2017 HIV/AIDS Statistics – Facts on Rates, Cost & More
12:45 AMPosted by: John S Kiernan
In the 1980s, at the height of the HIV/AIDS epidemic, more than 59,000 Americans lost their lives to this brutal disease. The $26.3 billion that federal funding have contributed to the battle against AIDS over the years is paying off. But the fight is far from over.
AIDS still claims far too many lives. And HIV is still far too costly, increasing the average patient’s healthcare costs by roughly 120% . So to help build awareness for this important cause, WalletHub put together an infographic filled with HIV/AIDS factoids and consulted a panel of experts about the disease’s various costs. You can find everything below.
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To gain a better understanding of the fight against HIV/AIDS, WalletHub posed the following questions to a panel of experts. You can check out their bios and responses below.
- Do you believe we will have a cure for HIV/AIDS in the next 50 years?
- How can state and local authorities work to reduce the transmission of HIV/AIDS?
- Should the government mandate pre-exposure prophylaxis (or PrEP) be covered by all insurance plans, including Medicaid?
Seth Welles Professor of Epidemiology and Biostatistics at Drexel University
Roger Detels Distinguished Professor of Epidemiology and Infectious Diseases, Director of the Multicenter AIDS Cohort Study and Dean Emeritus in the School of Public Health at the University of California, Los Angeles
Peter Memiah Assistant Professor of Epidemiology in the Department of Public Health at the University of West Florida College of Health
Matthew P. Fox Professor in the Departments of Epidemiology and Global Health at Boston University
Lillia Loriz Professor and Director of the School of Nursing at the University of North Florida Brooks College of Health
Lee B. Reichman Adjunct Professor of Medicine and Epidemiology and Executive Director Emeritus of the Rutgers Global Tuberculosis Institute at the Rutgers New Jersey Medical School
John Pryor Distinguished Professor of Psychology at Illinois State University
Cynthia Davis Assistant Professor and Program Director in the College of Medicine and College of Science and Health at Charles R. Drew University of Medicine and Science
Chris Beyrer Desmond M. Tutu Professor of Public Health and Human Rights Professor in the Bloomberg School of Public Health at Johns Hopkins University
Beth Meyerson Associate Professor of Health Policy & Management in the Department of Applied Health Science, and Co-Director of the Rural Center for AIDS/STD Prevention at Indiana University-Bloomington School of Public Health
Arni S.R. Srinivasa Rao Associate Professor of Epidemiology in the Department of Population Health Sciences at Augusta University
Anthony J. Santella Associate Professor of Public Health and Director of the Master of Public Health and Advanced Certificate in Foundations of Public Health at Hofstra University
M. Aaron Sayegh Clinical Assistant Professor of Epidemiology & Biostatistics, Internship Coordinator for Master of Public Health Field Experience and Director of Student Research in the Institute for Research on Addictive Behavior at Indiana University Bloomington School of Public Health
Do you believe we will have a cure for HIV/AIDS in the next 50 years? Based on the history of vaccine research for HIV, I am not very optimistic for a cure/vaccine in the next 50 years. HIV viral replication is a relatively sloppy process, with the viral reverse transcriptase having relatively low fidelity for replication -- escape mutants/viruses are regularly generated and have thus far been able to overcome efforts to generate immune responses that prevent infection. There have been advances made in our understanding of the role of neutralizing antibodies and host cell-mediated immune responses (CD8+ cells) in clearance of the virus, but the efficacy of vaccines thus far has been modest. However, vaccine research does continue, so that there is always hope for advancements. How can state and local authorities work to reduce the transmission of HIV/AIDS? To reduce transmission of HIV/AIDS, state and local authorities should continue their financial and administrative support of prevention strategies that are known to reduce transmission. Principal strategies need to include treatment as prevention (TasP) for HIV+ persons, educating HIV- persons with substantial risk for infection about HIV seroadaptive behaviors, and offering Truvada (pre-exposure prophylaxis, or PrEP) to reduce acquisition of HIV among HIV- high risk individuals. Treatment as