Confusion. Hysteria. Ignorance. Complacency.

In 1999, amfAR, The Foundation for AIDS Research, launched a public awareness campaign showing a timeline of the AIDS epidemic delineated by those four phases. “This may be the most dangerous time yet,” read the tagline. On this World AIDS Day almost 20 years on, complacency may be a far more dangerous threat than it was back then.

The danger of complacency

Complacency is perhaps an inevitable consequence of our progress on AIDS. Globally, more than half of all people living with HIV now have access to HIV treatment, and AIDS-related deaths have almost halved since 2005. In the U.S., HIV infection rates dropped 18 percent from 2008 to 2014. Today, Americans diagnosed with HIV by the age of 25 who take their treatment as prescribed can expect to live a long life with a statistically zero chance of transmitting the virus to their partner or children. Research breakthroughs over the last several years have brought the scientific community a better understanding of the challenges that must be overcome to get to a cure.

These impressive gains show that HIV research, prevention and treatment efforts in the U.S. and around the world are paying off. As a result, many people around the world – including Americans – no longer believe HIV to be a serious concern. 

“To end HIV, we must combat complacency wherever we find it. We must continue to sound the alarm that despite treatment advances, HIV remains a serious disease.”

Evolving challenges

The development and availability of highly effective, easy-to-take anti-HIV drug regimens has made people much less afraid of contracting HIV. However, there is growing concern that the emergence of HIV drug resistance could seriously undermine the effectiveness of widely used anti-HIV drugs. According to the World Health Organization, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Centers for Disease Control and Prevention, the prevalence of HIV drug resistance has increased from 11 percent to 29 since 2001.

Equally troubling is that many people who engage in high-risk behavior do not get tested because they do not believe, or are unaware, that they are vulnerable to HIV infection. Globally, it is estimated that 30 percent of people living with HIV do not know their HIV status. Of the 1.2 million people living with HIV in the U.S., one in seven don’t know they have the infection.

Progress remains uneven across communities and populations. Born after the first HIV/AIDS cases made headlines, millennials and young adults consider (not incorrectly) HIV to be a treatable disease – if they consider it at all. Few have witnessed the potentially deadly consequences of contracting the virus. In the U.S., a dearth of comprehensive sex education, low HIV testing rates, low condom use – and complacency – have contributed to a growing number of young people living with HIV, many of whom have no idea they carry the infection.

Gay and bisexual men continue to be at greatest risk for HIV. And while new HIV infections among people who inject drugs dropped 56 percent in the U.S. from 2008 to 2014, the nation’s chronic opioid crisis threatens the possibility of new HIV outbreaks across the country.

Once and for all

To end HIV, we must combat complacency wherever we find it. We must continue to sound the alarm that despite treatment advances, HIV remains a serious disease. Reaching young people with HIV prevention messages will require fresh and innovative approaches. We need to expand the reach of high-impact prevention intervention strategies, including syringe services programs for people who inject drugs. That substantially reduces the risk of HIV and hepatitis C infection without increasing drug use, and links people to vital health services.  

Above all, we must continue to prevail upon our lawmakers to stop proposed cuts to funding for global and domestic HIV/AIDS programs. Investments by the federal government in HIV/AIDS research, prevention and treatment have contributed significantly to the decline in HIV outbreaks that caused massive mortality and social disruption in our country’s not-too-distant past, and have been transformative in the global AIDS response.

The declining visibility of HIV/AIDS in the media has given rise to a sense among the public that the fight against AIDS has been won. We’re still far from the finish line. But we can get there if we stay the course, do the research, make the right investments and maintain the political will. If we give in to complacency, AIDS will remain a global epidemic.