The end of HIV is near … If we make use of the tools available to us today. And that is no short order. HIV stigma, slut shaming, lack of knowledge of HIV, fear: fear of infection, fear of discussion and continued substance abuse issues — all are feeding the continued epidemic. Yes, new cases remain stable, and those who are infected are living longer, healthier lives. But this is not enough to end new transmissions — not yet anyway.
Only about half of Michigan's residents living with HIV are successfully controlling their infection. By successfully controlling the infection we mean that they are on medications and their viral load — the measure of virus in their blood — is so low it's "undetectable."
Here's why that's so important. Science has shown that when a person living with HIV controls their virus like that, it has two important benefits. First, the person living with HIV will live a longer, healthier life. Secondly, when a person has an undetectable viral load, they are significantly less likely to transmit their virus. How significantly less likely? Early results – two years into a four year study — of hundreds of couples where one partner is positive and the other is negative, found exactly zero transmissions of HIV from partners with a suppressed viral load. Zero. Zip. Zilch. Is it possible a person with HIV who has suppressed their virus could transmit the infection? It's not something science can completely rule out, but the evidence is very strong that transmission is very, very unlikely when a person has an undetectable viral load.
So here's the other tool we have in our possession right now that is key in the end of new HIV infections in Michigan. It's called PrEP, or pre-exposure prophylaxis. This is a once a day pill taken to prevent a person who is not HIV infected from becoming infected. Studies have placed the efficacy of this drug in the low 90 percent range, but math models have placed it at 99 percent. It works, and it works very well.
San Francisco is the nation's first region to scale up PrEP as a prevention strategy. And it's paying dividends. The city reported the lowest number of new HIV infections in years.
Some naysayers are saying that PrEP is not effective, however, because San Francisco is seeing an increase in the number of reported bacterial sexually transmitted infections (those old standbys of syphilis, gonorrhea and chlamydia). While there has been an increase in the number of reported cases of those STIs, it's important to note that is an artifact of the reality that those on PrEP are being tested for those diseases every three months, when they may not have been testing for those infections at all in the past. That's overall good news. We're finding cases of STIs earlier, and treating them and we're stopping HIV infections. That's good for everyone's health.
With these two interventions — treatment for all, used as both a health benefit for those living with HIV and as a preventative to stop transmission and PrEP — we have a unique opportunity to stop new infections.
Barring a vaccine — which remains an elusive proposition — we are now the closest we will ever be to having the tools to end the epidemic. The question is: Do we have the strength of will and the commitment to end the epidemic?
BTL Editorial: The End Of HIV Is Near...
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