prevention (TasP) for HIV+ persons is highly effective in preventing transmission of the virus; transmission is prevented when viral loads are greatly suppressed in response to antiretroviral therapy. Serodiscordant couples studies have demonstrated the effectiveness of TasP, with few or no transmissions occurring in couples where the HIV+ partner is taking ART for his or her own infection, thus reducing circulating viral load and preventing infection of the HIV- partner. For TasP to be effective however, at least at the population level, it is important for persons at high risk for infection to know their HIV status, and to be receiving ART treatment. A major barrier for people to know their HIV status is stigma and availability of counseling and testing services. It is important for state and local authorities to establish or continue programs that counter stigma and offer judgment-free testing services. Providing information and training for HIV seroadaptive behaviors is a second, highly effective strategy to reduce transmission. This is essential harm reduction behavior based on at-risk individual knowing their HIV infection status, as well as knowing whether their partners are HIV+. Open dialogues with partners needs to be encouraged, so that sexual behaviors can be chosen based on a person’s and their partner’s HIV infection status -- for instance, if a person is HIV+, they may choose to have condomless intercourse with only other HIV+ persons, or HIV- persons who are taking PrEP (discussed below). If having sex with a person of HIV serodiscordant (not the same status) or unknown status and not on PrEP, a person should choose low-risk activities and not engage in condomless intercourse. State and local authorities should offer prevention materials and counseling to promote HIV seroadaptive behaviors. Taken together, in communities where TasP and seroadaptive behaviors are widely practiced, most transmission could be prevented. Finally, state and local authorities should educate HIV- individuals with substantial risk for virus acquisition about PrEP. When taken as prescribed -- once daily, at least four times per week -- most infection is prevented. What is particularly beneficial about PrEP is that is can be taken by HIV- individuals, without the need to worry about a sexual partner’s HIV status. There is no need to discuss HIV infection status and make decisions about the types of sexual behaviors that are appropriate given HIV infection status. This makes sexual behavior more spontaneous, with a greater degree of intimacy. Thus, while PrEP uptake in high-risk communities (such as gay and bisexual men) has not been highly successful, the potential to prevent transmission is powerful, and this should be one prevention approach in our HIV prevention “toolbox” which, in concert with other strategies, could prevent most HIV infection. Should the government mandate pre-exposure prophylaxis (or PrEP) be covered by all insurance plans, including Medicaid? Absolutely. The science findings behind the recommendation to prescribe PrEP to prevent HIV acquisition are inarguable. There have been many studies demonstrating virtually complete prevention of HIV infection if PrEP is taken as prescribed. Health, and by extension, freedom from HIV infection, should be basic human rights. And these should be available to all persons, regardless of income. In terms of health costs, I would think that offering PrEP should be highly cost-effective, and would be more than offset by the savings on costs for treatment, specialized medical care, and social support services needed if persons become HIV+. Roger Detels Distinguished Professor of Epidemiology and Infectious Diseases, Director of the Multicenter AIDS Cohort Study and Dean Emeritus in the School of Public Health at the University of California, Los Angeles 
Do you believe we will have a cure for HIV/AIDS in the next 50 years? The pace of research over the last several decades in the area of HIV/AIDS, and consequently in areas relevant to HIV/AIDS, such as immunology, biomarkers, epigenetics, etc. has been truly astounding and augers well for ultimately finding a cure within the next decade or two. How can state and local authorities work to reduce the transmission of HIV/AIDS? Through demonstration that treating individuals infected with HIV reduces their viral load, so that transmission of the virus from them is prevented bodes well for slowing, if not stopping, the epidemic. The key to achieving that, however, is to convince individuals who do not know they are infected to be tested and then to get them under and adherent