Eliminating new HIV infections by 2030
The ‘Ending the HIV Epidemic: A Plan for America’ (EHE) initiative by the U.S. Department of Health and Human Services (HHS) aims to reduce new HIV infections by 75 percent by the middle of this decade and at least 90 percent by 2030, with the goal of ending the HIV epidemic in the U.S.1
That’s a worthy goal we should all work together to achieve. For far too long, the HIV/AIDS epidemic has claimed the lives of hundreds of thousands of people in America, and around the globe. More than 700,000 Americans have died of HIV/AIDS since 1981 and more than 1.1 million are known to be living with it now.2 Many more continue to be at risk.
Education, additional treatment options and a great deal of outreach helped make significant progress in bringing down the number of new HIV infections each year, but that progress has stalled. An estimated 400,000 are expected to be diagnosed with the virus over the next decade and many more may acquire it without being aware of their positive status.3 According to HIV.gov, a coalition of agencies across HHS leading the EHE initiative, there is a real risk of the epidemic resurging because of “trends in injection drug use; HIV-related stigma; homophobia; lack of access to HIV prevention, testing, and treatment; and a lack of awareness that HIV remains a significant public health threat.”
Ending the epidemic will not be easy, but it is achievable. Three factors will play a key role:
- Education and awareness
- Access to pre- and post-exposure preventive treatments
- Widespread testing and timely treatment
Education and Awareness
Education about HIV/AIDS should include building awareness about its prevalence and its deadly nature if left untreated. However, it is equally important to help those affected by the disease, and those at risk understand “harm reduction.” Approximately 80 percent of new HIV transmissions are from persons who do not know they have HIV infection or are not receiving regular care.4 Education can not only help those at-risk develop and maintain safer behaviors, but also help reduce stigma and discrimination toward those affected by, and living with, HIV.5
Harm reduction strategies aim to help reduce behaviors such as injected drug use and risky sexual practices.6 These include:
- Awareness about sexually transmitted diseases
- Education about safe sex practices
- Peer-based education about risks of shared needle use
- Awareness of pre- and post-exposure treatments
It is important to note that the HIV epidemic disproportionately affects communities of color and younger populations. In 2018, Black Americans and African Americans accounted for 45.4 percent of 37,968 people who received an HIV diagnosis, while Hispanics/Latinos made up 22.4 percent.7 By age group, 31.5 percent of annual infections were among those aged 25-34, and 16.9 percent among those aged 35-44. Awareness efforts should be culturally competent. Educational efforts will need to speak to the unique needs and issues facing these communities.
Prevention
Prevention is possibly the single-most important component of ending the HIV epidemic. A variety of strategies can be brought to bear, including providing convenient access to supplies for safe sex and needle exchange programs. Anti-retroviral therapies (ART) can also help prevent transmission both from someone who has been diagnosed with HIV to another person, as well as from mother to child among pregnant women.
Relatively recent breakthroughs mean we now have preventive treatments — medications that can help prevent someone from contracting HIV. Prophylaxis can be pre-exposure — also known as PrEP — or post-exposure — also known as PEP. PrEP medications are oral medications taken daily. The goal of prophylactic treatment is to prevent the virus from taking hold and spreading through the body. The Centers for Disease Control and Prevention (CDC) recommends only using PEP in emergency situations and within 72 hours of exposure.8
PrEP can reduce the risk of contracting HIV from sexual contact by approximately 99 percent, and from injected drugs by at least 74 percent, according to the CDC.10 Currently, available daily PrEP medications include Truvada (emtricitabine/tenofovir disoproxil fumarate) and Descovy (emtricitabine and tenofovir alafenamide). Options for prophylactic treatments continue to expand with the launch of a U.S. Food and Drug Administration-approved generic PrEP therapy.11
The World Health Organization has stated, that while PrEP treatments are highly effective, adherence has been a challenge and inconsistent use reduces the prevention effect. Another potential preventive treatment in the pipeline has shown promising results in clinical trials and could become the first long-acting treatment that could help mitigate the risks of non-adherence. Cabotegravir, an injectable currently approved as a long-lasting ART, was significantly more effective in preventing HIV transmission than a daily oral regimen.12 If approved for prevention, it could help improve prevention efforts without requiring adherence to a daily oral regimen, and also increase treatment options.
HIV Testing and Treatment
For the best possible outcomes, early diagnosis is critical. And yet, 14 percent of those living with HIV in the U.S. — one in seven people — including nearly 45 percent of those aged 13-24, do not know about their positive status, according to the CDC.14
Getting tested for HIV is the only way to know for sure if someone has HIV. The agency recommends that everyone aged 13-64 should get tested at least once, and those at higher risk of exposure — or acquiring HIV — should be tested at least annually or more frequently. Getting tested not only helps ensure that anyone infected can get proper treatment. If someone has their viral load under control through treatment, they are less likely to transmit the infection to someone else. Most health care providers offer HIV testing. People can also get tested at health, family planning and sexual health clinics, community health centers, local health departments, substance abuse prevention or treatment programs, or veterans’ affairs medical centers. Many pharmacies also offer HIV testing.
In addition to helping prevent transmission, ART regimens have helped dramatically reduce morbidity and mortality, as well as AIDS- and non AIDS-related complications. These treatments have helped bring life expectancy for those with HIV to nearly at par with the general population.
Since the introduction of ARTs, treatment options have expanded significantly and newer agents are more potent, better tolerated and often display less toxicity compared with earlier therapy options.15 Treatment regimens today are also more simplified, which has helped improve adherence and lessen the risk of developing virologic failure with drug-resistant virus.
One in seven people living with HIV in the U.S. is unaware of their positive status.13
What Employers/Businesses Can Do
Employers can help support the fight against HIV/AIDS.
- Education and Awareness
Utilizing existing tools such as employee resource groups and communication channels to foster peer-to-peer conversations can help educate at-risk populations and increase awareness. Additional strategies such as health fairs where people can learn more about HIV/AIDS, treatment options and prevention can further build on this, as can human resource strategies that encourage and foster candid conversations. - Prevention
To truly bring about an end to the HIV epidemic, preventing new infections will be as critical as treating those who have been diagnosed with the disease. One way to do this is by encouraging greater use of PrEP and PEP. Adding these treatments to a preventive drug list — similar to those currently available for many chronic conditions — and making them available at zero out-of-pocket cost to members can significantly improve uptake. This can also help lower long-term, downstream medical costs for employers by helping ensure a healthier member population and better outcomes. - Testing and Treatment
Onsite clinics where employees can get tested could significantly help improve early diagnosis, and help at-risk populations learn more about treatment options. Employers can also help improve access to treatment by lowering a key barrier — member cost. Plan design strategies that lower out-of-pocket cost for HIV treatments can help improve access as well as adherence.
Much remains to be done and meeting the goal of ending new HIV infections by 2030 will take a concerted effort by a range of stakeholders. But by focusing on these three pillars — education, prevention, and testing and treatment — we can help stop HIV/AIDS from claiming any more lives.
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