AIDS 2012: Did It Matter That 23,767 People Came to D.C. to Talk About AIDS?

Posted on July 31, 2012 by David Evans

Writing recaps of events such as the 19th International AIDS Conference–which took place last week in Washington, D.C.–one always poses the risk of overshadowing brilliant, but small incremental steps by spending most of the time highlighting the big themes. When it comes to AIDS 2012, however, I’m in no danger of doing that, because aside from an almost robotic repetition of the phrase “AIDS-free generation,” and the official slogan “turning the tide together,” there was no big news or overarching theme.

Revolutionary science was in short supply, though there were some hopeful glimmers, which I’ll get to in a moment, but Obama was a no show. Instead we got a Clinton sandwich, our current Secretary of State near the opening and her husband, the former President at the closing, both peddling an optimistic view of the future that had noted AIDS journalist Laurie Garret asking, “What are they smoking?”

Media stories on the conference seemed even more scant and pallid here at home than in the past, especially considering that the conference took place in the United States for the first time in 20 years. Thus, the power of these conferences to force the world’s attention, for at least several days, towards the realities of the AIDS pandemic appears to be significantly diluted. And so, one has to wonder–did it make a damned bit of difference that we collectively spent millions of dollars to fly nearly 25,000 people from all over the globe to our nation’s capitol to talk about HIV for a week?

As I did not and could not attend every plenary, workshop, satellite session, talking circle and performance that took place I can only give my own opinion and acknowledge that it comes from a limited place. That place is as a treatment and prevention science advocate focused predominantly in the United States. For me, and the work that I do, it was worth it, but only just. Here are my big takeaways, from the most hopeful to the most discouraging:

Hopeful

I am probably biased, as cure research is one of the areas I’m most involved in, but I believe that studies presented in this area represented some of the most intriguing and exciting science of the entire week. The International AIDS Society (IAS) released a new strategy document for cure research two days before the conference started at a pre-conference titled “Toward a Cure.” I attended this pre-conference and most of the cure-oriented sessions during the week that followed.

With each presenter, there was always a stated caveat that we are at the very beginnings of a true search for a cure, but the baby steps we have made so far are impressive, especially considering that many of them were initiated only once word got out that we’d actually cured someone of the disease a couple of years ago.

Much remains to be done. While many acknowledge that a sterilizing cure–where every trace of HIV is removed from the body–will likely take a combination approach and at least a number of years further research, there is evidence that at least in some rare cases we might be able to achieve a cure more simply. There was evidence that simply getting people on ARV therapy within days of infection could help approximately five percent of those individuals ultimately go back off treatment later without losing control of the virus–and that they might be able to remain off treatment for life.

We also learned of two individuals with HIV and cancer who received bone marrow transplants and in whom researchers have not been able to find traces of HIV for at least a couple of years. Further tests will need to be conducted to look more deeply for the virus in this lucky pair. Also, since these individuals remained on antiretroviral (ARV) therapy throughout their transplant and up to the present, the real test will be safely interrupting their treatment and seeing what happens. In the meantime, these brilliant steps forward will undoubtedly keep hope and enthusiasm for cure research alive.

There were also a number of reports showing that expanding HIV testing in a targeted fashion and offering people with HIV treatment earlier than in the past, both for their own health and to prevent ongoing HIV transmission, can not only be cost effective, but in some cases cost savings. Some have objected to the great push toward treatment as prevention (TasP), citing concerns that people might feel coerced to start treatment for prevention reasons when they don’t need it themselves. Numerous studies and posters, however, confirmed that allowing the virus to reproduce, even when a person’s CD4 count is high, can cause all kinds of damage to the body. In fact, the IAS published its own guidelines during the conference, recommending treatment for all, regardless of CD4 count. A large study is ongoing to prove conclusively whether earlier treatment will be beneficial. In the meantime, however, the weight of the evidence appears to support it.

Cautiously Optimistic

One thing that left me feeling cautiously optimistic was a pledge announced by Secretary of State Hilary Clinton to develop a blueprint for an AIDS-free generation. While grand pledges are no guarantee that we will achieve the goals set out in plans of this sort, we have already witnessed the ways in which having a National HIV/AIDS Strategy has begun to transform our own domestic response to the epidemic. This pledge also came with a promise of additional funding to focus on special populations, including men who have sex with men (MSM), sex workers and drug users. This is critical, as the tremendous stigma and criminalization of these populations has resulted in some countries devoting almost nothing to reach individuals in these risk groups despite the fact that they often bear a disproportionate burden of the epidemic.