to treatment. These are not insignificant hurdles, but must be addressed. Should the government mandate pre-exposure prophylaxis (PrEP) be covered by all insurance plans, including Medicaid? It has been demonstrated that PrEP can significantly enhance the probability that the uninfected partner engaging in high-risk activities with an infected partner will remain uninfected, if they use the antiretroviral drugs consistently. The cost of prophylactic use of antiretroviral drugs is probably far cheaper in the long run than treating an infected individual for life, and should ultimately reduce the reservoir of infected individuals who can transmit HIV. Peter Memiah Assistant Professor of Epidemiology in the Department of Public Health at the University of West Florida College of Health 
Do you believe we will have a cure for HIV/AIDS in the next 50 years? So far, we have had isolated cases of people who have been “cured” of the HIV virus. However, this is to be taken with a grain of salt, because the HIV virus multiplies rapidly and now hides in areas that cannot be traced with HIV DNA techniques. Just like cancer treatment, scientists are working tirelessly to come up with a cure. There have been great advancements in coming up with agents that kill the virus, however, the virus seems to rebound. I strongly believe that in the next few years, as we look to end the AIDS epidemic by 2030, a cure may be found. Provision of funding to support this initiative is important. More importantly, we have good potent drugs that reduce the transmission of the HIV virus from one person -- with the caveat that only if the patient is adherent, but this is closer to eradicating the virus than a cure. How can state and local authorities work to reduce the transmission of HIV/AIDS? There has been a tremendous effort by state and local authorities in addressing HIV/AIDS. Notwithstanding, it's critical to respond to disease and behavioral patterns promptly and use evidence-based methods to understand what is going on at both the state and local levels. For example, in 2016, CDC reported the highest number of sexually transmitted diseases (STDs -- chlamydia, gonorrhea, and syphilis) since 1941 -- this should raise alarms about the risky sexual behaviors and the possibility of HIV infections in pockets of the country. Another example, do at-risk individuals know where to get information on HIV/AIDS prevention, care, and treatment? How do we ensure that our HIV patients adhere to treatment, and therefore almost guarantee no virus replication? Therefore, having effective surveillance and response systems is imperative. Both state and local agencies must utilize multi-disciplinary strategies to address HIV/AIDS, because as a disease, it cuts across different health and social issues. We need to focus on preventive efforts, especially for our adolescents and youth, and now we are also seeing cases of STI infections among seniors -- how can state agencies ensure prevention messages are disseminated and understood by at-risk individuals? Should the government mandate pre-exposure prophylaxis (or PrEP) be covered by all insurance plans, including Medicaid? Yes, PreP is a preventive mechanism. It is cheaper to offer PreP than lifelong HIV treatment. PrEP treatment is approximately $1,500 without insurance, and the plan to eliminate Affordable Care Act will even make it harder for low-income Americans. It is important to look at PrEP just like any other preventive mechanism, and therefore ensure that at-risk individuals can easily access PrEP. Different states have financial assistance to cover PrEP, however, more can be done. Surely, we have resource-limited countries offering PrEP at no cost, and yet we don’t have that in the U.S. Yet, we know that the estimated cost of treating HIV in one's lifetime is over $300,000, so availing PrEP should be a priority. Not ensuring insurance coverage of PrEP may reverse some of the phenomenal gains we have made as a country in curbing the HIV epidemic. Matthew P. Fox Professor in the Departments of Epidemiology and Global Health at Boston University 
