The Beginning of the End of AIDS?

Harvey Fineberg Photo by Amy Hart

To mark the 30th anniversary of AIDS, Harvard convened an international symposium in December, AIDS@30: Engaging to End the Epidemic. Leading researchers, activists and government officials from around the world gathered to discuss what we have learned from AIDS and how to apply those lessons to end the epidemic. Dr. Harvey Fineberg, President of the Institute of Medicine and former Dean of the Harvard School of Public Health, presented a summary of the first day’s proceedings:

From the outset, AIDS evoked and exposed both the best and the worst in the human condition: on the one side, fear, bigotry, stigma, distrust, hatred, and despair; and on the other side, love, compassion, caring, trust, community, and hope. Over the years, the good has gained on the bad—there is greater reason for hope today than ever before. We have come to understand that a unified community is the foundation for success against even the most dreadful conditions.

Over the years, the HIV experience has dissolved many traditional boundaries and separations. We heard today that prevention and treatment are no longer being distinguished, instead being viewed as one and the same in terms of ultimate purpose—to improve health. We’ve also seen a reduced separation between population health for rich and poor countries, thanks to the efforts of so many in this room and around the world.

We’ve heard that policy making in the United States has been transformed because of HIV/AIDS. AIDS activism changed the way drug policy was made in the United States, and it changed the way the National Institutes of Health embark on clinical trials. AIDS changed the way science, medicine, and public health are conducted in this country.

At a time when ideology is such a powerful divider, it is worth remembering that AIDS commands attention across the political spectrum. We heard from President Clinton at the beginning of our meeting, and we had today a wonderful announcement from President Obama, yet it was President George W. Bush’s administration that inaugurated the PEPFAR Program. This is one area where, despite the ideological separation in our country, people have been able to work together toward a common goal of humanity.

But we must not let the silver linings distract us from the severity, the enormity, and the ferocity of the problem. At the Battle of Fredericksburg, Robert E. Lee remarked to his generals, “It is well that war is so terrible lest we should grow too fond of it.” While we benefit from the sense of community that AIDS has created, cherish the friendships, celebrate the scientific progress, and delight in clinical advances, we must always remember that our goal is to end the need for all these things. The question this conference poses is, “Have we simply reached the end of the beginning, or are we prepared to make this the beginning of the end for AIDS as a major health threat?”

You do not have to wait until success is inevitable to begin the struggle to succeed. When the Human Genome Project began in 1990, it was imaginable, but it wasn’t easy or cheap, or even certain. It took 13 years, and it consumed $2.7 billion. By the end of the Human Genome Project, it was possible to do the same job in three to four months for $20,000. Today, we are on the threshold of the $1,000 genome. Yet it was the willingness to make the initial investment that made possible all of the progress in capacity and efficiency that has brought us to where we are today.

In a similar way, we must strive to end the AIDS epidemic while facing uncertainty and expecting high cost, but with the conviction that we have enough tools available to accomplish the task with a unified effort. In another 30 years, at the AIDS@60 symposium, we can dare hope that the largest group present will be historians because AIDS will be a story of the past. As we depart from this gathering, let us resolve to make the future of AIDS its history.

Click here for more information and videos of the AIDS@30 Symposium.