OPINION: What I Hope for: A World United Against AIDS

I was diagnosed with HIV 21 years ago but probably caught it several years before that. I am among the lucky ones who survived until good drugs became available to allow my life to continue.

But I have an income and health insurance. Those without these advantages would have far fewer chances to live this long with this disease -- or any disease for that matter.

The HIV epidemic was painful in its early years, especially as I and all of us buried many friends and suffered through its uncertainties and devastation. Fortunately, I can now also be happy that some progress has been made.

Almost 1,000 babies were born in the United States with HIV in 1992; today we have fewer than 50 HIV-infected babies born here each year.

Deaths due to AIDS in the United States hit an all-time high of 50,877 in 1995. Combination therapy was introduced in 1996, and deaths plummeted so that only 18,017 AIDS deaths were recorded in 2003.

Now there is news of even better drugs that are easier to take that have fewer side effects and offer more complete suppression of HIV.

A Turning Point

I remember well the International AIDS Conference in Durban, South Africa, in 2000. Until then, no conference had taken place where AIDS persists the most -- south of the equator and in the developing world.

"Access for All" was the main theme of the conference. Until then, no one thought it possible that anti-HIV drugs could be made available in the part of the world where 95 percent of the infections happen to be.

Now, in 2006, 15 percent of South Africans who need anti-HIV drugs have them, and that number is going up rapidly. That has brought hope and encouragement to health care workers and infected people there and everywhere.

On this, the 25th anniversary of HIV, I thought that we might share some of the things that we hope we will see in whatever remains of my lifetime.

I hope that the scientific advances continue, that the therapies get better, become easier to take, and become more effective. I hope that everyone who needs them can get them and that we develop an HIV vaccine.

Still, prevention is our best weapon against HIV. We have promising evidence from South Africa about the effectiveness of male circumcision, and we will now have to figure out how to deploy that strategy widely and safely. We also have to work hard on microbicides and other female-controlled methods so that women can take charge of their health.

Fighting the Inequities

There is a wonderful system of care in the United States for people with HIV. It includes coverage through Medicare and Medicaid, the Ryan White Care Program, and the AIDS Drug Assistance Program. But why should someone with cancer or diabetes not have the same level of care as someone with HIV? I hope that we live to see the day that the benefits of HIV care are extended to everyone with a chronic disease.

HIV hits African-Americans and Hispanics especially hard. And they are less likely to experience the benefits I have available to me. They are much less likely to have survived to this point and are more likely to die from HIV than their white or Asian counterparts with HIV. I hope that this problem is solved in our lifetime.

HIV has made us recognize that people express their love for each other in a variety of ways, and sometimes that love is expressed between people of the same gender. There is certainly much more tolerance today than there was 25 years ago, but I hope that we can say at the end of my life that full equality has been reached.

I hope that we can experience a time in the United States when we are realistic about the fact that adolescents are sexual, that some parents or groups might prefer abstinence, but that all adolescents need to know how to take care of themselves if they do decide to have sex.

HIV has focused attention on gender inequity, but inequality still remains and still fuels the epidemic. What will it take to create a truly gender-equal world?

HIV has taught Americans that there is a big world out there, and that our wealth and resources can do a lot of good. I marvel, every time I go to Africa or South America or China to do my AIDS research, at the energy and commitment of the people with whom I am privileged to work. HIV has taught us that we have much in common, and that we can work together for everyone's betterment.

I hope, at the end of my life, that our country recognizes that our fate is tied inextricably with the rest of the world, that we do our best work when we work together with others. I hope we can say that we really stepped up, did our best for our own citizens and the citizens of the world.

Thomas J. Coates, Ph.D., is professor of infectious diseases and director of the UCLA Program in Global Health at UCLA's David Geffen School of Medicine.