By Miguel Gomez , AIDS.gov Director
HIV Policy & Programs | November 13, 2011
This is the third in our series of daily highlights from the U.S. Conference on AIDS in Chicago. This post spotlights some activities related to treatment and the National HIV/AIDS Strategy (NHAS) from Saturday, November 12. Later this week we will provide a summary of the final day of the conference along with a blog post highlighting new media activities that took place.
Antiretroviral Therapy Discussion
Yesterday's plenary session featured a discussion of the HIV prevention benefits of antiretroviral therapy (ART) - also known as combination
therapy which involves using a combination of three or more antiretroviral (ARV) drugs from at least two different HIV drug classes to
prevent HIV from replicating (read more about ART on NIH's AIDSinfo site ). Dr. Tony Mills,
a UCLA HIV physician, discussed new evidence suggesting the potential for ARVs to serve two important new roles in the fight against HIV, in addition to their original function of prolonging health
and improving survival among persons living with HIV. These included: 1) reducing the risk of HIV transmission by lowering the infected partner's viral load with early treatment initiation (known as
"treatment as prevention"); and, 2) decreasing the risk of HIV acquisition through pre-exposure prophylaxis (PrEP). Dr. Mills reviewed the implications
of HPTN 052 , which
offers the most definitive evidence that early treatment initiation curbs the risk of HIV transmission in stable, discordant heterosexual couples. He also examined the potential of PrEP for averting new
infections, stressing that the research (see posts about the iPrex study ) indicates that the level of protection was dependent on adherence
to the treatment regimen. He also noted that currently the evidence base for the use of this prevention intervention exists only for men who have sex with men, but that additional studies are underway testing its effectiveness
with other populations. He highlighted CDC's interim guidance on the use of PrEP in men who have sex with men and raised some
of the questions the HIV community is facing regarding deploying this intervention such as how will it be administered and by whom? Finally, Dr. Mills highlighted recent revisions to the National Institutes of
Health's HIV Treatment Guidelines , which provide updates on treatment regimens, dosages, and interactions.
Reducing HIV Stigma and Discrimination
An important step in achieving the NHAS goal of reducing HIV-related disparities and health inequities is reducing stigma and discrimination
against people living with HIV. During a session on this topic, Ms. Allison Nichol , Chief
of the Disability Rights Section of the Department of Justice's (DOJ) Civil Rights Division, presented on the 2008 amendments of the Americans with Disabilities Act,
which define HIV as a covered disability. DOJ now has a one-click system for filing HIV-related discrimination complaints through their website and
encourages its use. Ms. Nichol also reported that DOJ has increased its policy work to address the misinterpretation of communicable diseases laws that may result in HIV discrimination. Other speakers from
the American Civil Liberties Union, Lambda Legal, and the Center for HIV Law and Policy presented several examples of the persistence of inaccurate information about the mechanisms of HIV transmission in recent discrimination cases.
Increasing Routine HIV Testing in Primary Care
According to the CDC an estimated 20 percent of people with HIV in the United States do not know their status. Studies show that most persons who are
aware of their HIV positive serostatus take steps to reduce transmission risks. Research also shows that many persons with undiagnosed HIV
infection regularly access health care services but many opportunities are missed to diagnose and link them to sustained, health
preserving treatment and care. In a session yesterday, representatives
of Urban Health Plan, Inc. , a New York City-based
multi-site federally qualified
health center , shared results and lessons from their effort to implement routine HIV testing in a primary care
program. Workshop participants acknowledged several challenges to implementing routine testing in primary care
settings, including administrative barriers, provider buy-in, patient flow, staff turnover, documentation,
and test costs. The presenters outlined how they leverage their existing Electronic Health Records
and a quality improvement (QI) processes to support and improve integration of routine HIV testing. In
a very short time period and with minimal additional resources, Urban Health Plan has dramatically
increased their HIV testing offer rate and testing completion rate. As a result of their QI
processes, they are continually addressing challenges and identifying solutions.
Tune in tomorrow for our final daily conference highlights post about today's closing activities.
AIDS.gov team members Aisha Moore and Michele Clark contributed to this post.
We would also like to thank Steve Holman for his significant contributions to the content of the USCA blog posts and all of his work
reporting on the National HIV/AIDS Strategy on behalf of AIDS.gov.