Presentations at the 21st Annual USCA Conference shed light on the fact that although overall rates of HIV are decreasing, some populations are seeing a startling increase.
Many advancements have been seen in the fight against HIV in the past 35 years. Recently released data from the Centers for Disease Control and Prevention (CDC) has shown that the work that the healthcare community has been doing has paid off, resulting in a 10% decrease in the number of new infections between 2010 and 2014. This might lead some to believe that the community should continue with the status quo in action, citing the adage, “if it ain’t broke, don’t fix it.” However, with a new political climate and much work that still needs to be done in the field, one pharmaceutical company, Gilead, is calling for an overall rethink of how the healthcare community is currently responding to the HIV epidemic.
Entitled, “REIMAGINE: Reset. Refuel. Retool,” the Gilead-sponsored Plenary Luncheon at the 21st Annual United States Conference on AIDS (USCA) in Washington, DC, on Friday, September 8, 2017 featured a myriad of speakers presenting their thoughts on how the community can reimagine its response.
One such speaker, Derrick Butler, MD, MPH, Associate Medical Director, from the T.H.E. Health and Wellness Centers who practices in South Central Los Angeles, California, focused his presentation on the individuals of color who are at highest risk of acquiring HIV. Highlighting the successes of Seattle, Washington and San Francisco, California, which reduced its rate of new infections down to 15.4 / 100,000 persons, Dr. Butler also called attention to the struggles of Jackson, Mississippi and New Orleans, Louisiana, which are struggling with increasing transmission rates.
Indeed, an almost ironic switch has occurred in the world as of late in that for so long, the United States has “pitied”—Dr. Butler’s words--African nations for their high rates of HIV infections and AIDS, but now, in 2017, some of these low-income countries, such as Swaziland, have been able to reach the 90-90-90 targets ahead of the United States. This fact prompted Dr. Butler to ask the audience, “Will [these countries] start to pity us? Maybe we have something to learn from them.” And, perhaps we do. Swaziland has been able to boast its low numbers, despite the fact that men who have sex with men (the population at highest risk), are stigmatized and shunned, not only in Africa, but also in the United States.
Over 60% of individuals with new HIV infections are gay and bisexual men of color, according to Dr. Butler. Perhaps more startling is the fact that 1 out of every 2 black gay men will be HIV-positive in their lifetime, and 1 out of every 4 Latino gay men, compared with 1 out of every 11 white gay men.
Dr. Butler urged the audience that more action needs to be done to aid and encourage gay and bisexual men of color to get tested, take on treatment if they are infected, and / or start taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) if they are exposed.
If an individual is infected with HIV at age 20, they have the chance of living to 70 or more if they adhere to current treatment regimens.
The toolbox of interventions (from testing to treatment to prevention, including PrEP and PEP) is vitally important. Dr. Butler implored providers to double-down on their efforts to support their high-risk patients. They need to reset their focus on disparities in treatment and ensuring there are no breaks in the treatment cascade. Providers need to advocate for routine HIV testing in order to normalize it and decrease the stigma. “An HIV test should be as routine as a test for cholesterol,” noted Dr. Butler.
And, although the healthcare community is doing a better job at focusing their attention on many of the groups at highest risk of HIV infection, one community remains excluded: the transgender community. As protestors stormed the stage at the end of Dr. Butler’s presentation, lamenting this oversight, there’s no hiding that the data speak for themselves: the transgender community was not represented when presenters were speaking about populations at highest risk of infection. Indeed, without the data, the healthcare community does not know what the rate of new infections is for the transgender population, and until they are included in the data, the true magnitude of the HIV epidemic will not be known.