On World AIDS Day 2011, we speak with Dr Martin S. Hirsch, MD, FIDSA to find out the latest news on the global fight against AIDS. Dr. Hirsch is editor-in-chief of The Journal of Infectious Diseases, professor of medicine at Harvard Medical School, professor of infectious diseases and immunology at the Harvard School of Public Health, and a physician at Massachusetts General Hospital. – Nicola
Q: Thirty years after the first reports of AIDS, why is HIV/AIDS research still important?
A: Although we have made enormous progress in developing effective combination antiretroviral therapies to control HIV infection, we have been far less successful in preventing infection. Thus, in the US, as well as in the rest of the world, there are more people living with HIV infection today than ever before; worldwide, this number is over 30 million. Many individuals who are infected do not know that they are and, thus, they continue to spread virus to contacts by sexual contact, needle sharing, or mother-to-child transmission. We are not near having an effective preventative HIV vaccine, nor is a cure for those already infected on the immediate horizon. The risk of emerging drug-resistant viruses is also always with us. For all these reasons and more, it is essential that research efforts continue until we can say that HIV has been eradicated or is no longer a public health problem in the world.
Q: What notable important discoveries or research findings have there been in the field recently?
A: In my view, the most notable research advances in the field recently have been in efforts to prevent new HIV infections by using treatment as prevention and pre-exposure prophylaxis. Studies published this year by Myron Cohen and colleagues have shown in placebo-controlled studies that by treating HIV-infected members of discordant couples (one infected, one not), new infections can be reduced by up to 96 percent. This emphasizes the need for early recognition of infections and early treatment. It has also been established that pre-exposure prophylaxis with antiretroviral drugs can reduce transmission in high-risk populations, whether they be heterosexual or men who have sex with men. Pre-exposure prophylactic regimens have taken the form of oral therapy or topical administration of vaginal microbicides. The challenge now is to find ways to implement these strategies worldwide to prevent new infections in cost-effective ways.
Q: What should the public take away from these findings?
A: The public should be aware that only by early recognition of infection can we reduce the scourge of continued HIV transmission and disease. The US Centers for Disease Control and Prevention and other organizations have indicated the need for more routine testing of all populations who enter medical care in the US, and gradually our states and other public health authorities are implementing these suggestions. Nevertheless, there are still thousands of individuals in the US and millions in the world who do not know they are infected and who continue to spread virus. The public should insist on more HIV testing with appropriate measures to protect confidentiality among those tested. It is also critical that efforts to make effective therapies available to those in need not be curtailed in these times of budget stringency. Cuts at this time would reap bitter harvests in years to come.
Q: What do you see as the priority areas for future HIV/AIDS research? Where will the next great advances be?
A: There are several priority areas for HIV research in the years ahead. These include:
- Continued efforts to develop safe and effective prophylacti
Lately I’ve been waxing nostalgic, lamenting how fast things are changing, and sometimes not for the better. I’m no Luddite, I feel naked without my FauxBerry and start to shake and seize when I’m away from Facebook for more than four hours, but there is something so…romantic about those things that have been the same for dozens if not a hundred years. For example, I was at the post office the other day when the postmaster pulled out one of those ancient date stamps and began twirling the bands around until he arrived at the proper combination for that day’s date. The soft click of the rubber bands over metal throwing me back to childhood afternoons spent playing in my parents' office.
I had to say something. “Boy, those haven’t changed much have they? You would think they would have come up with some modern alternative that would break down every few weeks and necessitate the purchase of a new one.”
His response surprised me. “Do you know we’ve been ordering these from the same family-run company for a hundred years? In fact, they’re guaranteed for life. They repair or replace them forever.”
“Forever?” I was shocked. I mean, how much could one of those things cost? Ten, maybe twenty bucks? Repair them for life? These people would give LL Bean a run for their customer service dollar.
As I looked around our house that afternoon, I thought about the many things that were throwbacks to—if you’ll forgive the cliché—olden times: sewing needles, cast iron pots, natural paintbrushes. But my gaze fell on the driveway and the one throwback that I most fear losing to “progress”: my car’s manual transmission.
I love my Ford Escape but I had just found out that Ford is no longer making it in stick version, from this year forward they will all be automatics. In fact, when my husband went to replace his F-150 truck a few weeks later he discovered that they no longer even offer that with a manual transmission. I mean really, pick-up trucks and stick shifts go together like a house and its foundation, or a road map and squiggly lines (forget GPS’s for a minute…work with me here). Now only sports cars and big ass trucks (it’s a technical term, I swear) come in manual. I can’t tell you how distressing this is to me. Yes, I can switch to a European brand, but they are harder to get repaired up here in rural ass (another technical term, give me a break) Vermont, and it’s more the point that disturbs me.
Now, over the years I’ve happily made the switch from vinyl to cassette tape to CDs to MP3s (yes, I skipped right over 8-tracks…but if you want to buy some my husband has a couple dozen rotting in the attic that he can't seem to part with), I mean, I now carry 8,000 songs with me wherever I go and that makes me really happy, but this is different. The manual transmission serves a real purpose.
Have you ever driven a stick shift? Even when I was a kid I used to play with our newfangled (it was the 60s) single-handled kitchen faucet pretending it was a stick shift. Vrum, vrum, vrum, making sounds with my lips that vaguely approximated the roaring sound of shifting gears as I imagined the New Jersey scenery whooshing by me as I drove 120 miles an hour down Broad Avenue, the wind in my hair. Even now I feel that thrill exercising a certain level of control over acceleration and braking you just don’t have otherwise (have you ever tried to pass with an automatic? It is scary, people! Lurching forward and hoping you get in front of the car you’re passing before the Mack truck that’s bearing down on you hits you head on).
And then there’s the winter. Trust me, when it is icy and you don’t want to hit the brake hard (which you certainly don’t unless you have a death wish), being able to gently downshift really comes in handy. Yes, I know you can downshift with an automatic but it just isn’t as…I don’t know, subtle…finessed…fun. And I don’t care what the car salesmen tells you, if you drive a manual transmission responsibly (no peeling out of the parking lot, vatos!)
you will use less gas. I hope this doesn’t sound like one of those “When I was young we walked eighteen miles to school uphill through twelve feet of snow in the summer with newspapers tied to our feet and we didn’t complain!” kind of rants. I really welcome advances in technology, but what I’m saying is that it’s nice to have to do something by hand once in awhile, to be able to feel the purring of the engine as you ease it into fifth gear on that empty stretch of tree-lined highway. And I recognize that even the technology of the manual transmission itself has changed significantly, but to lose it forever? I just don’t know.
For me this issue ranks almost as high as the electronic book. Sometimes you just need to feel the road, or the pages. As they say up here in the North Country: if it ain’t broke, don’t fix it!
Hear ye, freakin' hear ye. It was depressing, even in 1998, I went to a huge Toyota tent sale with more than 1000 cars available, and probably 500 of them Corollas, but it took me and the salesman almost 30 minutes before either of us could find a stickshift. Now I drive a Saab, just so I can truly enjoy my stick. Vrum vrum vrum. Thanks Annie for another awesome post.
that was four-on-the-floor good reading, ann. una pregunta: isn't "electronic book" an oxymoron?
mvs
I happened to get my hands or boricua ass (scientific term also) on a stick shift car. It was no corvette, but it was SO MUCH FUN!!!!! I had forgotten.
Wonderful, Tere, but I can't imagine dealing with a clutch in Old San Juan! Yikes!