This engagement is illustrated by (i) the organized lobbying for increased funds for targeted research on HIV (such as by TAG, the Treatment Action Group of New York) (ii) the participation of people living with HIV/AIDS in setting the research agenda in clinical trial committees, boards of foundations, advisory boards of pharmaceutical companies, and scientific conferences and (iii) the part played by groups of patients as channels for distributing the latest scientific information (largely through the Internet). Unlike any other health problem before, there has been a uniquely close involvement of and pressure from individuals and groups infected with or affected by HIV-mainly gay men in the industrialized world-in setting the agenda for AIDS research and pressing for the immediate application of the results. Thus, societal pressures and choices, as well as market forces, have clearly moved the HIV science agenda. Finally, it benefited from the existence of a new market for HIV-related drugs. Third, it stemmed from the drive of multidisciplinary teams of scientists-often young scientists who took their chances.
Second, research agencies made early and substantial commitment to HIV research under pressure from an influential sector of the public in the face of the threat of a new contagious disease. First, it is capitalizing on the formidable progress in the application of disciplines such as molecular biology and immunology of infectious diseases.
If biomedical research on HIV has been so successful, it is largely due to four reasons. This unresponsiveness is particularly sobering in badly affected developing countries, where earlier action might have prevented the current large-scale catastrophe-with some notable exceptions such as in Thailand and Uganda. In general, it appears that the broad societal response to this new epidemic has been slow and has lagged behind the successes of biomedical research. Why is it, then, that in many countries promotions of condom use are not allowed during prime-time television viewing? The majority of educational authorities in the world deny their children access to sex education, mostly on ideological grounds. We know that condoms protect against transmission of HIV, that they literally save lives. Again, there is sound evidence from numerous studies that sex and life-skills education for children promotes safer sexual behavior, but does not lead to earlier onset of sexual intercourse or to increased sexual activity. Another critical area for HIV prevention is sex education for school-aged children. For example, harm reduction among injecting drug users, including needle-exchange programs, has been shown in numerous studies to reduce the risk of HIV infection, and yet in many, if not most countries in the world, such programs are not supported by the government, or are even against the law. I have often seen science being neutralized by ideology when it comes to issues that are difficult for some members of our society. However, such scientific progress has been of little benefit to the millions of men, women, and children in poorer countries, who do not have access to highly active combination therapy or for whom regimens to prevent HIV transmission from mother to child used in the West are not a realistic option.įurthermore, it sometimes seems that solid scientific evidence has no impact on policy. As a result of newly developed therapies, the quality of life for many patients with HIV infection has drastically improved in most Western countries, where there has recently been a remarkable decline in mortality from AIDS. New data on antiretroviral resistance patterns or mechanisms have almost instantly influenced therapeutic approaches. A diagnostic test became available very soon after identification of the causal agent, thereby practically eliminating HIV infection acquired through blood transfusion. We know more today about the biology of this recently discovered virus and the infection it causes than for most other microorganisms and infectious diseases, demonstrating the power of modern biology when applied with intensity and the necessary resources. At the same time, the rate of scientific progress on HIV and the rate at which advances are applied for the prevention and treatment of HIV infection are with few precedents in the history of biology and medicine.
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