By Dr. Mike Stefanowicz | Austin American-Statesman
December 1st marks World AIDS Day — a solemn moment of reflection couched in this, the 40th year of the HIV epidemic. For many of the early survivors, World AIDS Day is a somber moment to pause in remembrance of those who lost their lives to HIV; celebration as we note the progress that has been made in science and medicine; and consternation as we pass yet another year of an epidemic that has not been brought to heel.
Today, we face public health crises on myriad fronts: the tiring ebb and flow of COVID-19 cases, a silent epidemic of opioid overdoses and the scourge of institutional racism. While the public health challenges we face may feel daunting, one should note the arc of the HIV epidemic to find glimpses of hope, a roadmap for success and hard lessons learned along the way.
The early years of HIV would be characterized by an unrelenting onslaught of death, fear, stigma, misunderstanding and feckless public health messaging. Many of my own patients and colleagues have relayed heartbreaking narratives of people left alone to die in an isolation room, bereft of friends or family; medical staff refusing to even lay hands on patients with AIDS or those with visible stigmata of HIV. These and other challenges would be met head-on by the communities who bore the brunt of the epidemic.
Fast forward to the present day and the HIV epidemic has been markedly transformed by the work of earlier community members, thought leaders and activists. While significant challenges related to health equity and service delivery remain, what was once a life-limiting illness is now a chronic manageable condition if afforded the right tools for success. Highly tolerable one-pill, once-a-day regimens are even simpler than treatment options for other chronic conditions such as diabetes or hypertension.
Today those living with HIV are living long, healthy lives. Their life expectancies are on par with those who are not living with HIV. They are celebrating healthy relationships with partners and starting families. Today we counsel every single person living with HIV that, based on over a decade of robust data, achieving an undetectable viral load on antiretroviral therapy means that one cannot transmit HIV to partners. This simple message of Undetectable = Untransmissible (U=U), has been profoundly transformative in our ability to minimize stigma around HIV. The advent of pre-exposure prophylaxis , a daily pill to prevent HIV, has rendered new transmissions entirely avoidable.
Make no mistake, significant challenges remain. Ultimately, HIV has transformed itself into a nearly universal affliction of poverty, marginalized communities and communities of color. In a manner not too dissimilar from other communicable conditions the modern-day distribution of new HIV transmissions is as much a reflection of broader public policy shortcomings as it is access to basic health care services. In the U.S. nearly 50 percent of all new HIV transmissions are in the southeastern part of the country, predominantly among people of color. This trend is continued locally in Austin, where Black individuals account for 18% of all new HIV transmissions while Hispanics account for 42% of all new HIV cases. The price tag associated with newer more tolerable medications remains unconscionably high.
Despite these challenges, today our message to patients and communities is still one of hope. Everybody should know their status and irrespective of that status, positive or negative, everyone can live a healthy fulfilling life whereby HIV is not necessarily the front and center of that life.
We have the tools to end the HIV epidemic. Now we just need the concerted wherewithal from policymakers, private industry, and the collective conscience of our community members to hold us accountable to implement these ambitions.
Stefanowicz is Associate Director Sexual Health Programs for CommUnityCare Health Centers David Powell Clinic, which provides HIV treatment and care for medically underserved communities in Central Texas.