Along these lines, I was impressed that the conference is finally giving a more central focus and space for exploring the epidemic in gay men and other MSM who are at highest risk of HIV in a majority of countries worldwide. MSM, particularly MSM of color have often received the least resources while having the highest HIV infection rates. Efforts to overcome the systemic homophobia that drives research and programming for MSM into the shadows is finally bearing fruit.

While I am pleased with this greater focus, we must now make up lost time. This is particularly true for black gay men and other MSM in the United States. New research presented at the conference has begun to outline some of the predominant reasons that black MSM remain at highest risk of HIV infection in the United States. Even though black MSM appear more likely to use condoms than other MSM, they have poorer access to health care (whether HIV-negative or HIV-positive). Also, because so many black MSM are already infected with HIV, it means that one slip-up in condom use is vastly more likely to result in HIV infection than for other MSM whose partners come from groups less likely to carry HIV. To make good on this new research we will need to quickly translate it into action.

While not a panacea, the Affordable Care Act (ACA) offers a great opportunity to expand sexual health and HIV care to more individuals. Further work must also address structural factors, such as aggressive racially biased law enforcement policies (think “stop and frisk”) that result in high incarceration rates among young MSM of color and also incredibly high rates of unemployment. Lastly, evidence-based interventions to help young MSM of color remain resilient in the face of racism and homophobia are also urgently needed.

Discouraged

When former President Bill Clinton closed the conference he urged us all not to despair over funding shortfalls at a domestic and global level. He insisted that as long as we (governments and civil society organizations) demonstrate that our programs are effective and cost efficient, “the money will be there.”

I would very much like to believe him, and perhaps this is where my views part ways with some others who attended the conference and expressed a more hopeful feeling upon leaving Washington, D.C. Yes, we have some very powerful tools to tackle the epidemic: 1) rolling out more aggressive testing efforts; 2) expanding treatment coupled with adherence support to more individuals, both for their own health and for the prevention benefits that would follow; and 3) offering combination prevention including PrEP for those at particularly high risk of infection.

Researchers have found that under certain cases, each of these can be cost effective, and at times, cost saving. Also, health care systems and non-governmental organizations have been retooling for the past several years to ensure that money is spent on high-impact, evidence-based programs. We’re doing exactly what Clinton outlines.

Yet, these are the realities on the ground:

  • The European Union has teetered on the brink for over a year and each announcement of a “rescue” is following by another announcement threatening impending collapse. Many experts suspect that if countries such as Greece or Spain end up being forced out of the Union, our own economy will slide back into a recession, thus leaving the biggest donor nations in dire financial shape.
  • Exploding economies in China and Brazil have begun to slow down, lending further weight to fears of more economic woes for us all in the near future.
  • When new efficiencies and costs savings were realized in the resource-poor nations where HIV treatment has been expanded, the U.S. government chose to cut money out of global funding for AIDS rather than commit the additional money they’d originally pledged toward expand treatment to more of the millions who still go without ARV therapy. When people claim that HIV is a “manageable chronic disease,” I can only laugh bitterly at their naivete when I think of the millions who still don’t have access to ARVs. You can’t manage your disease if you don’t have the medicine.
  • Experts say that Republicans–who have vowed to disable or kill the Affordable Care Act–could easily win both the Senate and the Presidency and make good on that promise. I’m astounded when I hear my compatriots claim that Obama has a good shot at winning a second term. No president, aside from Franklin Roosevelt, has ever won a second term with an economy as bad as ours is. Mitt Romney may be incredibly unlikeable, but that won’t matter if middle-of-the-road independent voters in swing states who are disenchanted with Obama outnumber the young people and people of color who swept Obama and many Democratic representatives and senators to victory in 2008–and voter suppression laws have already been put on the books or expanded in many of those swing states that disproportionately target those predominantly Democratic voters. If you care about the people with HIV, and if you further recognize the need for the Affordable Care Act with all of its flaws, you absolutely must do everything you can to ensure victories for Obama and a number of vulnerable Democratic senators and representatives throughout the nation.

These are just a few of the things that keep me up at night and that also leave me worried that just as we have gained the tools to turn the epidemic around we may find ourselves without the resources to implement them.

