World AIDS Day: Reflecting on Over 40 Years of Innovation and Collaboration

In today’s world, healthcare systems are under immense stress, navigating numerous challenges, including chronic diseases, infectious outbreaks, and resource constraints. This pressure has underscored the need for a comprehensive approach to patient care that moves beyond specialty silos and treats the whole patient. The fight against HIV/AIDS has provided a blueprint for such an approach.  

Innovative Science and Drug Development  

The scientific advancements in HIV treatment over the past 40 years have been remarkable. We now have six-monthly injections to control HIV, single-tablet regimens, and medicines with improved tolerability and safety profiles compared to those of two decades ago. These innovations have revolutionised the management of HIV, offering patients more convenient and effective treatment options.  

 Moreover, these medications are not confined to high-income countries. Global access initiatives have ensured that life-saving treatments are available worldwide, transforming the HIV/AIDS pandemic. The annual cost of therapy in the USA or Europe was approximately US $22,000. It eventually reached $50 per year in lower—and middle-income countries (LMICs), making treatment feasible on a vast scale.   

Death rates declined. Mother-to-child transmission slowed. New and better drugs, and eventually more potent preventive tools, were developed through a massive public sector investment in HIV research. Indeed, when the US National Institutes of Health sought trial sites for the COVID-19 vaccine trials in 2020, it turned to the HIV research networks and trial sites. Until COVID-19, the HIV research effort was the largest in history devoted to a single disease.  

Collaboration Across Sectors  

The success in tackling HIV has been a result of unprecedented collaboration between patients, patient groups, non-governmental organisations (NGOs), governments, and pharmaceutical companies. Innovative licensing deals with generic manufacturers have allowed the large-scale production of drugs without compromising commercial operations in key markets such as the US, Europe, or Japan.  

The partnerships and activism have not only improved clinical and social care for those living with HIV but, in many places (such as the UK), reversed prejudiced laws and sought to provide equitable treatment for individuals. For example, in 2024 in the UK, the discriminatory bar on same-sex people with HIV donating sperm or eggs was scrapped and passed into law.   

While remarkable progress has been made, the journey is far from over. Tackling the stigma associated with HIV remains a priority, as it continues to affect the lives of those living with the virus and hinders efforts towards prevention and treatment. Addressing the chronic immune activation seen in HIV patients is also crucial, as it has long-term impacts on their health and well-being.  

Research into the effects of chronic immune activation is essential for developing new treatments and improving the quality of life for those affected.   

Furthermore, enhancing public education and awareness about HIV and other sexually transmitted infections (STIs) will help reduce stigma and encourage safer sexual practices. A key lesson from the last 40 years is that it should be paramount that health campaigns focus on allowing individuals to make informed decisions, not pressurise them towards one potential option.   

As we look to the future, continued innovation, collaboration, and a holistic approach to healthcare are vital. By building on the successes of the past 40 years, we can move closer to a world in which HIV is no longer a public health threat and in which all individuals have access to the care and support they need. Despite the successes, healthcare systems mustn’t disinvest and divert resources away from HIV and sexual health medicine and social care.   

The innovation continues to aim to save lives and reduce healthcare costs. In 2018, the world’s first social impact bond (SIB) was implemented in South London. The SIB was a collaboration between the Elton John AIDS Foundation, The Foundation, Lambeth, Southwark and Lewisham Councils, The National Lottery Community Fund, ViiV Healthcare, Comic Relief, and Big Issue. This bond ran until 2021, allowing 265,000 people to receive an HIV test and more than 460 South Londoners living with HIV to enter treatment. This initiative saved the health system an estimated £90 million in costs. The UK government’s investment of £20 million in universal testing in high-prevalence areas further seeks to expand the knowledge gleaned from the SIB.   

The investment in research and data generation to categorise all the aspects of the pandemic has been startling. Decisions to invest scarce healthcare resources have been made based on deep foundations of understanding from research. This research has allowed medicines first developed to treat and now be used to prevent the acquisition of infection. The first 100% preventative efficacy result with a six-monthly injectable was reported recently. This is not only remarkable science but means we have a method of empowering many lives to take control of their sexual health. This empowerment otherwise would not be available to them.   

As we commemorate World AIDS Day, let us celebrate the remarkable progress made in the fight against HIV/AIDS. Let us also acknowledge the lessons learned and the ongoing challenges, particularly the need for holistic patient care and the importance of prevention. Together, we can continue to build on the successes of the past 40 years and strive for a future where HIV is no longer a public health threat, but we are better prepared for other threats. The science of COVID-19 vaccines was spectacular, but the solidarity and the passionate global advocacy that marked the HIV response was lacking as we fought COVID-19, resulting in inequity and a protracted pandemic battle.