Advances in HIV Science Must Not Leave Needs of People Behind, Experts Urge

Anthony Fauci, M.D., speaks alongside a sign language interpreter at the 2019 National HIV Prevention Conference in Atlanta, Georgia.
Kenyon Farrow

The 2019 National HIV Prevention Conference kicked off March 18 with presentations from the government's top HIV scientists, including Robert Redfield, M.D., director of the Centers for Disease Control and Prevention (CDC), Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases, and Laura Cheever, M.D., Sc.M., head of the HIV/AIDS Bureau at the Health Resources and Services Administration (HRSA).

But in a nod to the systemic discrimination that has perpetuated the HIV epidemic among African Americans, the opening plenary also featured talks from Gina Brown, M.S.W., community engagement manager with Southern AIDS Coalition, and David Malebranche, M.D., M.P.H., associate professor of medicine with the Morehouse School of Medicine.

By addressing the disproportionate impact of HIV on African Americans, Brown and Malebranche each delivered an important message to the attendees gathered at the Hyatt Regency in Atlanta: Science isn't enough to end this epidemic.

Although African Americans account for 13% of the population, in 2017 they accounted for 43% of all newly diagnosed HIV infections. Other minority groups, such as Latinx people, Native Americans, and gender and sexual minorities, bear a disproportionate burden of the HIV epidemic.

Though new HIV prevention science will be a key pillar in the effort to eradicate the epidemic, none of the new science will matter "if we can't give folks a better medical experience that's worth their engagement," said Malebranche.

This message is especially prescient in the wake of the federal government's pledge to end the HIV epidemic in the United States. The goal is to reduce new infections in this nation by 75% in the next five years and 90% in the next 10 years, eventually getting to a new infection rate of less than 3,000 per year.

According to the CDC, about 40% of people living with HIV either do not know their status or received a diagnosis but were lost to follow-up. On March 18, the CDC released new data showing that about 80% of new diagnoses come from the 40% of those who are not receiving HIV care.

Nationwide, only about half of people living with HIV have achieved viral suppression. Conversely, the Ryan White program, which devotes $2.3 billion per year to HIV testing and treatment services, does far better, with 85.9% achieving viral suppression.

The Ryan White program also more effectively enrolls people who are at risk of HIV, with 73.6% of its clients hailing from racial minority groups. Still, said Cheever, "there are approximately 400,000 living with HIV who are not engaged in care -- we need to reach them."

Since 2013, the rate of new HIV infections has remained relatively steady at about 40,000 per year. Redfield noted, "As you look at the overall [new infection rate] you begin to think, okay, we're doing well, but as you look into the specific groups, you begin to see that we're not making progress."

To continue chipping away at that number, it will be crucial for those most impacted by the current epidemic to craft the treatment and prevention strategies that make sense in their own communities, Redfield said.

The federal government, meanwhile, is seeing a renewed interest in ending the epidemic -- never before have so many large federal agencies banded together toward the singular goal of eradicating HIV. Those agencies include the CDC, National Institutes of Health, HRSA, the Substance Abuse and Mental Health Services Administration, and the Indian Health Service within the Department of Health and Human Services.

The now well-established science of pre-exposure prophylaxis (PrEP) and treatment as prevention (TaSP) will be key pillars of the government-backed HIV eradication effort, Fauci said. His comments on the undetectable equals untransmittable (U=U) HIV prevention paradigm were met with resounding applause from conference attendees.

"We have the tools now," said Fauci. "I think history is going to judge us very harshly if we squander this extraordinary opportunity."

Yet all speakers pointed out that without engaging communities most affected by HIV and fighting to combat persistent HIV stigma, the eradication efforts will be doomed from the start.

Minority patients, said Malebranche, "need a provider who will treat us like family."