Do you believe we will have a cure for HIV/AIDS in the next 50 years? Really hard to say, but this has been a very elusive virus and everything we have tried so far has not gotten us anywhere. That said, 50 years is a long time, so I wouldn’t say that 50 years from now we might not have made a complete shift in our thinking about how to attack the virus in the body, such that we might not have a cure. So, while I’m not overly hopeful, I don’t think it is impossible. More to the point though, we have the tools now to make serious progress in reducing incidence of disease, including early treatment, male medical circumcision and pre-exposure prophylaxis. These tools, in combination, could prevent a substantial number of infections. How can state and local authorities work to reduce the transmission of HIV/AIDS? By increasing access to pre-exposure prophylaxis, advocating for high-risk populations to get tested regularly and get onto treatment as early as possible, and ensuring that those who start treatment have the supports they need to be able to stay on treatment lifelong, without gaps in care and poor adherence. Should the government mandate pre-exposure prophylaxis (or PrEP) be covered by all insurance plans, including Medicaid? Personally, I would love to see this, but I don’t know if this is realistic, given the competing interests for what is covered. I do think that having Medicaid cover it would make a serious dent in the ability to access PrEP among those most in need, but I also think that covering the costs and getting people to use it are two very different problems with different solutions. Making sure it is affordable is essential, but that doesn’t mean people will use it, and use it consistently to prevent infection. Lillia Loriz Professor and Director of the School of Nursing at the University of North Florida Brooks College of Health 
Do you believe we will have a cure for HIV/AIDS in the next 50 years? Yes, I do believe so. However, much work is still needed. How can state and local authorities work to reduce the transmission of HIV/AIDS? Education. All the Public Service messages that were available in the 80s and 90s are no longer being used. We have a whole generation that does not understand the impact AIDS had in this country. Should the government mandate pre-exposure prophylaxis (or PrEP) be covered by all insurance plans, including Medicaid? Yes. Lee B. Reichman Adjunct Professor of Medicine and Epidemiology and Executive Director Emeritus of the Rutgers Global Tuberculosis Institute at the Rutgers New Jersey Medical School 
Do you believe we will have a cure for HIV/AIDS in the next 50 years? No question, likely far sooner. How can state and local authorities work to reduce the transmission of HIV/AIDS? Treat it like any other disease, eliminating the stigmatization. Major education effort among risk groups, as well as general population. Work within expansion to comorbidities such as tuberculosis, which is the unheralded largest killer of AIDS patients worldwide, as well as the largest killer on any communicable disease (including AIDS). Should the government mandate pre-exposure prophylaxis (or PrEP) be covered by all insurance plans, including Medicaid? Medicaid and all insurance must be expanded to cover these and other pre-AIDS situations. John Pryor Distinguished Professor of Psychology at Illinois State University 
How can state and local authorities work to reduce the transmission of HIV/AIDS? While there are some exceptions, HIV/AIDS is largely a sexually transmitted disease in the U.S. The simple fact is that transmission typically involves someone with HIV/AIDS having unprotected sex with someone who was previously uninfected. Often, the infected person does not know that he/she is infected. Early in the course of HIV infection, an infected person goes through what is called an acute phase, in which the virus is quickly multiplying and there is likely an abundance of the virus in the person's bodily fluids (e.g., semen). Transmission is more likely in the acute phase than in other phases of the disease. In the acute phase, the infected person is more likely to be unaware that he/she is infected. In the acute phase and in other phases of the disease, transmission can be prevented by effective condom use. What state and local authorities can do to effectively reduce transmission is to encourage consistent condom use among people who are not in monogamous relationships. There are several reasons people don't use condoms (e.g., they don't have one available, they don't like the feel of condoms during sex, etc.). However, one ironic factor is that using a condom can be stigmatizing because it implies that one has to worry about infection. If you insist on using a condom during sex, either you are concerned that you are infected or concerned that your partner is infected. Either way, there is a stigma. Sex education can help to reduce this stigma. Age-appropriate sex education starting at an early age can effectively normalize condom use. Empirical studies show that youth who receive evidence-based sex education are more likely to