Last month, I spoke at the closing plenary of the HIV Forum for Collaborative HIV Research National Summit in Arlington, Virginia. I began with a brief look back at how the fight against the HIV epidemic has evolved. I reflected on a time when there were only a few tools and even fewer resources available to make an impact on the disease. This is in direct contrast to the progress that we have made in today's fight, where we have many tools available to us that work to combat and bring an end to the HIV and HCV epidemics. But I am reminded, and wanted to remind everyone in attendance, that a challenge still remains. We need to work differently and more effectively to bring an end to both of these epidemics. The following is an excerpt from the presentation I gave, where I provided a top 10 list of things that we must consider and incorporate in our work to end both epidemics.
In last week's post, I asked about two of the key components of the HIV care cascade -- the "undiagnosed" vs the "diagnosed but not in care," and which group was larger in the USA. Here are your answers as of now:
The information is everywhere -- on your computer, your phone, your tablet -- whatever screen happens to be glowing in front of you.
Two years ago, the Alachua County Community Support Services, Victim Services and Rape Crisis Center in Gainesville, Florida, contacted me to inquire about Walgreens' partnership in assisting uninsured sexual assault victims to obtain HIV post-exposure prophylaxis (PEP) prescriptions during weekends and holidays. This issue is of great importance because once an individual is sexually assaulted, there is only a 72-hour window to begin PEP. Ideally, it is recommended to start the regimen as soon as possible. I have learned that when a person is sexually assaulted, local emergency rooms only provide a one-day dose of the regimen. As a result, this leaves the victim advocate and patient foraging for medication to cover the remaining days of the typical 28-day regimen. In addition, the problem is further compounded if the assault occurs on a holiday weekend.
One of the stupid things about being an HIV/ID specialist is the highly arcane code we use to abbreviate HIV treatments.
The Strategic Timing of AntiRetroviral Treatment (START) study began in 2009, enrolling over 4000 asymptomatic people with HIV and CD4 cell counts > 500, and randomizing them to immediate ART or to wait until the count dropped to 350. Now, from the National Institute of Allergy and Infectious Diseases comes this important announcement:
It's not often that a FDA drug approval for cosmetic dermatologists and plastic surgeons will get the attention of HIV/ID specialists, but this past week was an exception. From the FDA report:
The new Department of Health and Human Services (DHHS) HIV treatment guidelines are out, and thanks to skillful direction by Alice Pau, it's as usual a must-read document -- all 288 pages, of course!
The scientific publisher Frontiers recently published a paper disputing the link between HIV and AIDS. Yet, the belief system known as HIV/AIDS denialism has no scientific basis. As demonstrated anew with every person who begins a successful therapeutic program, the causative link between HIV and AIDS is among the strongest and most investigated in modern medical science. The published manuscript was also weak -- a one-sided, poorly researched, inaccurate screed by a non-expert on HIV/AIDS with training in theology and education.
Imagine a phenomenon that elicits distress and shame by simply mentioning its name. With heightened social anxiety, preexisting stigmas and correlations between risk factors, miseducation and distrust, HIV/AIDS is a phenomenon that has spawned rumors and conspiracy theories. From conflicting statements on transmission, to claims of the existence of a secret cure, skeptical narratives about HIV/AIDS still exist. The practice of HIV prevention can be at the mercy of these rumors and conspiracy theories, and those disproportionately affected by this epidemic are often the most difficult to convince that these misinformed notions can be life threatening.