International conferences can function like revival meetings, getting us fired up and reenergized to tackle our problems with new vigor. Some have publicly lauded this conference and expressed renewed optimism about the field. I think we’ll only come to understand AIDS 2012′s value and legacy in future years. What I most hope, however, is that we will watch our governments carefully and hold them accountable for the promises made. Perhaps this conference will ultimately be seen as the moment when we actually did turn the tide on the epidemic. Over the past 30 years of the epidemic we have, in fact, made epic accomplishments that many skeptics argued would be impossible. I’m not giving up hope, but I am watching and witnessing the promises made this year and I will do everything I can to ensure that those who made them are held accountable if they never come true. I hope you will join me in that task.

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Letter: HIV test expansion law is a key step

August 17, 2012

By

If you don’t know your HIV status, you should.

Today, it’s easier than ever in Massachusetts to learn your status through your doctor thanks to a change in the state’s HIV testing law that went into effect on July 26. This new law, “An Act to Increase Routine Screening for HIV,” modernizes the Commonwealth’s HIV testing laws by replacing the need for written consent before an HIV test can be administered with verbal consent. The new law still maintains all privacy protections for patients that were present in the old law.

With an estimated 26,000 to 28,000 people living with HIV/AIDS in Massachusetts, and approximately 21 percent of them unaware that they are HIV-positive, it’s clear that we need expanded HIV testing of state residents to end the epidemic. Expanded testing in communities like Boston should make an impact; the city ranks second out of the state’s top 15 municipalities with the highest rates of new diagnoses of HIV infection. Statewide, about one-third of those who learn that they are HIV positive are also diagnosed with AIDS within just two months of their HIV diagnosis, which shows that they may have been HIV-positive for years without knowing it—and without their health care providers ever suggesting that they get tested for HIV.

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<img src=’http://d1.openx.org/avw.php?zoneid=231653&cb=INSERT_RANDOM_NUMBER_HERE&n=a1386b9f’ border=’0′ alt=” />

Massachusetts has long been a national leader in the fight against AIDS. New diagnoses of HIV have declined by 54 percent since 1999, which will result in $2 billion savings in health care costs. At approximately 650 new diagnoses annually, we are tantalizingly close to eliminating the spread of HIV in Massachusetts. A critical tool in this fight will be the ability to more easily test those who are most vulnerable to HIV infection, including people of color and gay and bisexual men.

All that said, it is clear that we can’t test our way out of the epidemic. In 2009, between June 27 and July 29, 2009, AIDS Action Committee held five town hall-style meetings to solicit feedback from providers, patients, and activists around current testing practice. We learned that stigma around HIV testing prevents some people from getting tested. We learned that some people who are vulnerable to HIV infection fear losing health care insurance if they test HIV positive. We also learned that there is a profound lack of confidence in the confidentiality of HIV tests.

Now that the challenge of expanding HIV testing is behind us, we need to work together with the medical and public health communities to find a way to reduce stigma. And as we continue to move toward universal electronic medical records, we need to find ways to address patient concerns about confidentiality and ensure their full participation in the process.

In the meantime, the single most important thing you can do to end the epidemic is to learn your HIV status.

Rebecca Haag

President and CEO

AIDS Action Committee of Massachusetts

NY – Judge rules against felony HIV prosecution for second time

Created on 14 August 2012 Category: U.S. HIV Policy & Law News

Syracuse, NY – For the second time in as many months a judge has ruled Onondaga County prosecutors don’t have sufficient evidence that unprotected sex with someone with HIV creates a “grave risk” of death.

In a 13-page decision made public today, state Supreme Court Justice John Brunetti ruled the District Attorney’s Office did not have evidence to support a felony reckless endangerment prosecution against Terrance Williams for knowing he had HIV and having unprotected sex with another man.

Instead, the judge ordered the felony charge of first-degree reckless endangerment reduced to a misdemeanor count of second-degree reckless endangerment.

The judge also ruled there was sufficient evidence to support a prosecution for a misdemeanor charge of third-degree assault.

Williams, 23, has been indicted twice on felony reckless endangerment charges based on allegations he created a grave risk of death to another man from July to October 2010 by engaging in consensual sex without revealing he had been diagnosed as HIV positive in December 2009.

Brunetti dismissed the felony charge the first time last month, ruling that the prosecution could not prove a grave risk of death to the victim without having presented expert medical testimony to the grand jury about the nature of the HIV virus, AIDS and the prognosis for someone diagnosed with either condition now.

The prosecution presented new evidence to another grand jury in obtaining an indictment again charging Williams with felony reckless endangerment.

But in the latest decision, Brunetti concluded the testimony of the victim’s treating physician, Dr. Timothy Paul Endy, did not provide sufficient proof for that charge either.

