PrEPing for the End Of The HIV/AIDS Epidemic

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Now 30 years after the first AIDS case was diagnosed in America, evidence is quickly mounting that we are turning the corner and the tools that could end the HIV pandemic lay in our hands.

Now 30 years after the first AIDS case was diagnosed in America, evidence is quickly mounting that we are turning the corner and the tools that could end the HIV pandemic lay in our hands.

Recently the Centers for Disease Control and Prevention (CDC) announced the results of two clinical trials involving heterosexual men and women that demonstrated for the very first time that antiretroviral (ARV) medications taken daily can dramatically reduce their risk of becoming infected with HIV. This strategy of providing daily ARVs to uninfected people to reduce their chances of infection is called pre-exposure prophylaxis (PrEP).

The two trials, conducted in three African nations, provide evidence that ARVs, originally developed to save lives, also offer a powerful strategy for preventing new HIV infections acquired through heterosexual contact—the epidemic’s primary method of transmission across the world and a disproportionate factor in Black America.

The smaller of the two studies, known as TDF2, involved just over 1,200 sexually active, HIV-negative young adults, ages 18-39. Researchers found that participants who took a daily pill of Truvada—a mix of tenofovir and emtricitabine—reduced their risk of becoming infected with HIV by 63 percent. This study was conducted in Botswana and managed by the CDC and the Botswana Ministry of Health.

The second study, known as Partners PrEP, was conducted in Kenya and Uganda by researchers from the University of Washington and funded by the Bill and Melinda Gates Foundation. The study recruited 4,758 sero-discordant couples—that is, couples in which one partner has HIV and the other does not. The uninfected partners were randomly assigned to take Truvada, Viread—an ARV containing only tenofovir—or a placebo. Those taking Truvada saw their infection risk drop by 73 percent. The HIV-negative partners taking Viread had an average of 62 percent lower chance of becoming infected.

The Partners PrEP findings were so definitive that it was stopped early because it would be unethical to continue providing participants placebos.

These study results come on the heels of promising clinical-trial findings showing that vaginal microbicides can prevent HIV-infection in women and that PrEP can prevent infection among gay and bisexual men. And only two months ago, breakthrough research showed that when participants started taking ARVs almost immediately after being diagnosed with HIV rather than waiting until the disease had progressed, they were much less likely to infect others, a strategy known as "treatment as prevention."

We have reached a deciding moment. HIV is 100 percent preventable, including among some of our most at-risk populations: women, gay and bisexual men and young adults. HIV is also 100 percent diagnosable and in many cases treatable. Our prevention toolbox is now exploding with options. We now have the all of the tools needed to end the AIDS epidemic!

The promising new PrEP results arrive at a critical time. Wednesday marked the one-year anniversary of the launch of the historic National HIV/AIDS Strategy, the nation’s first comprehensive roadmap for fighting the epidemic, and one that places the wellbeing of Black people front and center. We also have health-insurance reform to provide care to the least among us.

But the anniversary and this remarkable string of study results come during an economic downturn that has seen many people lose jobs and others slip through the proverbial “safety net”—losing health insurance, unemployment, and other benefits. It also comes at the same time many states are cutting funding for HIV/AIDS-prevention programs and the AIDS Drug Assistance Program (ADAP).

So while we have the toolkit to end the epidemic, the question remains whether we have the political will to invest in using the tools strategically, effectively and compassionately.

It’s time to call on Congress, the Obama Administration, and federal and state agencies to do three things:

1. Invest in expanded access to testing and linkages to care. People need to know their HIV status, and those who are HIV positive need to be linked to appropriate care immediately.

2. Increase access to care for vulnerable communities including the ADAP waiting lists. Nationally over 8500 people remain on ADAP waiting lists. Fourteen states have reduced the number and types of drugs they will pay for. A number of states have stiffened financial eligibility requirements, capped enrollment or removed some people who were already enrolled. Other states are considering doing the same.

This approach is outrageous. Not only are such cuts immoral and financially shortsighted, as these recent data prove, starving ADAP programs creates a public health threat.

3. Raise HIV science and treatment literacy in vulnerable communities. HIV health disparities are growing in the U.S., and Black people are disproportionately impacted. Black Americans become infected at a younger age and at higher rates, are diagnosed at a later point in their disease and die faster than any other racial ethnic group. Our lack of scientific understanding about how the virus behaves in the body and what options exist to treat it is one of the biggest barriers to efforts to confront HIV in our communities.

Lacking this knowledge too many of us in the Black community become distracted by myths and misinformation. When we don’t understand the science of HIV/AIDS, we are unable to protect ourselves, we put off getting tested, delay starting treatment, fail to adhere to the treatment regimens and are reluctant to own the disease and/or our responsibility for ending it.

If we don’t raise HIV-related science literacy, capacity and infrastructure in Black communities, Black people will continue to be left behind, and we won’t succeed in ending the disparities, despite the biomedical advances we’re making.

PrEP offers tremendous promise, but it is not a magic bullet. We still need to use condoms, offer comprehensive sexual education, provide prevention counseling, and choose fewer partners and know our status and our partner’s stratus. Policy makers need to step up and leaders need to lead. But PrEP has the potential to become a powerful weapon in the war against HIV/AIDS.

It’s time to get serious about PrEPing to end this epidemic.

Phill Wilson is the President and CEO of the Black AIDS Institute, the only National HIV/AIDS think tank in the United States focused exclusively on Black people. He can be reached at PhillWilson@BlackAIDS.org

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