What are the hot topics in public health?
Posted at 9:00 a.m.
It is safe to name COVID-19 and monkeypox. The mysterious hepatitis that affects children has caused ink to flow. Cancer and cardiovascular disease continue to make their way into our public discourse.
But there is a disease that we hardly talk about anymore. A disease yet incurable, against which there is still no vaccine: AIDS.
It is in this disturbing silence that the 24e International AIDS Conference. It brings together, both face-to-face and virtual, no less than 12,000 researchers, patients, journalists and members of the affected communities.
The theme of the event: reengagement. Because the fight against AIDS is the victim of a worrying disengagement.
A disengagement that affects research efforts as much as those of prevention and public health. And who must be overthrown.
First, because despite what we may believe, AIDS remains a serious illness with which more than 38 million people on the planet live, including 63,000 Canadians. A disease that killed 650,000 people last year.
Then because the human immunodeficiency virus (HIV) is in a way the perfect enemy of the virologist. For 40 years, this dodging ace has thwarted the best scientists on the planet. It sabotages the lines of defense of our immune system. Mute to thwart our attacks. Remains lurking in hiding places where we cannot eliminate it.
Defeating such a tough enemy for good would represent one of the greatest scientific feats of our time. The knowledge generated would be invaluable. They would have repercussions in several spheres of medicine.
In short, we can think that if we succeed in beating HIV, we will have developed tricks to beat many other viruses.
And if there’s one thing we’ve learned over the past two years, it’s how important it is to have advanced tools against viruses.
If we talk too little about the fight against HIV, it is a lot, paradoxically, because of its successes.
Today, triple therapy allows HIV-positive people to have a life expectancy comparable to that of HIV-negative people. Their viral load is so low that they no longer transmit the virus. The problem: more than a third of people affected do not have access to it on the planet.
For their part, HIV-negative people who fear catching HIV benefit from preventive drugs that reduce their risk of infection by 95% (the famous PreP, or pre-exposure prophylaxis).
These advances are obviously great. But they have a backlash: the fear of AIDS, omnipresent in the 1980s and 1990s, has fallen. And this greatly undermines prevention efforts.
Réjean Thomas, founding president of the Clinique l’Actuel and a key figure in the fight against AIDS in Quebec, says that he recently announced to one of his 18-year-old patients that he was HIV-positive.
“He didn’t even know what I was talking about,” he said.
The Dr Thomas reminds us that AIDS is a serious and impossible to cure disease, which requires taking medication for life. We would do well to say it again and again to the public, especially to young people.
In addition to undermining public health messages, the trivialization of AIDS affects research efforts. Jean-Pierre Routy, a professor at McGill University and co-chair of the conference taking place in Montreal, says that research funds dedicated to the disease have shrunk by a quarter in Canada over the past five years.
To this, we must obviously add the effects of the COVID-19 pandemic. This planetary emergency has mobilized scientists, diverted dollars and monopolized public health discourse. It was perfectly legitimate. But we must recognize the collateral damage.
At the start of the pandemic, testing and access to HIV drugs were made very difficult. This is particularly true in Africa, but also here, where most testing centers have been closed.
Result: last year, the number of new infections increased on the globe, a first since 1997. It is both sad and worrying.
Despite this setback, there are reasons for hope. Messenger RNA vaccine technology, propelled by the fight against COVID-19, is now being tested against HIV. Same thing for monoclonal antibodies.
In Montreal on Friday, the case was described of a patient who appears to have overcome HIV after receiving a stem cell transplant. A handful of similar cases have been documented. Three patients also appear to have recovered spontaneously from HIV. Count on scientists to try to figure out their secret.
The fight against HIV continues. Let’s give ourselves all the means to win it.