HIV 101: The Difference Between Control, Elimination, and Eradication
Natella Rakhmanina, M.D. Director of Technical Leadership
HIV/AIDS has killed more than 36 million people since the epidemic began in the 1980s, and it remains one of the greatest global health threats of our time.
Now, with UNAIDS’ new accelerated strategy to end the AIDS epidemic by 2030, it’s more important than ever to prioritize that goal and comprehend what achieving it really means.
The first step is to understand a few terms that might seems like synonyms to the average person, but each has a very different meaning to public health experts, especially when it comes to ending serious public health threats like HIV/AIDS.
Disease Control: When public health experts talk about controlling a disease, they mean reducing the number of new infections, the number of people currently infected, and the number of people who become sick or die from a disease in local settings. This is achieved through deliberate efforts such as vaccines, medications, contact isolation, or other public health interventions. Malaria is a good example of a disease that can be controlled in local settings. You can't get rid of malaria entirely because the mosquito-borne parasites that transmit the disease can develop drug resistance. But you can control it through health care and prevention strategies such as bed nets and anti-malaria medications.
Regarding HIV/AIDS, controlling the epidemic means providing the care and resources necessary to stop the virus from spreading from one person to another. At EGPAF, we focus on both preventing mothers from acquiring HIV during pregnancy and breastfeeding and on prevention of mother-to-child transmission of HIV (PMTCT) by providing HIV-positive pregnant women, breastfeeding mothers, and their children with medicines they need keep their babies HIV-free.
Elimination: Elimination means stopping the transmission of a disease in a specific geographic area or country, but not worldwide. Often, the first step toward disease elimination is disease control. Pediatric HIV is an example of how, by using control measures like PMTCT to stop the virus from infecting infants and children, the disease among children can be eliminated in some countries. In the United States fewer than 200 babies become newly infected with HIV annually, however, pediatric HIV is still at epidemic levels in sub-Saharan Africa where almost 700 hundred babies become newly infected every single day!
- Eradication: Disease eradication is the permanent reduction of a disease to zero cases through deliberate measures such as vaccines. Once a disease has been eradicated, intervention measures are no longer needed. The only disease to ever be fully eradicated in human history has been smallpox, which was declared officially eradicated by the World Health Organization (WHO) in 1980.
Now that we understand the terminology, how do we use it when it comes to meeting the ambitious goals set out to end the AIDS epidemic by 2030? The reality is that we must take several steps to end HIV/AIDS.
As UNAIDS highlighted in its 2014 report, we must scale up current efforts to control the virus by ensuring that more people know their HIV status, are on treatment , and have achieved suppression of the virus in their bodies so they can live healthy lives and can reduce the risk of passing the virus onto others.
In tandem with these efforts, scientists and researchers must continue to work to develop innovations that could eradicate the epidemic, either through a cure or through the development of a vaccine. However, it is important to note that developing a vaccine and developing a cure are two unique and very complex endeavors that are yet to be successfully developed and put into practice.
An HIV vaccine would be used to prevent HIV-negative people from becoming infected with the virus. And an effective vaccine to immunize against HIV would need to be usable in a variety of settings and for people of all ages, similar to vaccines against polio or measles.
But even if we could stop new infections with a vaccine or other highly effective prevention interventions, 35 million people who are currently living with HIV will continue to need to take their daily antiretroviral therapy (ART) and receive other related services for the rest of their lives. Therefore, scientists are also working to develop a cure for HIV, which would be used to destroy and/or remove the virus from the bodies of people who are already infected. Being able to cure people of their HIV infection would, over time, reduce the number of people living with HIV and thereby reduce the individual and societal burden of HIV care and treatment.
If we ultimately want to reach the end of AIDS, now is the time to scale up our efforts so that we achieve the 2030 UNAIDS goal. At EGPAF, we are committed to supporting the necessary programs, research, and advocacy to end this epidemic, and we will continue our work until no child has AIDS.