25 Years in HIV/AIDS: Much Progress, but No Cure

Today, a Tale of Two Worlds

In the developed world, patients on many current regimens need take only a single pill once a day, a far cry from the late 1990s, when the rule was several dozen, taken at various times, with and without food depending on the drug.

Adverse effects still occur but they are more easily managed.

And resistance is constantly monitored, so that medications can be switched if it develops. And there are many more drugs, so that switching is possible.

There has been, Toronto's Berger says, "a massive transformation of the whole terrain of HIV. I wouldn't have believed it 20 years ago."

But the developed world is only a part of the story. In many parts of the world, access to the life-saving drugs remains poor and HIV/AIDS remains a death sentence.

Berger spends part of his time working in Lesotho, one of the hardest-hit regions of Africa. In that country five years ago, he said, it was like 1984 in Canada.

"People were dying in front of your eyes," he says.

Matters have improved -- at least a little -- as the world finally starts to get together on battling the pandemic. In Lesotho, he says, some of the advances -- HIV testing and CD4 counts, for instance -- are now available most of the time and others occasionally.

And overall, the most recent U.N. AIDS report offers grounds for modest optimism that efforts to slow the pandemic are having an effect.

Chief among those efforts, according to Bartlett of Johns Hopkins, is the President's Emergency Plan for AIDS Relief, or PEPFAR, which has poured money into treatment and prevention in the developing world.

Despite some controversy when it started, the program is now seen as a major success story that "dwarfs" any other health program in our lifetimes, he says.

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