use condoms, particularly in their initial sexual experiences (so-called sex education programs that stress "abstinence only" result in youth who are less likely to use condoms in their initial experiences). The stigma surrounding HIV/AIDS has other deleterious effects as well. People who might be at risk for HIV/AIDS often avoid testing for HIV/AIDS infection because they are afraid of being stigmatized by a positive test result. Public education programs might cut into this stigma by emphasizing that HIV/AIDS should be regarded as a chronic and treatable disease. Should the government mandate pre-exposure prophylaxis (or PrEP) be covered by all insurance plans, including Medicaid? From what I know of PrEP treatments, mandating that insurance programs cover them might help disseminate them to high-risk individuals. In addition, I would encourage authorities to undertake concomitant health education efforts with the PrEP treatments. Because HIV/AIDS disproportionately affects people of lower income, including PrEP treatments in Medicaid should also help to make them more available to higher-risk people. I know that there is concern among the religious right that PrEP will give license to people to have risky sex. We know by analogy that making condoms more widely available does not result in increased sexual activity, so why would we expect PrEP to have that effect? Cynthia Davis Assistant Professor and Program Director in the College of Medicine and College of Science and Health at Charles R. Drew University of Medicine and Science 
Do you think there will be a cure for HIV/AIDS in 50 years? We are quickly approaching the fourth decade of the global HIV/AIDS pandemic, and I do not see a cure for the disease in my lifetime, or in the next 50 years. In the first decade of the pandemic, it was projected that the scientific community would discover a vaccine for the deadly virus, but sadly, to date, despite best efforts, there has no vaccine produced. In nearly forty years, there has only been one person living with HIV in the world cured of HIV, Mr. Timothy Brown, utilizing a technique where he received a bone marrow transplant from an HIV resistant donor. Presently, the only hope for a cure lies in the possibility of using a combination approach that would include techniques like gene therapy, broadly neutralizing antibodies, and a vaccine. What do you think that state and local health officials can do to stop the transmission of HIV? There are several things that local state and local health officials can do to stop and/or slow the transmission of HIV. First, we have available an “HIV Prevention Toolkit,” that includes both biomedical and non-biomedical primary, secondary and tertiary methodologies that have proven effective in slowing the spread of HIV. These tools include:
- Educating sexually active individuals about the correct and consistent use of male and female condoms in all sexual encounters;
- Making available clean needles and injection equipment for individuals who inject drugs, including referrals for substance use treatment, as needed;
- Making available culturally and linguistically appropriate comprehensive sexual health education, targeting at-risk sexually active populations;
- Effectively identifying HIV-positive individuals who are unaware of their HIV status and linking them into care;
- Developing effective “prevention for positives” or “Undetectable = Untransmittable” health education and risk reduction programs, which speak to the clinical effectiveness of ARV adherence and reduced risk of HIV transmission with undetectable viral load;
- Ensuring that all pregnant women are screened for HIV and if found to be HIV positive, immediately placed on ARV therapy to prevent vertical transmission;
- Increasing access to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and appropriately targeting HIV negative individuals at risk for acquiring HIV;
- Ensuring that there is ongoing epidemiological HIV surveillance, community-wide HIV gap analyses, and needs assessments conducted on an annual basis in regions of the country highly impacted by the HIV/AIDS epidemic;
- Ensuring that public and private sector dollars are being proportionately disseminated to communities and populations most heavily burdened by the HIV/AIDS epidemic;
- Making available HIV testing and treatment infrastructure to the nation’s prison populations;
- Developing and implementing public policy initiatives that address gaps in housing and create access to “on-demand” mental health services for the nation’s homeless populations, who are also vulnerable for HIV acquisition.
