Mitchell is the executive director of AVAC.
I think the most overlooked issue is really understanding the individual needs of a patient on treatment, or an individual at risk for prevention. We have spent a lot of time over 30 years, 35 years, really doing so much better science of the medical [aspects]. I think we are still needing to do a great deal more around the behavioral components of that -- whether it's about taking treatment, whether it's about using a condom, using a vaginal ring -- really understanding the dynamics of using products and understanding the dynamics of people's perception of risk.
I think we often get into this, like these are biomedical fixes, and these products, treatment and prevention, don't work because they don't get used. I think we need to really understand that much, much better.
When I look out at the future, it's both about prevention but, also, when you look at these very ambitious global goals, and "90-90-90" [UNAIDS aim for 90% of people with HIV to know their status, 90% of people who know their status to be on treatment, and 90% of people on treatment to have undetectable viral loads by 2020], getting basically 73% of people virally suppressed -- we're, in this country, [now] at 30% -- there are a lot of issues there. A lot of it is around stigma. A lot of it is about risk. A lot of it is about, "Do I want to stay on drugs when I'm healthy?" for treatment.
It's not just about understanding the prevention needs for people, whether positive or negative, but also about treatment -- understanding why people are adherent, because adherence is a problem for treatment as much as for prevention.