World AIDS Day, on Dec. 1, is a good time to measure how far we have come in the fight against AIDS. The first official report of what would become known as the AIDS epidemic was published in 1981 by the Centers for Disease Control and Prevention (CDC). Back then, HIV was considered a death sentence. Since then, new medications have helped shift HIV to a manageable disease, but more than 36 million people worldwide are now living with HIV. In Montana, 634 people have HIV as of the end of June; in Billings, about 120 people are living with HIV.

The first effective weapon against AIDS came six years later, a drug called AZT. Taking it involved a complicated routine, and people taking AZT were only expected to live months longer, not years longer.

In 1996, doctors started prescribing antiretroviral medications in combinations, usually of three medications at once, to attack HIV simultaneously. Fast forward to today, when HIV is treated with one pill once a day.

Those medications have paved the way for individuals to lead longer, healthier lives. Although the cost of the medication continues to average a staggering $2,000 to $3,000 a month, most insurance plans, including Medicaid, will cover the cost with a minimal co-pay. In the United States, AIDS drug assistance and patient assistance programs help keep prices affordable so no one should ever have to go without their medication.

While death rates from HIV have declined, about 1.1 million Americans are living with HIV. Testing uncovers about 38,000 new infections each year. One method of combating the spread of HIV focuses on treatment as prevention. It works by making sure that HIV infected individuals take their antiretroviral therapy (ART) the right way, every day. Taken correctly, the therapy reduces the “viral load,” or presence of the virus in the blood and body fluids. If individuals with HIV have a very low, or undetectable viral load, they greatly reduce their chances of spreading HIV to others.

In a recently published CDC study of viral suppression, Montana HIV prevention and treatment programs were able to achieve viral suppression in 92 percent of newly diagnosed persons within a year. Montana programs achieved the highest percentage among 38 jurisdictions the CDC studied.

Another prevention tool is called PrEP, which stands for pre-exposure prophylaxis. PrEP helps prevent high-risk individuals from getting an HIV infection. When the medicine is taken correctly each day — and used in combination with condoms and other safer-sex measures — it can lessen a person’s risk of getting HIV through sexual contact by up to 90 percent. Truvada was the first prescription drug approved for high-risk individuals.

Other existing prevention strategies include abstinence, limiting sexual partners, using condoms correctly, and never sharing needles or syringes. A combination approach is ideally the most effective.

HIV continues to affect people of all ages, races, sexual orientations and social classes. Since an estimated 15 percent of those who have HIV do not know that they are infected, the CDC recommends that all individuals between the ages of 13-64 be tested for HIV once in their lifetime and continue to be tested annually if they are involved in high-risk behaviors, such as sharing needles or having sex without condoms.

While medical researchers haven’t reached the goal of curing HIV infection, public health efforts can make a difference in slowing its spread.

Jace Dyckman, a prevention health specialist, may be reached at 651-6416 or jace.dyc@riverstonehealth.org

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