Do you believe we will have a cure for HIV/AIDS in the next 50 years? 50 years is a very long time frame. I don’t think we’ll have a cure in the coming 10 years, I think that’s clear. The new gene editing technologies, such as CRISPR, really could be transformative, but that is for the longer term. The current goal in the field is not a sterilizing cure, as much as achieving sustained remission off ART for significant numbers of patients, with interventions that are cost-effective, scalable, and feasible. A combination of approaches and the use of therapeutic vaccine approaches might lead to meaningful remission strategies in 10-20 years, that seems more achievable given the ingoing challenge of the HIV reservoir(s) in the tissues, and the ability of the HIV virus to integrate into human DNA. How can state and local authorities work to reduce the transmission of HIV/AIDS? First, repeal and remove harmful laws, policies and practices that currently aid and abet the virus, not the community. State bans or limits on needle and syringe exchanges are a great example. Laws on many state books that continue to criminalize HIV transmission do not protect the public and maintain stigma and discrimination. The expansion of the ACA and the protections for people with pre-existing conditions were powerful HIV/AIDS improvements. The worsening HIV epidemics in the southern states that refused the Medicaid expansion under ACA are evidence of how misguided these policies have been. Untreated HIV is infectious HIV, so not treating all in need assures ongoing HIV incidence, and ever-increasing treatment burdens. Should the government mandate pre-exposure prophylaxis (or PrEP) be covered by all insurance plans, including Medicaid? Yes. Not only has PrEP proven to be highly effective at reducing individual-level risks, the recent data on PrEP efficacy as a public health strategy to reduce HIV infections at community levels is emerging, and is really impressive. San Francisco, the state of Massachusetts, London have finally seen declines in new infections in gay and bisexual men as PrEP coverage expanded. The combination of immediate treatment for those living with the virus, and PrEP for those at high risk of acquisition holds promise for HIV control. This is the basis of the national HIV/AIDS strategy from the last years of the Obama administration, and since we don’t have a new strategy (and POTUS shut down the White House office of national AIDS policy, which drafts the strategy), the BHO one is still operative and working, where PrEP has been made available. Beth Meyerson Associate Professor of Health Policy & Management in the Department of Applied Health Science, and Co-Director of the Rural Center for AIDS/STD Prevention at Indiana University-Bloomington School of Public Health 
Do you believe we will have a cure for HIV/AIDS in the next 50 years? Absolutely. The science is evolving so quickly, and with many and varied foci: viral remission and eradication, and some interesting genetic studies. I have high hopes. How can state and local authorities work to reduce the transmission of HIV/AIDS? First, they can increase their investments in public health. The state of public health investment (measured as per capita funding) is not only varied across the country, but paltry in many cases. Take Indiana, for example. In 2015, we had the largest HIV outbreak in decades among injection drug users. At the time, Indiana invested about $17.43 per capita in state funding for public health (this included Medicaid funding). That was comparatively low then (I think 37th among states). But today, it is even lower: around $13.00. Were there robust HIV and HCV testing opportunities, we would have identified the health need much earlier; but at the time, the state was in the midst of cutting funding -- and had even removed the last affordable testing option (Planned Parenthood) from Scott County (home of the outbreak) a year before. Second, many state and local governments are still in the stone age when it comes to supporting evidence-based sexual health interventions. Not all states are this way (California, Massachusetts, Maryland, New York, Minnesota all get it; and sometimes, Florida does, too). But in the Midwest and South, we are stuck in ideologic muck, with little opportunity for meaningful movement. This is not just an issue for HIV, as it is often the case that state governments are at war with comprehensive sexual health programming. Just think what might be possible if we collectively educated our communities (all ages) about sexual health, and invested evidence-based prevention interventions (including biomedical interventions, such as PrEP)? This is not just an issue of disease intervention, as it gets to the core of what it means to live as a sexually healthy nation. So, in essence, our funding behaviors will follow our values. How ironic that we talk about this very topic (sexual health) today, as many in power are revealed as perpetrators of sexual violence without as much as a public blink from ideologically blinded leadership. Should the government mandate pre-exposure prophylaxis (or PrEP) be covered by all insurance plans, including Medicaid? In this age of unraveling health reforms, I fear that all essential health service options (such as PrEP) will be removed from insurance coverage requirements. The simple answer to your question here is, yes, PrEP should be considered an essential health service option (medicine). But today, in our unraveling reforms, the long view is not the current view of policymakers. Otherwise, primary care preventive services would be funded fully. Arni S.R. Srinivasa Rao Associate Professor of Epidemiology in the Department of Population Health Sciences at Augusta University 
