We have made unthinkable progress in the fight against HIV/AIDS. Where do we go from here?

Since HIV was first discovered in 1983, medical experts and scientists have grappled with how to best treat the condition. In the 40 years since, there have been significant advancements in treatment that have lengthened lifespans, made identification of the virus easier, and improved the quality of life for those living with HIV and subsequent AIDS diagnoses if patients do not remain in care. 

Over the past four decades, a diagnosis of HIV has evolved from essentially a death sentence to what is considered a manageable chronic condition. From the first identification of the virus that causes AIDS, it would take four years to develop and gain FDA approval for the first medication treatment, called AZT

AZT had been originally developed to treat cancer but was found to be effective in interrupting the HIV-infected cells’ ability to make new viruses and was hailed as a game changer, proving that HIV was treatable. However, it would take many more advancements to loosen the death grip that HIV/AIDS had on the world in the 1980s and through the 1990s.

Challenges and limitations 

While initial HIV treatments brought about hope for those who acquired the virus, they also presented a host of challenges and certain limitations. Traditional antiretroviral regimens were complex, necessitating a cocktail of drugs taken simultaneously, and each drug within the cocktail had its own dosing schedule and side effects, ranging from vomiting and diarrhea to insomnia and bone marrow suppression. 

The complex nature of early treatments lent itself to human error in dosing and non-adherence to the regimen. Those who were living with HIV and in areas with limited resources, such as rural areas or those facing homelessness, were more likely to lack adherence to the regimen and suffer the consequences of dosing errors — if they were able to access antiretroviral medications at all.

The side effects of early HIV/AIDS treatments significantly diminished the quality of life for patients. Although AZT was hailed as the “light at the end of the tunnel” by the company responsible for its production, it was also fast-tracked through the approval system. Additionally, AZT was still costly and out of reach for many. 

Over time, HIV mutated and began to resist AZT. By 1992, AIDS had become the number one cause of death for men ages 25 to 44. It became evident that scientists and experts had to go back to the drawing board to find out how to better combat this stronger strain of the virus.

Advancements in HIV treatment and prevention

As the Centers for Disease Control (CDC) and other experts on HIV and AIDS learned more about how the virus was contracted, spread, and progressed once someone acquired the virus, they began to develop stronger, more effective treatments and prevention methods. 

In 1990, the CDC developed a patient-centered counseling model for the prevention of HIV. This model focused on the important aspects of consent, confidentiality, counseling, correct test results, and a connection to prevention, treatment, and care. This approach wildly changed how the medical community faced the virus and those who carried it, focusing on the human aspect of care instead of a virus-centered model. 

Clinical trials for HIV treatments continued through the 1990s, with different antiretroviral approaches established to see which were most effective in making the virus undetectable. Meanwhile, methods of preventing HIV and other sexually transmitted diseases, such as condoms, became a hot topic of conversation. Everywhere one looked in the early 1990s, people were talking about safe sex. Tests for HIV improved as well, with the first oral HIV test introduced in 1994. By 1995, the first protease inhibitor was approved by the FDA, opening the door for “highly active antiretroviral therapy” (HAART) and ushering in renewed optimism. 

By the end of the 1990s, medical experts were advocating for a “hit early, hit hard” approach to HIV infections, coined by HIV/AIDS researcher Dr. David Ho. This approach advocated for an earlier introduction of highly effective antiretroviral treatment to keep people healthier for longer and is still widely used today to keep HIV undetectable in people for years through early, aggressive intervention. 

What advancements mean for those living with HIV

In the past 20 years, there have been other major strides in HIV and AIDS treatment, including the development of pre-exposure prophylaxis (PrEP medication), highly effective antiretroviral therapy (ART), and even the beginning of clinical trials for a possible HIV vaccine. While it may still be too early to tell if we can eliminate HIV for good, these significant steps forward have brought a measure of hope to communities more commonly affected by the spread and stigma of HIV and AIDS. 

Clinics such as ours, Hope & Help in Winter Park, Florida, continue to offer free HIV testing, primary care availability for those with HIV, and prevention education. Our efforts harken back to the early days of the AIDS epidemic when groups such as the storied Friends in Deed created support for a population who felt as if they had been abandoned. These community efforts go a long way in supporting those who are living with HIV and AIDS, offering not only medical care but also necessary emotional assistance. 

While statistics show that the number of new HIV infections has diminished, the problem has not disappeared. Real change will come with continued scientific study, support, fundraising, and education. As we continue to harness the power of collaboration and technology, bold solutions in HIV treatment will pave the way for a future where HIV/AIDS is not only significantly managed but eventually eradicated.

Lisa Barr is the Executive Director at Hope and Help Center of Central Florida, Inc. d/b/a Hope & Help. She has the privilege of leading an incredible team of talented, compassionate, and dedicated nonprofit healthcare professionals who make a difference every day. For over nine years, she has been overseeing the strategic planning, implementation, risk management, and organizational development of this vital community resource that provides HIV/STD prevention, education, testing, and treatment services. With an MBA from Johns Hopkins University and a background in business development, marketing, and grant writing, Barr brings a combination of analytical skills, strategic thinking, and creative problem-solving to her role. She is passionate about enhancing the quality of life and health outcomes of Hope & Help’s clients, partners, and staff, as well as expanding the organization’s reach and impact in the region. Her mission is to foster a culture of excellence, innovation, and collaboration that enables Hope & Help to fulfill its vision of a world without HIV/AIDS.