AIDS researcher
In 1982, Dr. Kenneth Mayer treated some of the first patients with AIDS in New England. He has devoted his career to AIDS research and treatment, and now serves as the head of the Brown University AIDS Program, which focuses on educating doctors, students, and the community about this syndrome. We talked with him about how HIV/AIDS has changed in the last quarter century.
Q: It seems like HIV/AIDS is now considered more of a chronic disease than a fatal one, at least in places where medications are available. Can you talk about the current treatments for people with HIV?
A: Right now we can treat HIV with as little as one pill once a day. It's really been a dramatic change since the early days when we had no effective treatment, and people were dying terrible deaths, getting one infection after another. Now HIV is a chronic, manageable condition—I'm taking care of some people right now who are leading full lives. It's still serious, there's still a stigma, but we understand how it's transmitted and we can provide effective therapy.
Q: Do you think people today aren't as worried about getting HIV because treatments have improved?
A: A kind of fatigue has set in. For example, one of the communities first heavily impacted by the epidemic was men who have sex with men. People who were seeing their friends die in the 1980s changed their behavior quite dramatically. Now, though, we're seeing more new infections among gay men, and certainly among young people, heterosexual and homosexual. There's much less of a sense of vulnerability. And that's a combination of things. The treatments are better, so having HIV is not a death sentence. But the other issue is that in the beginning of the AIDS epidemic, people were very sick. You could see someone on the street and guess that they had AIDS. Now it's very much a silent epidemic.
Q: What are the guidelines regarding HIV testing? Is it recommended for everyone?
A: In 2006, the CDC [Centers for Disease Control and Prevention] issued guidelines suggesting that there should be more routine HIV testing. Right now in Rhode Island and many states, before an individual can get an HIV test, they have to sign a separate informed consent and have pre- and post-test counseling. Those features were developed during the early days of the epidemic.
The CDC felt that separate informed consent and counseling was probably creating undue barriers. They also found that, in the U.S., about a million people are living with HIV and a quarter to a third are unaware of their infection. So the thrust of the CDC's guidance is that tests shouldn't be based on risk. Doctors—whether in emergency or primary care settings—should just ask someone, "Have you been tested for HIV?" If they say no, we should run the test. Some people may have relatively low-risk lives, but could have had one partner infected with HIV.
Q: You've been to Africa, India, and other places where people are still dying from AIDS. Is increased access to generic drugs helping?
A: There are some countries where the epidemic has stabilized. It's a combination of access to medication and good local political leadership. It's people saying this problem is here in our community and these are the things we can do to protect ourselves. In Africa there has been a marked increase in the number of people in treatment. Still, the majority of people in Africa and India who are infected are unaware of their infection, so there's a need to get people tested and, if they test positive, to get them into care.
Q: Is there much hope for a cure at this point?
A: I'd love to say that there'd be a cure in my lifetime, but I don't know that there will be. What I can say is that the treatment has become much better, and we do know how HIV is transmitted. So just by relying on education and behavioral interventions, we have the tools to decrease people's risks. If people do become infected, we want to work with them so that they stay as well as possible and don't transmit to others. It's amazing that the treatment has gotten to such a good point that we're talking about people getting old with HIV, which 25 years ago, we didn't have any reason to expect.
