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Late Sunday afternoon, less than a mile from the White House, the U.S. will witness something that it has not seen in 22 years: the opening of an International AIDS Conference.
The meeting, which this year is expected to draw about 25,000 scientists, activists and celebrities, has been held abroad for two decades because in 1987 the U.S. Senate unanimously passed a measure preventing anyone with known HIV infection from entering the country. At the time, the gathering—launched in 1985, four years after the first recognition of cases in the U.S.—alternated every year between U.S. and foreign locations. The 1990 conference in San Francisco, the first held after the rule was finalized, was gravely disrupted by thousands of delegates who stayed away—so much so that Harvard University, set to be the next U.S. host, announced it would withdraw its sponsorship unless the ban was lifted. It was not. The 1992 conference moved instead to Amsterdam, and the annual meeting stayed away until President Barack Obama lifted the travel ban in late 2009.
So much changed in that 22-year span that the conference’s return effectively marks a truly new phase in the epidemic. The latest report from UNAIDS, the United Nations agency that monitors the global epidemic, backs up the sense that things are changing. The report, released Wednesday, found that among the 34.2 million people living with HIV, fewer are dying: There were 1.7 million deaths last year worldwide, compared to 1.8 million the year before and a peak of 2.3 million in 2005. At the same time, the report said, new infections are declining too, by almost 20 percent in the past 10 years.
Simultaneously, after many years of disappointments, research is returning hopeful results for both prevention and treatment. Three years ago, scientists reported the first promising findings in the search for an HIV vaccine, considered the key to global eradication. Two years ago, researchers published the first partially successful trials of both a microbicide and a drug cocktail that may prevent infection. Last year, a nine-country trial demonstrated that getting infected people into treatment very quickly can keep them from passing the disease along. And since 2007, scientists have been closely watching the "progress of the “Berlin patient"—the only person, out of 60 million believed to have been infected in more than 30 years, who appears to have been cured of HIV.
The situation now is so different from 1990—when AIDS was a fast-moving, terrifying and invariably fatal disease, as captured in the new documentary How To Survive A Plague—that two HIV researchers writing in this week’s New England Journal of Medicine daringly titled their editorial: "The Beginning of the End of AIDS?"
For anyone who remembers HIV's apocalyptic arrival—I’m one of them, and lost many friends in the early days—the current moment feels as major a shift as 1996, when multi-drug cocktails came to market and people visibly on the verge of death recovered in ways that seemed miraculous. A friend quipped then that it was the first time in 15 years he could take his florist off speed-dial.
And yet: Major challenges remain, and in many ways the perception of AIDS as a chronic disease may make them harder to tackle.