The 2019 National HIV Prevention Conference opened on Monday, March 18, with a plenary session titled “Getting to No New HIV Infections,” which is the theme of the conference and the focus of the President’s proposed initiative Ending the HIV Epidemic: A Plan for America. The conference is taking place in Atlanta and is organized by the Centers for Disease Control and Prevention (CDC).
At the opening session, leaders of key federal HIV activities from CDC, the Health Resources and Services Administration (HRSA), and the National Institutes of Health (NIH) shared their vision and insights on the proposed coordinated federal plan to eliminate HIV in the United States within a decade. They each underscored the vital roles that individuals attending the conference, along with many other stakeholders from communities across the nation, will play in achieving the ambitious but achievable goals of reducing new HIV infections by 75% in five years and by 90% in 10 years.
Ending the HIV Epidemic: Seeing the Possible and Leading the Nation to Act
Dr. Robert Redfield, Director of the CDC, highlighted data that provide a strong foundation for the plan. He first pointed to data recently released by CDC indicating that the number of new HIV infections has plateaued in recent years rather than continuing to decline.
He also reviewed CDC data that show that new HIV infections are concentrated demographically and geographically in the United States. HIV disproportionately affects different groups [PDF, 246KB], especially gay, bisexual, and other men who have sex with men, with young African American and Latino men who have sex with men particularly affected. Geographically, Dr. Redfield explained that more than 50% of new HIV diagnoses occurred in just 48 counties plus, Washington, DC, and San Juan, Puerto Rico [PDF, 72KB] in 2016 and 2017. He also noted that seven states have a disproportionate rural HIV burden.
Dr. Redfield then referenced data released just this week by CDC that show that 80% of new HIV infections in the United States in 2016 were transmitted from the nearly 40% of people with HIV who either did not know they had HIV, or who had received a diagnosis but were not receiving HIV care. (Learn more about this newest data).
These important data that are descriptive of the state of the epidemic today, coupled with the most powerful HIV prevention and treatment tools in history, present us with a major opportunity, Dr. Redfield remarked. “The time is now to apply the tools we have, in a concentrated effort hand-in-hand with communities across the nation, to put an end to the HIV epidemic once and for all.”
In Phase I of the initiative, the focus will be on those 48 jurisdictions, DC, San Juan, and the seven rural states where more than 50% of all new diagnoses occurred in 2017. Phase I will provide additional technical assistance, technology, and resources to stop the HIV epidemic. For the first year of the initiative, the President’s fiscal year 2020 budget proposes $291 million of new funding for the initiative.
“Never underestimate the possible,” Dr. Redfield remarked as he concluded. “Recognize and embrace the possible and we can work together to bring new HIV infections to an end.”
Ending the HIV Pandemic: From Science to Implementation
Dr. Anthony Fauci, Director of NIH’s National Institute of Allergy and Infectious Diseases (NIAID), spoke next. He elaborated on powerful tools that are now available to treat and prevent HIV.
Reviewing how much HIV treatment strategies have evolved over the history of the HIV epidemic, Dr. Fauci emphasized that, with today’s highly effective HIV treatments, a person diagnosed with HIV at age 20 who takes treatment as directed can live as long as his/her peers who are not living with HIV.
That same HIV treatment that suppresses the HIV viral load and protects the health of a person living with HIV has also become a game-changer in HIV prevention, he explained. Findings from several studies have made very clear that a person with HIV who takes HIV medication as directed and achieves and maintains a suppressed (or undetectable) viral load has effectively no risk of transmitting HIV sexually. This is known as treatment as prevention.
But, Dr. Fauci cautioned, NIH-supported studies have shown that treatment as prevention alone is not sufficient to eliminate HIV incidence. That’s why we also need pre-exposure prophylaxis (PrEP), another one of the powerful tools now available. PrEP is a daily pill taken by HIV-negative individuals who are at high risk of HIV to significantly lower their chances of getting infected.
The evidence behind these powerful HIV treatment and prevention tools provides the theoretical basis for the Ending the HIV Epidemic Plan, according to Dr. Fauci. The plan sets out to address what he characterized as an implementation gap, addressing the gap between what science tells us is theoretically possible and where we are today. As evidence of what can happen when this gap is thoughtfully and vigorously addressed, he pointed to very promising results from three jurisdictions—San Francisco, New York City, and Washington, DC—that have implemented focused efforts to deploy these tools and have seen declines in new HIV infections and improved outcomes for people living with HIV as a result.
Finally, Dr. Fauci discussed the role of NIH in implementing the Plan. NIH will focus on implementation science, collecting and disseminating data on the effectiveness of approaches being used in the initiative. This will inform CDC, HRSA, and other federal partners, as well as state, county, local, and tribal partners, about what is being learned about the best practices in pursuing the Plan’s four key areas of action for various populations across different settings.
Dr. Fauci concluded his remarks by noting that now that we have these highly effective tools to end HIV infections, we have both an ethical and moral responsibility to implement them.
Closing the Gap: The Ryan White HIV/AIDS Program Maximizing Viral Suppression
Dr. Laura Cheever, HRSA’s Associate Administrator for the HIV/AIDS Bureau, discussed the Ryan White HIV/AIDS Program’s (RWHAP) comprehensive system of HIV primary care, medications, and support services that reached nearly 535,000 clients in 2017. She highlighted a continued upward trend in viral suppression among RWHAP clients, with 85.9% of clients achieving viral suppression in 2017—a 16.4 percentage point increase since 2010.
Dr. Cheever also provided an overview of how HRSA uses data to drive improvement. For example, HRSA identifies disparities in outcomes by geography and subpopulation and then works with grantees and other partners to develop interventions to address them.
Under the Ending the HIV Epidemic Plan, Dr. Cheever explained, RWHAP will focus primarily on the second key area of activity: Treating HIV infection rapidly and effectively after diagnosis to assist RWHAP clients in achieving sustained viral suppression. Its efforts will build on the successful outcomes achieved to date at RWHAP clinical sites across the nation. The program will work to improve viral suppression and decrease disparities among patients who are in care, enhance linkage to and engagement in HIV care of the newly diagnosed, and expand re-engagement and retention for those diagnosed but out of HIV care.
Dr. Cheever elaborated, “We estimate that there are approximately 400,000 people living with HIV who are not engaged in care—either because they are not yet diagnosed or they are diagnosed but not in care and therefore, not achieving viral suppression. We need to reach them in order to achieve our goal of ending the HIV epidemic. This is the next great challenge for the Ryan White Program—and for the nation.”
Reflections and Challenges: Voices from the Community
The opening session also included presentations by Gina Brown of the Southern AIDS Coalition and Dr. David Malebranche of the Morehouse School of Medicine. Each shared personal reflections about ways in which they’ve connected powerfully with others in their HIV work in communities. Ms. Brown, an advocate and a woman living with HIV, discussed the power of sharing her personal story with other women and about the importance of persisting in efforts to reach some individuals who initially resist learning about HIV, believing they are not risk. Dr. Malebranche, a clinician and researcher, reflected on lessons in empathy and understanding gleaned from his experience seeing patients living with HIV. He noted that giving people a better healthcare experience, one that supports their continued engagement in care... “requires going further than ‘meeting people where they are.’ It requires imagining being them.”
View the video of the opening plenary session on the CDC’s National Prevention Information Network’s Facebook page.