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Ben Young: CROI 2015 Data Bolster the Call for Initiative to End HIV/AIDS Epidemic

February 27, 2015

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Benjamin Young, M.D., Ph.D.

Benjamin Young, M.D., Ph.D.

According to Ben Young, chief medical officer of the International Association of Providers of AIDS Care (IAPAC), the world has everything it needs to end the HIV/AIDS epidemic and related deaths. He told that new data from CROI 2015 in Seattle, Washington, reinforce the vision of the Fast-Track Cities Initiative, and that the biggest barrier is not a lack of data or tools, but a "shortage of imagination."

Ben, what is the Fast-Track Cities Initiative, and what data did you find here at CROI 2015 to support this global strategy?

The UNAIDS/UN-Habitat/IAPAC Fast-Track Cities Initiative is a seemingly ambitious, but also critically important, initiative. It joins our three organizations with the mayor of Paris, Anne Hidalgo, in an initiative to get cities in the global North and the global South, in the East and West, to commit their municipal governments, medical organizations, civil society leaders and other affected individuals to the idea of ending [HIV/AIDS epidemic-related] death in their cities in five years, by the end of 2020.

The way to do that is to commit ourselves to a transparent process, a verifiable process, that leads toward the achievement of the 90-90-90 targets that UNAIDS set forth at the General Assembly last year. In brief, 90-90-90 is 90% of people living with HIV tested and knowing their status; 90% of them on treatment; and 90% of treated people with undetectable viral loads.

The initiative has signed over 30 major cities around the world, including Amsterdam and Paris; including Kingston, Jamaica, and Port-au-Prince; including Kinshasa, Durban and Nairobi. It includes Delhi and Bangkok and, as of last week, San Francisco.


We mean business. We mean, in doing this, to end the epidemic of death that has happened and ravaged our planet. And most specifically -- and this aligns with Ambassador Birx's presentation about doing the right things, in the right places, at the right times -- it's focusing efforts, not by excluding people who might be less crushed by the epidemic, but rather by focusing it where the people are, where there's the greatest burden of disease.

That is what PEPFAR 3.0 is about. It's about the geographical understanding, and using new technologies to understand that -- but, mostly, about finding the right places.

In this case, we're saying that many of those right places exist in a relatively short list of major cities around the world. And commensurate with getting cities on board is getting regions, and perhaps even nations, to believe that epidemic death can end. If you believe it, then you will do something about it.

Consistent with that, one of the most important sets of presentations at this conference was when we looked at amazing data on pre-exposure prophylaxis [PrEP] from the PROUD and IPERGAY studies. The presentations from Sheena McCormack and by Jean-Michel Molina were really important because they confirm to us that PrEP does work, at least in men who have sex with men. And the IPERGAY study suggests that daily administration is not necessary to achieve the targets of HIV prevention.

Most importantly, the two studies came up with very similar numbers on the number needed to treat [(NNT)], which is less than 20 individuals. That means that 5% of people, or even more than 5% of people, who are given PrEP in high-risk populations will actually benefit. Namely, they will not get HIV. From a public health perspective, both in low-income countries and high-income countries, that's an incredibly important number. But also that number means that this should be implemented.

So you take those two studies, and you add to that the presentations from Jared Baeten and Bob Grant. Baeten’s presentation on an implementation pilot project in Kenya and Uganda, says that combination PrEP and treatment-as-prevention dramatically protect people from getting HIV -- and, oh, by the way, help prevent death, and dying, and disease. So that's a demonstration project in low-income countries in East Africa. And then Bob Grant's magnificent presentation on the experiences of scaling of therapy and prevention in the city and county of San Francisco tells us that these things work.

The aspirations of Fast-Track Cities in achieving 90-90-90 are not just aspirations; these are things that can, and actually -- as Bob Grant showed us -- have happened, in at least one city. And other cities are actually approaching these numbers. So, collectively, we're beyond the tipping point. The data and the science is now there. It's compelling. From a public health standpoint, it's met at least some of the benchmarks for the quality necessary to do this.

The San Francisco experience says that even in the post-2008 recession, where public health departments and city governments were facing declining revenue and declining budgets, that public health departments can actually expand the number of people tested, expand the number of people in care, expand the number of people getting treatment and, ultimately, make AIDS and AIDS death rare, making new infections less. These are doable things.

That's what Fast-Track Cities is about. It's about cities around the world -- global North, global South, rich countries, poor countries -- getting their municipal governments to support and believe the idea that we can actually end epidemic death. That's Fast-Track Cities.

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This article was provided by TheBodyPRO. It is a part of the publication The 22nd Conference on Retroviruses and Opportunistic Infections (CROI 2015).


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