He has researched HIV and AIDS for decades and has campaigned for better conditions in the treatment, but also in the acceptance of HIV-positive people: Pietro Vernazza, head physician at the Clinic for Infectious Diseases and Hospital Hygiene at the St.Gallen Cantonal Hospital.
In your opinion, how has prevention developed since the beginning?
Pietro Vernazza: AIDS prevention in the early years relied on an innovative strategy of personal responsibility: it actively and openly gave people the right information so that they could assess their risk themselves and act independently. And that without the warning finger. That was a change in thinking: It was accepted that people consume drugs and need clean syringes for it. Prevention stopped drug transmissions. Two groups were mainly affected: men who have sex with men (MSM) and the migrant population.
HIV infections in Switzerland have been falling steadily since 2002: 421 new infections were reported in 2019. The preliminary number for 2020 is 236 infections. Aids Hilfe Schweiz attributes this sharp decline to the corona pandemic – to fewer HIV tests and fewer unprotected sexual contacts. How do you see it
The “Corona year” certainly influenced both behavior and test activities. It is too early to judge at the moment.
Has PrEP (= pre-exposure prophylaxis) in the form of a daily pill contributed to the decrease in new infections?
The fresh infections have already halved between 2010 and 2017. PrEP has not been in use that long to be able to precisely quantify its influence. The increase in fresh infections in 2019 doesn’t exactly speak for it. But PrEP has additional potential, especially in the MSM group: There are still young men who are poorly informed about HIV and who do not deal with their sexual orientation enough. This is because they may live in an environment in which sex between men is taboo. We have to reach this group better. The gay community, on the other hand, is now very well informed about the risks and protection strategies.
HIV can be treated well today, but not yet cured. At the end of 2019, around a hundred studies on the healing of HIV were running. Is there any evidence in current research that an early cure for HIV is in sight?
I once said that AIDS would be curable until I retire. But now time is of the essence. Nevertheless, I am convinced that a cure will be possible in the near future. One therapeutic approach could at least be proven in animal experiments: The body’s own white blood cells (T cells) are genetically modified in such a way that the HI virus can no longer dock onto the T cell.
What measures will be needed for HIV prevention in the future?
The most important thing is that prevention continues at all. In the current corona crisis, all the work around HIV and AIDS could collapse. There are currently major concerns that funds will no longer be available. And when early diagnoses and treatments or the PrEP program are no longer possible, at some point this leads to a population that becomes infectious again because prevention and therapy compliance are no longer in place.