What did the NCAIDS accomplish? First, it carried out the most wide-ranging study of the epidemic done to that time. As commissioner Larry Kessler noted at the group's last press conference (June 28, 1993), the NCAIDS reports constituted a veritable "Michelin Guide" to America's HIV epidemic. Did it break fresh ground or set new precedents for studying and responding to public health crises? The NCAIDS was the first such group to include as commissioners "non-experts" who were directly affected by the disease, and it encouraged such "community representation" for other advisory bodies (such as the NIH working groups.) It worked hard to include the voices that had been left out of earlier investigations, especially those from communities of color. The commission's work also reopened discussions about America's approach to drug misuse. Because the NCAIDS operated for four years, providing regular reports and public statements about their work, it helped keep HIV disease visible to both the public and to politicians and other leaders; likewise, it provided hope to those working on the front lines.

The biggest changes to the HIV epidemic were brought by new drug development. The first protease inhibitors were available by 1996, and others followed rapidly. These anti-retroviral medications, used in combination "cocktails," suppressed HIV replication so well that HIV infection increasingly became a manageable chronic disease rather than a death sentence. However, this was only true in countries where the new drugs were easily available; in places where health care infrastructure was minimal and governments were poor, as in many African countries, AIDS would continue to spread unchecked. Many of the global initiatives of the early 2000s aimed to make HIV drugs more accessible for everyone.

Despite these encouraging developments, former NCAIDS Chair June Osborn, writing about the AIDS epidemic in 1999, was still worried, and not optimistic. Globally, she said, many countries had responded to AIDS at first with denial, just as the U.S. had. While anti-retroviral therapy was a great advance, there were still issues of toxicity, viral resistance, demanding regimens, cost and access, and government funding. There had still been no serious efforts to reduce HIV transmission by providing drug addiction treatment on demand. And while many hoped for a HIV vaccine, Osborn noted that even should we have one, we wouldn't find much use for it, because the main at-risk group is adolescents--and in a culture where many parents didn't even want children to have sex education, it was unlikely that they would rush to vaccinate them against a sexually transmitted disease. (The human papilloma virus (HPV) vaccine, first licensed in the United States in 2006, demonstrated this point.)

Over twenty years later, anti-retroviral therapies can keep HIV levels so low as to be undetectable, allowing people with AIDS to live relatively normal lives. They remain healthy and, importantly, cannot transmit HIV to others. Anti-retroviral drugs can also prevent HIV infection if used immediately before or after exposure. Even so, as NIAIDS director Anthony Fauci has noted, uptake of treatment remains suboptimal, in both rich and poor communities. Control of HIV/AIDS is hampered by many of the same stubborn problems cited repeatedly by the NCAIDS, including lack of transport, substandard housing, mental health issues, substance abuse, drug toxicity, stigma and discrimination. In the ten years after AIDS first appeared, the epidemic—as disasters usually do—revealed our collective strengths and exposed our collective shortcomings. The work of the National Commission on AIDS elucidated those strengths and liabilities, and provided a blueprint for limiting the disease's impact, but the fundamental challenges posed by AIDS and other epidemic disease events remain.