With respect to patients with AIDS, Endy testified that treatment with the appropriate medications enables such patients to recover and live a normal lifestyle, the judge noted.

With respect to patients with the HIV virus, Endy testified that treatment with the proper medication – coupled with proper nutrition, no abuse of alcohol and a stop to smoking – “can actually put the virus to sleep” and allow the person to live a very healthy normal life, Brunetti added.

In a worst-case scenario, someone with HIV who did not seek treatment and developed AIDS would have a mortality rate of 20 percent or higher, Endy testified. But even that situation would improve dramatically with treatment, the doctor added.

If the victim in Williams case were to stop taking medication, he could die within five years, according to Brunetti’s rendition of Endy’s testimony.

Given what Endy testified to about HIV and AIDS, there is insufficient evidence to support the allegation Williams’ conduct created a grave risk of death to the victim, Brunetti concluded.

Additionally, the judge concluded there was insufficient evidence to support allegations Williams’ conduct amounted to depraved indifference to human life given a lack of proof that it was “imminently dangerous” or created a grave risk of death.

Even a one-in-five risk of death for someone who did not seek treatment does not amount to a grave risk of death, Brunetti ruled.

As he did in his earlier decision, Brunetti noted legislators in New York could address the issue by joining more than 30 other states in passing legislation that specifically makes it a crime to create a risk of passing HIV to another.

Such legislation was introduced in Albany in January, the judge said.

Assistant District Attorney Geoffrey Ciereck, who responded to Brunetti’s initial ruling by presenting the case to a new grand jury with additional medical evidence, was unavailable for immediate comment today on what the prosecution intends to do in the wake of the judge’s latest decision.

Author: Syracuse.com
“WHAT DO YOU THINK OF THE RIGHTS OF PLWHA VERSUS NON POSITIVE.  DO WE NOT BECOME WHAT STIGMA HAS DONE TO PLWHA?
“LEPER”?  ”   DIRTY”?   “THOSE PEOPLE”?

Op-ed: Getting Wiser About AIDS Activism

Created on 14 August 2012 Category: North America HIV News

A Cycle for the Cause rider talks about his maturation as an HIV/AIDS activist.

I was born in 1983, the year The Center was founded, during the height of the AIDS crisis in the United States. By the time I came of age, HIV had been identified, accurate testing methods were developed to detect it, and there were already effective treatments to prolong or prevent an AIDS diagnosis.

My desire to understand the events of the past coupled with anxiety about HIV transmission led me on a search for information. I educated myself about the epidemic through reading works like Randy Shilts’sAnd the Band Played On, and I became more attuned to the gravity of those years and the struggles my community faced.

Andy Cataldo

As a young gay man new to New York City, where I arrived fresh out of the closet in 2003, I didn’t want to fall victim to the complacency that Larry Kramer warns my generation about. I sought ways to get involved. I volunteered for more than three years as a peer hotline counselor for Gay Men’s Health Crisis. Then, as the AIDS Walk New York Team Leader in my workplace, I leveraged my employer’s charitable contributions by rousing the support of my colleagues, ultimately convincing the company to become an event sponsor.

Thanks to the persistence and diligence of many brave men and women who advocated for public awareness, government funding and drug trials, I was spared the horror of watching a multitude of my friends suffer and die. However, looking at current infection statistics in New York City alone is a reminder that HIV/AIDS is still a very real problem.

I am a new rider in Cycle for the Cause for those still affected by HIV/AIDS. I’m riding as a reminder for myself and for my friends in honor of what it must have been like during the worst years of the epidemic, when close friends were lost and there were no answers.

ANDY CATALDO is a member of Team Eagle. Support this rider and the Center’s HIV/AIDS-related services by visiting CycleForTheCause.org

Author: Advocate

PMBSGN @ MIRC 8/21/2012

Positive Mind & Body Support Group Network

&

Midway Immunology & Research Center (MIRC)

Cordially invites you to an

Evening Dinner

Amongst Friends

Tuesday, August 21st, 2012

Topic:  HIV & Depression

 Presented by – Dr. Noah Lee DO

 

Sponsor by – ViiV Healthcare  – Melanie E. Hopkins

     Regional Clinical Specialist

6:00 – 6:30pm Dinner

6:30pm – 7:30pm Presentation

7:40pm – 8:30pm – Conclusion     

 

             

 

Location

Midway Immunology & Research Center (MIRC)

356 East Midway Road

Fort Pierce, FL  34982

772-464-9746

 

For additional details regarding this meeting you may also contact:

Positive Mind & Body Support Group Network

“A Positive Life is a Sound Mind & Body”

(772) 563-2503 – (772)453-1067

www.positivemindbody.wordpress.com  

 Project Response – 772-464-0420

 

 

 

 

Stigma of HIV

By Deborah Kotz, Globe Staff

The retiree was sitting in a bed at South Shore Hospital last December, chatting with two visiting friends, when her physician walked into the room and declared, “I understand you have HIV.”

