliminate the chance of becoming infected, most experts believe that progress will be made step by step. The path to the vaccine will be similar to HIV treatment research's search for the cure – the first products to be introduced will most likely only provide us with partial levels of protection against the virus.
An example of a partially effective vaccine is the first polio vaccine introduced in this country, which offered protection to about 60 percent of the population. The vaccines that came later were much more effective, eventually leading to the elimination of the disease. Protecting 60 percent of the population was an important first step. If we found a partially effective HIV vaccine, we'd still have to practice safer sex but as a community, our overall risk level would go down. So, too, would infection rates.
Another possibility would be a vaccine that slowed down the time it takes to progress to an AIDS diagnosis. If someone got vaccinated and then became infected during sex or drug use, they would stay healthier for a longer period of time before needing HIV medications. It would work by training the body's immune system to recognize the virus immediately upon exposure and to keep it at low levels. Teaching the body to recognize HIV without ever exposing someone to the virus is the challenge of vaccine research. None of the vaccines being tested contain HIV.
This type of vaccine holds several promises for HIV prevention. When someone's viral levels are low, it is probably less likely that HIV will be transmitted to someone HIV negative. The vaccine might also prevent the incredibly high surge in levels of the virus that occur during the first weeks of infection, a period that researchers now believe is responsible for one-third of all new infections.
For women, vaginal creams, called microbicides, that prevent HIV infection are also being studied. If these products prove effective, women could protect themselves independently for the first time, without their partner's knowledge or cooperation.
Another study is evaluating if a common HIV medication, tenofovir, is safe for HIV-negative people to take on a daily basis. If it proves to be safe, it may be tested to see if it can prevent HIV infection. Again, this strategy could prove beneficial to people who need an option that doesn't require the consent of their partner or who need an extra level of protection.
To realize these goals, it will take activists pushing for greater cooperation between international corporations and governments, as well as firm commitments to make discoveries available to everyone who needs them. In the coming years, it will also take thousands of HIV-negative people from every racial and ethnic group who are willing to volunteer in clinical trials.
Last year, I became an HIV-negative activist by volunteering to take part in a new HIV vaccine trial. I did it for many reasons – for my nieces and nephew, so that they might live in a world safer from HIV infection. For the gay community as a whole, who have already suffered enough. And for the people of the world without access to enough condoms, information, or other resources to keep themselves safe.
Tom Kennedy is a member of the HIV Prevention Planning Council and group counselor at the AIDS Health Project. For more information, visit www.sfisready.org or www.avac.org.