Greece was never known for the quality of its health system. But in 2009, at least among drug users, HIV was not a major threat — just 15 were diagnosed with the virus that year.

Then came the financial crisis and the harsh austerity that followed. In 2011, another 256 drug users learned they had HIV. In 2012, the number was 484. The reason for the explosion: the Greek financial crisis and the harsh austerity measures that followed.

The ballooning epidemic illustrates the importance that politics and policy plays in the fight against AIDS. Though there’s still no cure, experts say we already have the tools to eliminate HIV as a threat to human health.

The problem is not the science. It’s the political will — and the fact that the most vulnerable tend to live on the margins of society. Lingering homophobia in some countries holds back men who have sex with men from getting care. Where they’re accepted, sex workers and migrants are still at risk — and blamed for the spread of the epidemic.

“These groups are generally discriminated [against] and stigmatized,” making them less likely to seek help with prevention and treatment, said Nedret Emiroglu, the chief for communicable diseases in the World Health Organization’s European Region. HIV isn’t just a medical condition; it’s “a social disease,” she added.

Marios Atzemis was one of the Greek drug users diagnosed with HIV in 2011. He had been addicted to heroin and a regular in Athens’ open-air drug markets well before the crisis. Then in 2010, street services to help drug users stay safe lost a third of their funding. Atzemis stopped seeing the vans that used to distribute fresh syringes, even as new users were entering the scene, shooting newer, cheaper drugs.

“As a community of drug users, we didn’t have an effective means of defense,” said Atzemis, now a harm-reduction coordinator with the Association of People Living with HIV Greece (Positive Voice). “It was very easy for us to be targeted and to be scapegoats.”

The doctor refused to put him on anti-AIDS antiretrovirals medication until he got clean at a rehab clinic — even though the clinic was on the brink of being shut down for lack of funding.

For Atzemis, now 44, this was enough motivation to wean himself off the drugs. “It didn’t work the same for other people,” he said.

Whether it’s inconsistent funding for programs that are working or social stigma blocking help from getting to the people who need it most, activists and public health professionals say even relatively wealthy countries are struggling to close the remaining gaps in the fight against the epidemic. Worldwide, just four countries — Burundi, the Dominican Republic, the Democratic Republic of Congo and Portugal — are on track to meet the global goal to reduce AIDS deaths by 75 percent between 2010 and 2020, according to UNAIDS.

AIDS is in many ways a 21st century success story. The epidemic tore communities apart in the 1980s and 1990s. In 2000, only 680,000 people were on antiretroviral therapies. Today, 62 percent of people with HIV — some 23.3 million people — have access to the life-saving drugs. New infections are down 40 percent since their peak in 1997, according to UNAIDS.

Early diagnosis and speedy treatment create their own virtuous side effect. The drugs that prevent HIV from exploding into full-blown AIDS also prevent HIV-positive people from transmitting it to others.

London serves as an example of what is possible. An estimated 95 percent of people with HIV in the British capital have been diagnosed with the virus. And of those, 97 percent of them have such low levels of the virus that it’s undetectable (and therefore not contagious).

On top of that, some antiretrovirals taken in advance of exposure, a treatment known as PrEP, can actually drastically reduce people’s chances of getting infected in the first place. Lower-tech methods like condom campaigns and needle-exchange programs help prevent HIV’s spread further. There’s justified optimism that London can end HIV transmission in the coming years.

Then there’s what happened among drug users in Greece. Backsliding threatens progress worldwide. Complacency is another major threat.

Funding to fight HIV dropped in 2018 compared with the previous year, the NGO Doctors Without Borders warned in a report published this month. This dip in donations, the first since the turn of the century, could trigger an “epidemic rebound” in some poor African countries that can’t afford to pick up the slack left by the loss of international aid.

HIV diagnoses are down in the EU as a whole; however, in a third of the bloc’s countries, the trend is moving the wrong way. Ireland, for example, saw a record high number of diagnoses in 2018. Public health officials pointed the finger at migrants, but activists argue the country needs better access to PrEP and self-testing kits.

Indeed, late diagnosis is a problem around the EU, where about half of patients don’t find out they’re HIV positive until several years after infection, according the the European Centre for Disease Prevention and Control.

Sex between men is still the top mode of transmission in the EU, but it’s also a bright spot: Diagnoses among this population are down 20 percent between 2015 and 2017. PrEP has the potential to drive further improvements, but it’s not reimbursed in many countries, and the principal developer, Gilead, has found itself in some bitter pricing disputes.

Russia represents a horrifying story of complacency, denial and discrimination. The epidemic there didn’t take off until the mid-1990s, and then mainly among people who inject drugs. But the country refused to fund harm-reduction measures, and in 2013, it outlawed targeting information to gay men. More recently, its rate of infections has been increasing by 10 to 15 percent annually, with 100,000 infected in 2017 alone, and most transmissions are between heterosexual couples.