It was supposed to be a secret, and the patient insisted to the friends from her retirement community that she didn’t carry the virus. But they left quickly and one no longer speaks to her.

“We used to eat together all the time. Now we never do. She just avoids me as much as she can,” said the 65-year-old woman, who wanted to remain anonymous. “My closest girlfriend doesn’t even know I have HIV. I don’t want people to shun me. I’d be alone.”

Three decades after the start of the HIV/AIDS epidemic, thousands of people like her are unwilling to disclose their condition because they fear losing their jobs, their friends, or a significant other.

More than one in five Massachusetts residents living with HIV reported that they “work hard” to keep their infection status a secret from everyone, and nearly half said that they had not revealed their status to anyone outside of immediate family, according to a 2009 study conducted by Harvard Law School’s Health Law and Policy Clinic.

Early treatment of HIV infections is one of the best ways to slow the spread of the virus, but the stigma that still surrounds the disease leads people to delay HIV testing, put off needed care, or not reveal their infection status to medical providers, the authors wrote.

In the survey of 284 HIV positive people, about 30 percent said they recently had been treated badly by health care providers or felt stigmatized by doctors and support staff. Some reported their HIV status had been involuntarily disclosed.

That has happened to the South Shore Hospital patient twice. She said she had not told anyone when she was diagnosed with HIV in 1985. No one knew for 10 years, until she was admitted to South Shore with seizures caused by the HIV infection. The doctor treating the woman announced her HIV status to her mother and brother in a hospital waiting room, also without her approval.

“It was horrible,” she said, “but I guess they didn’t know better back then. At this point, they should be educated.”

Though South Shore Hospital officials would not discuss the circumstances of the incidents, they confirmed the authenticity of letters to the patient communicating the hospital’s wish to rectify the most recent privacy breach. The Globe obtained them from the nonprofit Gay & Lesbian Advocates & Defenders in Boston.

In a letter from the physician in the 2011 case, Dr. Fadi Chalhoub apologized to the patient for “any stress” that his actions may have caused her and added that he had completed “additional training in patient privacy.”

He no longer works at the hospital and did not respond to telephone messages left at the hospital in Florida at which he works and at his home.

Under federal law, providers can in some cases be fined for publicly disclosing health information without a patient’s consent, and state law specifically prohibits health care providers from disclosing patients’ HIV status without their written consent.

Last year, Massachusetts General Hospital agreed to pay $1 million to the federal government after a hospital employee lost medical records for 192 patients, including some infected with HIV. South Shore would have been required to report the HIV disclosure to the US Department of Health and Human Services. Officials would not say whether an investigation was underway.

South Shore Hospital spokesperson Sarah Darcy said in an e-mailed statement that whenever breaches of privacy occur, hospital administrators “review the factors that led to the situation and take steps to strengthen our systems and procedures.”

Lingering myths about how HIV spreads may be contributing to the stigma against those who are infected. Some people still believe the virus can be transmitted via plates of food, toilet seats, or a spray of saliva, according to the federal Centers for Disease Control and Prevention. (It spreads only through blood or sexual intercourse.) And few are aware that the latest drugs to treat HIV often make the virus undetectable in the bloodstream and, thus, far less likely to spread, even through unprotected sex.

As a result of these misconceptions, some say they would prefer to avoid people infected with the virus. A 2011 Kaiser Family Foundation survey of nearly 2,600 Americans found that 18 percent of respondents would not feel comfortable working with someone who had HIV, and nearly 30 percent would not want their child to have a teacher who was HIV positive. Close to half of the survey respondents would not want to eat food prepared by an infected individual.

HIV specialists say such attitudes are one reason some people at risk of infection do not get tested for the virus. Of the state’s 26,000 to 28,000 residents estimated to be infected with HIV, about 15 percent to 18 percent do not know they are carriers, according to Rebecca Haag, president of the AIDS Action Committee of Massachusetts. To encourage more patients to get tested, the state implemented a new law last month that removes the requirement of specific written consent for HIV testing, allowing patients to provide just verbal consent.

