Shockingly, an estimated 428,000 of the 1.1 million people who have HIV in the United States either do not know they are infected or are not engaged in care and treatment. During the 2008 campaign, a coalition of AIDS service organizations and advocates called upon all candidates for president to develop a national HIV/AIDS strategy to address serious gaps in progress against HIV/AIDS. The future President Barack Obama pledged that his administration would develop a strategy and since his election, Jeff Crowley, director of the Office of National AIDS Policy, has guided a thoughtful process to develop this much needed blueprint for further controlling the epidemic. Locally, Project Inform, the San Francisco AIDS Foundation, and Randy Allgaier have served as members of the steering committee of the Coalition for a National AIDS Strategy and have provided significant advice as to what we believe the strategy should contain.
In December 2009, Project Inform and the Community HIV/AIDS Mobilization Project co-hosted a meeting of leading HIV experts who recommended that the strategy include an initiative called Testing and Linkage to Care Plus (TLC+). Data are mounting that HIV-positive people who are effectively treated and also practice safe sex are highly unlikely to transmit HIV to their partners. TLC+ therefore proposes that by greatly increasing HIV testing nationally and quickly linking newly diagnosed HIV-positive people to primary medical care, social services, and prevention counseling, plus treatment, the U.S. could greatly increase the percentage of HIV-positive people adhering to care and treatment, improve their health outcomes, and prevent new infections.
Just over a month ago, on July 13, Obama released the national HIV/AIDS strategy and warmly welcomed HIV advocates to a White House reception to mark this important development in the epidemic. The strategy is almost entirely what Project Inform hoped for. It is a narrowly focused, well-reasoned plan that sets the assertive but achievable goal of reducing new infections by 25 percent within five years, as well as important goals for increasing participation of people with HIV in care and treatment.
First and foremost, the strategy takes a solid public health approach previously missing in the epidemic. HIV treatment has historically been focused on improving the health of the individual, as well it should be. However, just like TLC+, the strategy is focused on making certain that more HIV-positive people know their status and are voluntarily linked as quickly as possible to care and social services that will prepare them to take HIV medications early in infection and remain adherent to treatment. It asserts that doing so will help to greatly prolong life and improve quality of life for HIV-positive individuals, in addition to reducing new HIV infections.
Some HIV prevention agencies have expressed concern that this approach to prevention is too medical in nature and dismisses traditional behavioral approaches. But the strategy makes clear that effective HIV prevention requires combining different proven methods, including promotion of condoms, availability of sterile syringes for injection drug users, and various forms of support to help HIV-positive people avoid transmitting the virus to others.
San Francisco can be proud of the national HIV/AIDS strategy, which precisely mirrors the smart direction the city itself is taking with regard to the epidemic. Under the leadership of Dr. Grant Colfax, the city's HIV prevention director, and Brad Hare and physicians in San Francisco General Hospital's HIV program, among others, a clear focus on assuring that more gay and bisexual men know their HIV status and are engaged in care and treatment early in infection is responsible for demonstrated improvements in the individual health of HIV-positive San Franciscans and reductions in new cases of HIV infection. San Francisco is being looked to once again as a model for how to build innovative approaches to further controlling the epidemic.
This is an extremely encouraging and opportune time in the fight against HIV and AIDS in the U.S. The strategy sets the proper course for improving the health of HIV-positive individuals, reducing new HIV infections, and reducing great disparities in the HIV health outcomes now experienced by women and people of color. National health care reform will help us to assure access to care and treatment for most, though not all, people living with HIV. The current arsenal of HIV medications, while not perfect, is capable of greatly prolonging the length and quality of life of HIV-positive people when taken early in infection and also of preventing new infections. It is vital that the nation seize on this set of advances and fund them adequately if it genuinely wants to end the epidemic.
Gay and bisexual men in San Francisco have a role to play in the success of the strategy, the basis of which is universal and regular HIV testing. Even though it is still painful to learn of an HIV diagnosis, in 2010 there is no solid reason for being unaware of one's HIV status. Yet too often, even people who know they are at risk for HIV avoid testing, in part because they have some basic misconceptions about the current state of HIV treatment. Although not perfect, current HIV medications are capable of greatly prolonging life, particularly when taken early in HIV infection, and they have far fewer side effects than in the past. HIV medications associated with changes in body composition and appearance are no longer used in initial HIV treatment. Laws vigorously protect the privacy of HIV patients and protect them from discrimination. And an array of programs fully or partially covers the cost of HIV care, treatment social services and emotional support for those who need assistance.
Gay men in San Francisco can help end the epidemic by continuing to build a culture that values protecting one another's health, of course, but also by being tested regularly, actively encouraging everyone they care about to know their HIV status, and perhaps most importantly, by offering to be fully available to support any friends who learn they are HIV-positive.
Dana Van Gorder is the executive director of Project Inform. The agency's summary of the national HIV/AIDS strategy is at http://www.projectinform.org/nhas/NHAS_summary.pdf. Its suggestions about considering HIV testing and treatment are at http://www.projectinform.org/info/when/index.shtml. The agency is always eager to receive questions or comments at [email protected].