Getting the Word Out About HIV Treatment as Prevention at USCA 2018

Content From: Nathan Fecik, MPH, Public Health Advisor, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human ServicesPublished: September 12, 20185 min read


Photo of two men. People living with HIV who take HIV medication daily as prescreibed and get and keep an undetectable viral load have effectively no risk of sexually transmitting HIV to their HIV-negative partners.

We continued our efforts to share more widely the evidence about HIV treatment as prevention at last week's 22nd annual U.S. Conference on AIDS (USCA). This included a workshop organized by our office, the HHS Office of HIV/AIDS and Infectious Disease Policy (OHAIDP), that was titled "The Consensus: Communicating about HIV Treatment as Prevention (TasP)."

Workshop Explores Federal TasP Messaging

During a workshop representatives of CDC's Division of HIV/AIDS Prevention and HRSA's HIV/AIDS Bureau joined me to discuss the process that several HHS agencies have undertaken to arrive at consensus about a shared core message about the relatively new evidence on the prevention effectiveness of HIV treatment. We also discussed how our respective agencies and offices are integrating that message into our work. Colleagues at NIH also contributed important information that summarized the evidence base for treatment as prevention.

During that workshop, I discussed the process that our office – the HHS Office of HIV/AIDS and Infectious Disease Policy (OHAIDP) – has been facilitating with federal partners from CDC, HRSA, NIH, and SAMHSA to develop easy-to-understand, consistent, and scientifically accurate messaging on the effectiveness of achieving and maintaining an undetectable viral load to prevent transmission of the virus to others through sex. That workgroup of subject matter experts, communication experts, and policy leads reviewed the growing number of large-scale research studies that have shown there were no HIV transmissions within HIV discordant couples when the HIV-positive partner had a suppressed viral load. We then conferred about how best to communicate this information to the diverse audiences and stakeholders our various agencies and offices serve. The consensus message is:

People living with HIV who take HIV medicine every day as prescribed and get and keep an undetectable viral load have effectively no risk of sexually transmitting HIV to their HIV-negative partners

In other words, HIV treatment is prevention.

Workshop presenters (l-r) Nate Fecik, HHS/OHAIDP; David Purcell, CDC/DHAP; Antigone Dempsey, HRSA/HAB; and Jo Stryker, CDC/DHAP.
Workshop presenters (l-r) Nate Fecik, HHS/OHAIDP; David Purcell, CDC/DHAP; Antigone Dempsey, HRSA/HAB; and Jo Stryker, CDC/DHAP

Workshop panelists and participants joined in a conversation about the importance of effectively communicating about this powerful benefit of HIV treatment. Not only does it have the potential to improve health outcomes among people living with HIV by giving people living with HIV an additional reason to start treatment and remain adherent, it also holds great potential to prevent new infections as well as reduce HIV-related stigma. We all discussed the importance of sharing this important information with health care providers, policy makers, people at risk for and living with HIV, and others through print and web content, social media, trainings, technical assistance, and other activities.

CDC's Dr. David Purcell discussed some of the challenges to achieving the full benefits of treatment as prevention. Dr. Purcell is the Deputy Director for Behavioral and Social Science at CDC's Division of HIV/AIDS Prevention (DHAP). He underscored that the potential of treatment as prevention is huge.  He encouraged the session participants to be mindful of and work together to address challenges to achieving and maintaining viral suppression if we are to realize the full benefits of treatment as prevention. He also emphasized the importance of developing messages about the benefits of treatment as prevention that are not only readily understood, but also acceptable to and well received by key populations most affected by HIV.

With that in mind, his colleague Dr. Jo Stryker discussed how CDC translates research findings into messages for different audiences. Dr. Stryker is the Branch Chief for CDC/DHAP's Prevention Communication Branch. To ensure that the CDC's health messages are clear and actionable, she explained that they test different messages. She shared some findings from message testing about treatment as prevention that CDC had done recently with both HIV-positive and HIV-negative individuals and explained that additional testing was underway with more consumers. CDC encountered disbelief among a significant portion of people about the treatment as prevention message. So they are exploring what increases or decreases believability to help increase message acceptance. She also noted that for complex topics or topics that challenge previously held beliefs, brief messages are often harder for people to believe or accept. In the case of viral suppression and treatment as prevention, people may be more accepting when they have more context including some of the challenges discussed by Dr. Purcell.

Dr. Stryker and Antigone Dempsey of HRSA's HIV/AIDS Bureau spoke about how each of their agencies had and will be further disseminating the messages about HIV treatment as prevention. Dr. Stryker noted that CDC had incorporated the consensus message into all of the fact sheets that their team had recently updated and is integrating it into the Act Against AIDS campaigns as they've started to do with the Start Talking. Stop HIV. campaign. She also highlighted a recently updated technical fact sheet, Evidence of HIV Treatment and Viral Suppression in Preventing the Sexual Transmission of HIV [PDF, 153KB]. Ms. Dempsey, who is the Director of Division of Policy and Data at HRSA/HAB, shared that HRSA/HAB is working to share the information widely with its recipients, clinical providers delivering care services, and others, including at the upcoming 2018 National Ryan White Conference on HIV Care and Treatment as well as working with the Ryan White HIV/AIDS Program AIDS Education and Training Centers (AETCs) to weave it into training activities and materials.

After the presentations, we had about an hour for conversation with attendees. During that time we answered questions about the research on the effectiveness of treatment as prevention. Attendees also offered insights from their own experiences on the nuances of this important messaging. They also shared recommendations about various stakeholders who also need to be better educated and engaged in order to ensure that all those who need this information have it. This feedback was very useful to the panel. We look forward to sharing more materials – fact sheets, web pages, blog posts, trainings, and more – incorporating this information in the months to come as well as to seeing how health departments, community based organizations, health care providers and clinics, and others adapt the messaging in creative ways to help us realize the full potential of treatment as prevention.