Do you believe we will have a cure for HIV/AIDS in the next 50 years? Yes, I do. How can state and local authorities work to reduce the transmission of HIV/AIDS? Mathematical models that I develop for HIV/AIDS for understanding transmission dynamics at national and sub-national level always have some behavioral component, apart from treatment components. On the one hand, risky behaviors are to be checked, and preventive mechanisms for HIV spread are properly disseminated in the community by public health departments, especially for young adults’ populations, and on the other hand, if treatment adherence is properly monitored for HIV infected individuals, then that would lead to reduction of transmission. Models would assist in prioritizing the allocation of budgets by state and local authorities. Should the government mandate pre-exposure prophylaxis (or PrEP) be covered by all insurance plans, including Medicaid? I support PrEP. But, I am not sure that making PrePs available in the market without proper controlling measures, and counseling high-risk behavior adults against unprotected behaviors would be beneficial comprehensively. Who are eligible to be covered by insurances for PrEP and who are not eligible is a debate, and actuarial modeling can provide solutions for cost-effective analysis. Anthony J. Santella Associate Professor of Public Health and Director of the Master of Public Health and Advanced Certificate in Foundations of Public Health at Hofstra University 
Do you believe we will have a cure for HIV/AIDS in the next 50 years? Yes, but if HIV research and development continues at its current pace, we are looking at 15-20 years from now. Our best bet is a vaccine. The vaccine development process (from development to approval by the Food and Drug Administration, better known as the FDA) takes about 15 years. Vaccines (and other new medical devices and medications) must go through rigorous testing to produce enough credible data to be accepted by the FDA review panels. There are three phases of clinical trials. Phase one focuses on safety, phase two on dose-ranging, and phase three is for effectiveness. Our best HIV vaccine candidate is now in phase two trials. To put this in context, in the 35-year history of HIV, there have only been four HIV vaccine candidates tested on humans. Unfortunately, the HIV virus is genetically diverse, even more so than the flu, which makes it difficult to stay ahead of. As a community of people living with HIV, clinicians, scientists, social service providers, and researchers, we also must do a better job in improving the HIV cascade of care. The “cascade” is a series of steps showing the gaps between those living with HIV, diagnosed with HIV, linked to medical care, engaged in medical care, on anti-retroviral therapy (ART), and have an undetectable viral load. In the United States, about 15 percent of people living with HIV are unaware of their status, so we must do a better job of screening people for HIV, including in non-traditional settings, such as dentistry and community pharmacies. We also need to educate clinicians and people at risk for and living with HIV, on the concept of U=U (Undetectable = Untransmittable); someone living with HIV who has achieved an undetectable viral load (often the outcome of being adherent to their ART over time) has virtually zero risk of sexually transmitting the virus. HIV will only be cured in my lifetime if public health and medical professionals work together to not only advance scientific research and development, but engage providers and lay communities in health promotion and harm reduction strategies. How can state and local authorities work to reduce the transmission of HIV/AIDS? State and local authorities can work together to reduce transmission of HIV by promoting evidence-based strategies and policies found in the prevention “toolbox.” The toolbox includes but is not limited to:
- HIV testing: provide sufficient funding to implement and enforce the Centers for Disease Control and Prevention’s guideline that recommends all Americans ages 13-64 know their HIV status;
- Biomedical interventions: facilitate access to both pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) through programs like New York State’s PReP-AP program, which provides reimbursement for primary care services for eligible individuals being seen by providers who are experienced providing services to HIV-negative, high-risk individuals;
- Harm reduction: encourage medical and social providers, as well as government officials to promote evidence-based and cost-effective harm reduction strategies, such as needle and syringe exchange programs;
- Condoms: reverse “condom fatigue” by providing free male and female condoms in schools and other places at-risk persons congregate and socialize;
- Sex education: mandate all publicly funded K-12 schools provide age-appropriate, comprehensive, school-based sex education.
Do you believe we will have a cure for HIV/AIDS in the next 50 years? I believe that a vaccine will be developed in the next 50 years, and that people who have access to that vaccine will not contract HIV. I believe treatment will continue to improve and increase lifespan, and the quality of life of people living with HIV/AIDS who have access to such treatment. How can state and local authorities work to reduce the transmission of HIV/AIDS?
- Strengthened disease surveillance that allows for the assessment of behavioral and other risk factors, along with routine disease monitoring;
- Safe and/or safer sex promotion, sterile needle exchange programs, anonymous testing have shown to be effective, but efforts must be constant and consistent.
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