Each year on December 1, we commemorate World AIDS Day to honor the estimated 36 million people world-wide who have died from HIV-related illnesses and to celebrate the advances in AIDS/HIV treatment. It is also, importantly, a time to bring awareness to the ongoing fight against the virus.
World AIDS Day was first observed 33 years ago, when news of an HIV diagnosis felt like a death sentence. Although more than 700,000 persons in the United States have died since HIV/AIDS was first identified in 1981, today many people living with HIV who are in treatment are more likely to die of age-related illnesses than complications from the virus.
Nonetheless, the goal of those of us who support HIV-positive patients is to end the epidemic altogether. While new HIV diagnoses have declined significantly since their peak in the early 1990s, progress more recently has stalled. Today, we still see more than 36,000 newly diagnosed cases in the U.S. each year.
In 2019, several federal health agencies announced a bold initiative to reduce new HIV cases in the U.S. by 90 percent by 2030—Ending the HIV Epidemic in the U.S. (EHE). About $20 billion has been set aside for this collaborative effort, focusing on HIV prevention and care. The goal is to increase awareness, testing, and treatment, while decreasing stigma, phobia, and misinformation.
Ideally, the initiative will be able to leverage critical scientific advances in prevention, diagnosis, treatment, and outbreak response using the resources, programs, and infrastructure available under the federal Health and Human Services.
The first phase of the project targets 57 geographic regions where infections are most prevalent, focusing on the populations most at-risk such as IV drug users and men who have sex with men (MSM). Priority jurisdictions include specific counties and states. In California, those counties include San Francisco, Alameda, Sacramento, Los Angeles, Orange, San Bernardino, Riverside and San Diego.
Phase II will expand target areas and improve the timeliness of diagnosis and treatment by expanding and improving access to HIV testing services. When people don’t know they have HIV, they do not seek treatment and are therefore more likely to spread it. Importantly, of the 1.2 million people living with HIV in the US, about 150,000 are undiagnosed and consequently untreated, therefore, putting others at risk of infection. In addition to increased testing, resources will be directed to reduce the time between a confirmed diagnosis and the onset of treatment. In the past it could take weeks to begin treatment after a confirmed HIV diagnosis. The goal of this strategy, called Rapid Start, is to begin treatment the same day the diagnosis is confirmed whenever possible.
With existing scientific technology and public health practices, we have all we need to end the epidemic. HIV-positive individuals who take antiretroviral therapy as prescribed and who have an undetectable viral load, cannot transmit the virus to their partner sexually. This is referred to as U=U (Undetectable = Untransmittable).
In addition to timely treatment, pre-exposure prophylaxis (PrEP) and needle exchange programs have proven highly effective in reducing the spread of infection. PrEP includes taking a daily pill that can reduce the risk of HIV infection by 97 percent. If the EHE initiative is successful, it could help avert as many as 250,000 new infections by the year 2030.
Here in Mendocino County, as in other regions, the COVID-19 pandemic interrupted many people’s routines—including access of routine health care. People delayed check-ups and testing, so it’s likely that HIV cases went undiagnosed and untreated. We typically see eight new cases a year in Lake and Mendocino counties. Last year, we only saw three. As with so many illnesses, the earlier HIV is diagnosed and treated, the better. People with advanced-stage HIV can get very sick, so if you’re in a high-risk group, it is important to get tested regularly.
I also encourage everyone to get a COVID vaccine to protect themselves as well as those around us who do not have strong immune systems, including those living with HIV and seniors. While you’re at it, get your seasonal flu vaccine. Like COVID, the flu puts those who are immunocompromised at risk for serious complications.
While COVID and the flu can put people with HIV at risk, an even bigger threat is the stigma associated with the virus. In our rural communities, especially among young MSM of color, homophobia and the stigma associated with HIV can prevent them from seeking care. If you or someone you know has questions about HIV care or PrEP services, or you would like an HIV test, please contact MCHC Health Centers. We offer a welcoming environment and provide care in open, non-judgmental and LGBTQ+ affirming way.
Stephan Ouellette is a licensed clinical social worker and the manager of the Ryan White Program, which provides HIV care at MCHC Health Centers, a community-based and patient-directed organization that serves Mendocino and Lake Counties, providing comprehensive primary healthcare services as well as supportive services such as education and translation that promote access to healthcare. Learn more at mchcinc.org.