HIV Prevention: A New Beginning?

It feels a bit ironic to be blogging for the first time from the National HIV Prevention Conference on the same day that the Boston Globe publicized the drastic budget cuts that the Massachusetts HIV/AIDS Office has made to its very successful HIV prevention programs (see article).  At the same time, the notion of “a new beginning” for HIV prevention, despite the new austerity, has been very much at the heart of the opening day of this meeting.

For example, at the opening plenary, Moupali Das, Director of HIV Prevention Research at the San Francisco Department of Health (SFDOH), described their efforts since 2010 to “test and treat” – meaning that “All patients, regardless of CD4 count, will be evaluated for initiation of anti-retroviral therapy.” The SFDOH maintains this policy was based on new information about the health benefits of early treatment for individuals infected with HIV. However, a “side effect” of this policy is to reduce “community viral load” – the amount of HIV circulating in individuals in the community – and thereby reduce new infections. The downward trend in new infections in San Francisco appears to support the effectiveness of the policy.

Also at the opening plenary, Dr. David Holtgrave of Johns Hopkins University described a shift from looking at the cost-effectiveness of HIV prevention strategies to modeling activities to find the “optimal combination of HIV prevention, care and treatment services” in each jurisdiction. His modeling of this optimal mix has provided a blueprint for the City of Baltimore to reduce new infections while moving those newly diagnosed into care quickly. However, Dr. Holtgrave noted that even with this mix of services, additional funds would be needed for Baltimore to meet the goals of the National HIV/AIDS Strategic Plan (NHAS).

Richard Sorian, Assistant Secretary for Public Affairs at the U.S. Department of Health and Human Services, reiterated the need for broad public education with respect to HIV/AIDS, as envisioned in the NHAS. He reported that according to the Kaiser Family Foundation, the number of Americans describing AIDS as the nation’s “most urgent public health problem” declined from 68% in 1987 to 7% in 2011. With AIDS out of the limelight, more people in this country need basic information about how HIV is and isn’t transmitted, how to prevent transmission, and how we can all combat stigma and discrimination. The good news, according to Sorian, is that the percentage of young adults concerned about HIV/AIDS increased between 2009 and 2011 indicating that a growing number of young people are paying attention to this issue. The bad news is that young gay and bisexual men, and especially young African-American gay and bisexual men, are the only groups in the U.S. experiencing increases in HIV infection rates.

A major theme of the conference is using resources wisely in an era of resource constraints. At a breakout session focussed on use of surveillance data, numerous presenters made the case that surveillance data, including electronic laboratory reporting, can be an essential and existing source of data to track trends in the epidemic and progress on almost all of the goals articulated in the NHAS.

Dr. Lucia Torian, Deputy Director of HIV Epidemiology at the New York City Department of Health, proposed that we begin to consider opening HIV surveillance registries to medical providers, to assist patients by maintaining a continuity of care as they move from provider to provider or in and out of care. This strategy would duplicate the success of other electronic surveillance systems, such as immunization registries. If HIV/AIDS is truly to be de-stigmatized and treated by our health care system as just another disease, notions such as this one, that seem almost unthinkable today, may soon become reality.

Stewart writes from the 2011 National HIV Prevention Conference, where JSI is represented at exhibit booths through its work with (booth #227) and Centers for Disease Control (CDC)’s capacity-building efforts (booth#318). The 2011 National HIV Prevention Conference is taking place just a little more than a year after the release of President Obama’s National HIV/AIDS Strategy. The theme of the 2011 National HIV Prevention Conference is: “The Urgency of Now: Reduce incidence. Improve access. Promote equity.”

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