In Greece, government officials, civil society and activists were relatively quick to acknowledge the problem. While the government faced heavy criticism from human rights advocates when it posted photos of alleged HIV-positive prostitutes, the public health community also rallied, doubling the number of needle exchanges in 2011 and cutting wait times for addiction treatment. Greece also introduced a novel system of paying drug users €5 to get tested and €3 for referring others, while connecting them with treatment and other services. That approach is now considered a model for responding quickly to outbreaks.

For better or worse, Greece shows that a country doesn’t need to fix its entire health system to deal with HIV. As a case in point, its progress on AIDS hasn’t translated into progress on correlated problems like hepatitis C. Those rates rose during the debt crisis and haven’t ebbed much; based on 2017 data, around 62 percent of drug users in Greece have tested positive for hepatitis C.

The crisis-era HIV outbreak marked “the first time that all the stakeholders — NGOs, state structures, every single one — worked together to face this epidemic,” said Atzemis. “And probably the last time.”

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Researchers say they have removed HIV from the DNA of mice, an achievement the scientists say could be an early step towards an elusive cure for humans.

The breakthrough, detailed earlier this week in a study credited to more than 30 scientists from Temple University and the University of Nebraska Medical Centre, was made possible by an antiviral drug in combination with the tool called CRISPR that can edit genes.

The researchers eliminated HIV in nine of 23 mice that were modified so their immune systems better mimicked those of humans.

Clinical trials for the gene-editing component of the cure could start as early as next year if the Food and Drug Administration approves them, said Kamel Khalili, one of the study’s senior investigators.

But he and other HIV experts emphasised that there is a big scientific leap from promising results in mice to success in humans.

“We knew what we needed to do, but the technology was unavailable,” Dr Khalili told The Washington Post, saying he and his team had been awaiting a tool like CRISPR to combat a virus that “becomes part of the fabric of our chromosomes”.

With gene editing finally a reality, he said, “the outcome was amazing”.

Once deadly, HIV can now be managed with a treatment called anti-retroviral therapy.

The therapy only keeps the virus in check; without constant medication, the virus will quickly decimate a patient’s ability to fight off sickness.

HIV infects 37 million people worldwide, according to the latest data from the World Health Organisation (WHO), and only about 22 million of those people receive antiretroviral therapy. Nearly one million people died of HIV-related issues in 2017, according to WHO.

Earlier this year, revelations that a second person had seemingly been rid of the virus raised hopes that another patient’s cure 12 years earlier was not a one-off victory.

But scientists cautioned that it was too early to declare the anonymous second patient cured – and that, regardless, the case did not herald a widespread cure for the devastating condition.

Both patients were treated with stem cell transplants, which experts say are risky, bring serious side-effects and would not be preferred for most patients.

Previously, Dr Khalili’s team at Temple had found a way to remove significant amounts of HIV DNA from rats and mice.

But the technique could not completely remove the infection.

So Dr Khalili’s lab joined forces with a University of Nebraska Medical Centre (UNMC) lab attacking the problem in a different way. Together, the scientists combined the gene-editing strategy with a drug designed to beat back HIV.

Howard Gendelman from UNMC said that his team’s experimental drug is engineered to act over a longer time than normal therapies, meaning it can be administered every couple of months instead of every day.

It is also better able to target HIV in the body, he said. It is crucial that gene editing remove every last bit of HIV, he said, and the drug makes that task easier.

“If you can reduce the amount of virus that’s left for CRISPR, the likelihood that the CRISPR will be effective will go up enormously,” he said.

But if Dr Khalili’s team is able to move forward with trials with humans, it will use standard drugs rather than the one developed by UNMC’s lab, since it probably would not be approved yet for use, Dr Khalili said.

Steven Deeks, a professor at the University of California at San Francisco who has worked extensively on HIV, said the use of gene editing to remove HIV from a live animal is a notable step forward.

But he cautioned that using the technique on humans will be far more challenging: scientists will have to grapple with more variations in the virus, more difficulties in delivering the gene-editing technology and the possibility of cutting up human genes while trying to target HIV, he said.

Those are formidable problems, Prof Deeks said, especially with success depending on removing the virus completely.

“For this approach to work, they have to really knock out 100 percent of the genomes – you can’t leave anything behind,” Professor Deeks said. “One of them can reignite the whole process.”

The scientists behind the new study recognise those challenges. Dr Khalili said researchers are in the process of publishing another study on the use of gene editing to target HIV in primates and are hopeful about bringing the solution to human subjects.

But the scientists need to make sure their techniques are safe, he said. They also want to increase their methods’ chances of working from the roughly one-third success rate they saw with mice.

Dr Gendelman said that while modern drugs are good at keeping HIV at bay, a permanent cure would bring big benefits to patients.

Constant drug treatment can contribute to other health complications, he said, and just keeping the pills in your medicine cabinet can invite unwanted scrutiny from family or significant others.

“There’s a tremendous stigma,” he said. “Every time you take those pills you’re reminded that you have HIV.”

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