“We pushed for this law to try to normalize testing for HIV,” Haag said, “to allow doctors to offer it without any judgments” and for patients to not feel a stigma surrounding the test itself. The CDC has recommended for years that doctors stop using separate consent forms for HIV testing, and Massachusetts was one of the last states to require such forms.

Theresa Nowlin, 49, of Dorchester said she was cut off from her mother’s side of the family after she was diagnosed with HIV more than 25 years ago. “At first they served me on paper plates with plastic forks but then they just stopped inviting me to Christmas and Thanksgiving,” she said. “They still treat me like a germ.”

The woman whose HIV status was disclosed at South Shore Hospital said a fellow resident in her retirement community who is open about being HIV-positive is referred to as “the girl with HIV” by other residents and shunned.

“People are going underground more with their HIV status,” said Haag. “Some who used to be active in our organization are pulling away; they tell me they don’t want HIV to be their primary label on the job or when they’re dating someone new.”

Deborah Kotz can be reached at dkotz@globe.com. 

The HIV Pandemic: Turning the Global Tide

 

Posted: 08/07/2012 12:49 pm

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The XIX International AIDS Conference (AIDS 2012) was convened from July 22-27 in Washington, DC. This was an historic moment – not only because it was the first of these biennial conferences to be held on this nation’s soil since 1990; but also because it took place amid rapid expansion and development of new, innovative therapies for treatment and prevention.

During his plenary lecture, “Ending the HIV/AIDS Pandemic: From Scientific Advances to Public Health Implementation”, Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, stressed that the robust arsenal of antiretroviral drugs and scientifically proven interventions now available to treat and prevent HIV infection offers unprecedented opportunities to make major gains in the fight against HIV/AIDS and ultimately end the pandemic.

Over the past three decades, the accumulation of scientific knowledge has enabled scientists to better understand the virus and know what interventions work. While there’s still no cure and no vaccine, there are over 30 licensed drugs currently on the market. For persons with HIV and AIDS, biologic medicines are the cutting-edge drugs that hold the promise to transform their lives. As the name suggests, biologic medicines are created using biologic materials — living starter cells. These cells are then manipulated in a lab to produce large, multifaceted compounds. The end-result is both complex and genetically complicated.

The U.S. Food and Drug Administration (FDA) has helped to layout an initial framework to a pathway for follow-on versions of biologic drugs, or biosimilars, since first tasked with the responsibility in 2010. But before any new medicines are approved for broad consumption, there are still several issues that must be resolved to ensure that these medicines are safe.

Most Americans are familiar with generic drugs. At the pharmacy, one can purchase either the innovator drug or the generic version. According to the FDA, a generic pharmaceutical must have the same active ingredient, dosage form, strength, route of administration, quality and performance characteristics, and intended use as the brand name product. This is possible because generic drugs are produced in an identical fashion with the same chemical molecules.

Biotech medicines are very different. By virtue of their unique starter cells, it is impossible for another pharmaceutical laboratory to perfectly replicate the innovator biologic medicine. Scientists can certainly get close though, which is why these copycat medicines have been dubbed biosimilars.

The FDA has the opportunity to take several extra steps that will create a standard to ensure that biosimilars are safe for their patients. Rigorous clinical trials coupled with a vigilant tracing program will limit the number of adverse effects experienced by patients. Also, giving each new biosimilar a unique name and distinct label will help physicians and pharmacists recognize the medicine and determine whether it is suitable for a particular patient. States must also ensure that physicians and pharmacists are notified if a patient is switched from the innovator biologic to its biosimilar.

A few additional precautions will make an enormous difference in assuring health care providers that these medicines are safe for patient use. With the proper safeguards in place, patients can be assured that they have access to these biosimilars and have hope for an enhanced quality of life as they live with HIV/AIDS. For example, biologics are currently used to treat anemia, which is a serious complication seen in 95% of people with HIV and AIDS. Further, new monoclonal antibody therapies in development (including Progenics’ PRO 140, and Tanox’s TNX-355) hold promise for HIV-positive patients who no longer respond to other drugs. And in the future, biosimilar versions of these medicines will increase accessibility for all patients.

Thirty years in, the U.S., indeed the planet, is making great strides in HIV and AIDS research. Dr. Fauci’s vision of an AIDS-free generation will only be realized with innovative biologic and biosimilar medicines that are effective in and accessible by all affected populations. The continuing challenge is harnessing the societal and economic will and resources to make it a reality.