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AIDS epidemic in U.S. remains at "unacceptable high" level


WASHINGTON, Nov. 25 (Xinhua) -- In the United States, the AIDS epidemic has plateaued, but it is still at "unacceptable high" level, a U.S. expert said ahead of the World AIDS Day.

"The situation is stable in the United States, stable in an unacceptable high level for at least 10 years and has not gone down. It's still a serious problem," Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), told Xinhua in an exclusive interview.

According to Fauci, there are about 1.1 million people infected with HIV in the U.S., of which about 20 percent do not know they are infected. Those are the ones that more likely will infect other people. Since the world's first AIDS case was reported 30 years ago, the U.S. has seen close to 600,000 AIDS-related death. And among the 65,000 new infections each year in the U.S, about 50 percent are African Americans. In the United States, about 12 percent of the population is African American.

"Our new approach to prevention is to try and get access at community level, to people at most risk, to seek out to voluntarily test, to link them to care, and to automatically get them treatment," said Fauci. "When you get someone on treatment, it is extremely unlikely that they will infect their sexual partner."

Fauci thought the international community's battle against the HIV/AIDS has gotten better over the last 30 years.

Early on, when the disease was inaccurately thought to be a disease of developed world. There was a denial in many countries in Asia, in Southern Africa, South America and Caribbean, that this will turn out to be an extraordinary problem in those countries. As the years went by, it was clear that it was not a disease of gay men in the United States and the developed world. It was a disease mostly in the developing world when 90 percent of new infections occur in low- and middle-income countries and 67 percent of the cases are in Southern Africa.

"The response of the global community first was denial and not full appreciation of the potential impact of the pandemic. As the years have gone by, the response has been better and better," said Fauci, an immunologist that has made substantial contributions to research in the areas of AIDS and other immunodeficiencies, both as a scientist and as the head of NIAID.

The advance in the arena of therapy with drugs has been " spectacular" and "very impressive", he said.

In the early 1980 before there were any drugs, the median survival period of people in the United States who was infected with HIV, was about six to eight months. "Today in 2010, if someone was newly infected with HIV and he's 20-25 years old, and you put them on therapy, you can predict mathematically that they will live additional 50 years," said Fauci.

Over the last couple of years, there has been "significant but slow" advances with vaccines against HIV. For example, there was a trial that was conducted in Thailand in which there was a modest degree of efficacy, about 31 percent of protection.

"That's not enough to have a vaccine available for widespread use but give us some important clues into what next generation of vaccines would be," said Fauci.

As to the "three zeros" target adopted by the United Nations this year, Fauci said that it's "aspirational but not gonna be easy."

"It is good to set very high goals for the future. I don't think that we realistically are gonna get to zero new infections, zero new discrimination, zero (AIDS-related) death in the next few years," said Fauci. "I think it will take several years to get there. I believe that if more countries and the international community are engaged to play a role in trying to stop HIV, to prevent and treat and care for HIV-infected individuals, that we will automatically achieve that objective."

Reducing stigma critical to fighting AIDS epidemic

Reducing the stigma attached to HIV/AIDS by creating an enabling environment for people infected and affected by the disease is a huge challenge, but is really important to making prevention efforts work, a senior U.S. AIDS expert said Wednesday.

"We estimate only one in five Americans who have HIV are actually in treatment, on therapy and fully controlled," Renslow Sherer, director of the International AIDS Training Center at the University of Chicago, told Xinhua in an interview.

Sherer, one of the founders of the AIDS Foundation of Chicago, has been a primary caregiver for persons with HIV since 1982. A visiting professor at Wuhan University in central China's Hubei province, Sherer once met in Badong county a young HIV-positive man who had lost his job because of discrimination and was unable to find a new one. The young man later started a small brick-making business and hired local people with HIV.

"I think it is still the biggest challenge in China, the U.S. and around the world for World AIDS Day to eliminate discrimination against people with HIV ... People with HIV now can live normal and productive lives with a life expectancy of 60 to 70 years ... That's an astounding accomplishment to note for World AIDS Day," he added.

Apart from expanding testing and counseling, it was critical to reduce stigma and discrimination related to HIV/AIDs through laws and regulations, Sherer stressed. "We have to have an environment where a person can be free to be tested and feel that they won't be discriminated against, shunned in their community, and fired from their job, or else no one will feel safe," he said.

Around 2003, the Chinese government decided to provide free treatment to all people who were HIV positive, Sherer noted. "So in a short period of time, the government of China put together a very laudable, comprehensive plan to take care of people who were sick."

"I was impressed by the deep-level of commitment that the government made to HIV prevention and treatment around 2003," Sherer said. He was also impressed by how aggressively the Chinese government and provincial government in Hubei province decided to act against HIV.

A report published by the Joint United Nations Program on HIV/AIDS (UNAIDS) ahead of World AIDS Day on Dec.1 lauded international efforts to stem the spread of the disease and those helping infected persons mitigate symptoms and stigma, calling 2011 a "game-changing" year for the international AIDS response.

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