“No more excuses. We have the tools to end the HIV/AIDS pandemic.”
– Anthony S Fauci, director of National Institute of Allergy and Infectious Disease, Washington Post Jan. 8, 2016
Approaching another National HIV testing Day on Wednesday, June 27, we have reason to hope, and causes for concern. Hope, because in so many ways the tide has turned, with estimated HIV incidence in the U.S. declining by 8 percent from 2010 to 2015.
Universal testing for HIV for people ages 15 to 65, as advocated by the U.S. Preventive Services Task Force, is one reason, with people being diagnosed and treated earlier, and in so doing dropping their viral loads to Undetectable levels, spawning the phrase U=U. Undetectable equals un-transmissible, meaning essentially zero risk to sexual partners. It is hard to underestimate the profound relief people living with HIV feel when they understand that if they take their medication, they can be at peace.
Sometimes I feel like Dorothy in the Emerald City, as a physician treating people with HIV/AIDS, emerging from the nightmare ’80s and ’90s, when my patients died usually gruesome deaths, to now an era where if they take one pill a day, they can live long healthy lives, and have partners and children without fear.
Another essential tool in the armamentarium against HIV is pre-exposure prophylaxis, or PrEP using the drug tenofovir-emtricitabine for those who are at higher risk for HIV, including those who have unprotected sex with people of unknown HIV status in areas of increased risk (including Durham and Raleigh). Recommended since 2012 by the Centers for Disease Control and Prevention, one pill a day when taken as directed prevents more than 90 percent of HIV.
So what is the concern?
There are disproportionate impacts of the ongoing HIV epidemic:
▪ African Americans, at 12 percent of the U.S. population, make up 44 percent of HIV diagnoses and suffer from being diagnosed later and sicker, with increased death rates.
▪ Up to 1 in 2 black men who have sex with men could be diagnosed with HIV if current rates continue. HIV prevalence and death rates are higher in the southern U.S., where a combination of lack of insurance or Medicaid expansion, and higher levels of stigma prevent access to care.
▪ PrEP, the prevention medication, is not reaching the people who most need it. The CDC estimates that 44 percent of the people who could most benefit from PrEP are African Americans, but only 1 percent have been prescribed the medication.Latinos were estimated to be 25 percent of those needing PrEP, with 3 percent prescribed.
In Durham, despite lack of new federal funding, we decided we couldn’t wait to address the gaps.
A combination of health-care institutions, Duke Health, Lincoln Community Health Center, and the Durham County Department of Public Health, along with an activated citizenry (HIV/STI Committee of Partnership for a Healthy Durham, the Durham Knows Campaign, Triangle Empowerment and Tri-Prep El Centro Hispano) have worked to make testing universal and to provide PrEP treatment. We are reaching more of the people who need PrEP, but numbers are still not near where they need to be.
▪ “Ignite Durham Are We PREP-pared” is a community forum to create awareness about PrEP and determine ways to improve access to PrEP for Durham residents taking place from 10 a.m. to 3 p.m. Monday, June 25, at the Durham County Human Services Building, 414 E. Main St. This event is free and open to the public, but registration is required. (Space limited; email firstname.lastname@example.org if interested.)
▪ On Friday June 29, National HIV Testing Day, Health Department workers and volunteers will be testing at the Go Durham bus terminals.
Dr. Barbara Johnston, M.D., is the chief of HIV Services/Early Intervention Clinc at Lincoln Community Health Center in Durham.