Why this matters
- Some populations are being left behind.
- Funding declining while care/treatment needs increase.
- Fewer than half of people with HIV are virally suppressed.
- Health disparities, structural barriers remain key issues.
- Case numbers hit records lows in some places (e.g., San Francisco), but disparity gap widens.
- Black men living with HIV have highest mortality rates; e.g., in Atlanta, 80% of newly diagnosed are black men.
- Thompson says, “We are not going to end anything until we stop leaving people of color behind.”
- Treatment is prevention, she says, if there is zero transmission and virus is durably suppressed.
- She cites PARTNER 2 study, where transmission was 0 from main partner, despite high rates of condom-free sex.
- Pre-exposure prophylaxis (PrEP) works, but the problem is that among population indicated for PrEP, only 8% were prescribed it in 2015 (mostly white men; only 1% of black people who needed it got it).
- Despite new drugs approved or on the horizon, costs remain unclear.
- New looming problems include:
- Neural tube defect signal detected in Botswana with dolutegravir.
- Other potential developmental neurological signals with in utero exposure to efavirenz.
- Other considerations are structural barriers to, e.g., rapid ART start, which can cut time to viral suppression in half.
- People with HIV are aging, so comorbidities are increasing; e.g., HIV doubles cardiovascular disease risk.
- Without change, says Thompson, another 55,000 people with have a new HIV infection by 2030.
- Implementing 95-95-95 targets would drop that to 19,000/years; adding in PrEP would decrease to 14,000.