Zack Ryder shows off his San Diego Comic-Con toy haul
PHOTO ABOVE: Sharon Grant, pharmacist at Hillcrest Pharmacy, said preventive approaches to dealing with HIV -- including use of the drug Truvada -- will likely increase dialogue between doctors and people infected or at higher risk of becoming infected with the virus.
San Diego County is among a growing number of communities nationwide to begin championing a goal that would have seemed downright audacious a few years ago: driving HIV infection rates to zero -- or as close to it as possible.
Public-health experts said similar programs already underway in San Francisco, New York and Washington, D.C., show that big drops in new HIV cases are difficult but possible. They"re cautiously optimistic about getting targeted people to consistently take prescribed drugs and practice safer s*x two behaviors that have persisted despite decades of other outreach efforts.
Taking the San Diego region from nearly 500 new HIV infections per year down to almost zero will rely partly on the meticulous use of antiretroviral medications. Research shows that daily use of these drugs, particularly Truvada, massively lowers transmission rates of the human immunodeficiency virus and boosts resistance to infection by more than 90 percent.
But Truvada can cause serious side effects such as kidney damage and loss of bone density in a small percentage of patients. And critics of Truvada-based prevention programs contend that they could lull people into more careless sexual practices.
Truvada, a drug made by Gilead Sciences, can dramatically reduce transmission of HIV. / courtesy photo APTruvada, a drug made by Gilead Sciences, can dramatically reduce transmission of HIV. / courtesy photo / AP
For the Getting to Zero plan passed last week by the San Diego County Board of Supervisors to work, it will also take extensive coordination, said nationally known AIDS activist Peter Staley.
He said there must be strong connections between public-health departments, medical providers and the outreach organizations that serve communities facing the highest risk of HIV infection.
The only way these things work is when you get these massive coalitions. You get everybody sitting down regularly looking at the data. Its using science and adding a little elbow grease, Staley said.
San Diego appears to have built that kind of coalition. The special task force that put together the countys plan includes not just public health officials, but also representatives from the medical community and advocacy groups.
Patrick Loose, chief of the countys branch dealing with HIV, hepatitis and sexually transmitted diseases, said he believes that the programs ambitious aim is truly achievable, though the timetable for success has not been determined.
There has to be a community engagement and effort around this, and there have to be a lot of partners who come together to forward this message, but today were living in a world where the CDC describes HIV as a winnable battle. Thats a very amazing thing, Loose said.
Victory isn"t likely, Staley said, without additional resources. He said New York has invested about $20 million in additional resources for housing, nutrition and transportation services necessary to solve some of the social challenges that keep some from staying enrolled in treatment regimens.
San Diego County has not identified funding sources to bolster its HIV-prevention efforts, but officials said they will do so in the future.
New drug, old stigma
The U.S. Food and Drug Administration in 2012 approved Truvada, a new application of existing antiretroviral medications used to manage HIV infections from becoming AIDS.
In San Diego County and elsewhere, the Truvada-based strategy seems simple: Keep treating all infected patients while having everyone who is at elevated risk of infection take a daily preventive dose. If both actions can be done consistently for a few years, HIV could be vanquished.
Experts said pulling off the "zero" feat will not be nearly as easy as it sounds.
The county Health and Human Services Agency said there about 20,000 HIV-positive people in the region, along with an estimated 2,300 who do not know they are infected and 6,400 who have tested positive but are not in treatment.
Many AIDS activists said today"s overriding culture in gay communities is to lessen your risk of infection by steering clear of people who admit they are HIV-positive. This in turn creates social pressure against disclosure of an HIV diagnosis and makes many people reluctant to get tested regularly.
San Diego county"s new program calls for not only Truvada prescriptions, but also outreach to the affected demographic groups and increased HIV testing.
Most insurance companies and Medi-Cal cover Truvada prescriptions, and the drug"s maker, Gilead Pharmeceuticals, offers financial help to people who are uninsured or have trouble meeting their copays.
High-risk groups include gay, bisexual and straight men and women who have multiple sexual partners; intravenous drug users; and men who have s*x with other men but identify themselves as straight.
Quick work
Loose, the county health official, believes progress can be made by working with health providers to make HIV testing an automatic step in patient care and by appealing to people"s noblest instincts.
If you are someone who is afraid of the stigma, were going to make it so that you dont have to seek out HIV testing. Its just going to be offered to you, Loose said. We think the message needs to be that we all have a role in ending the HIV epidemic.
The first wave of cities that launched similar programs have seen substantial results, even none of their rates have come close to zero, said the prominent AIDS activist Staley.
D.C. probably preceded everyone else, and they started ramping up their testing programs in 2006. They have seen close to a 50 percent drop in annual HIV diagnosis rates. San Francisco has seen a 30 percent drop in the last two years alone, Staley said.
He said the most impressive results seem to come in places where public-health departments work very closely with local advocacy groups. A seamless connection between HIV testing and treatment is critical, he said.
You ramp up testing to find those who dont know theyre positive and you have these hand-holding programs to get them treatment right away," Staley added. "Now its pretty standard in San Francisco that youre put on antiretrovirals the very same day (of diagnosis). Within weeks, you have no detectable viral load and are therefore un-infectious.
Not controversy-free
Its a far cry from how the AIDS epidemic started.
In 1981, rare lung infections detected in otherwise healthy, young gay men living in Los Angeles led to evidence of severe immune-system deficiency an effect also quickly linked to intravenous drug users.
By 1984, there were 7,699 AIDS cases and 3,665 deaths in the United States.
The world reported 4.7 million cases in 1995. And by 1999, 14 million people had died from the disease.
Antiretroviral drugs have turned HIV infection from a death sentence to a chronic, largely manageable condition. San Diego County recorded 475 new cases in 2015, a nearly 90 percent decline from the peak caseload seen in 1984.
Epidemiologists believe Truvada can help them minimize new HIV infections, but they have faced opposition from the Los Angeles-based AIDS Healthcare Foundation. The organization"s position is that using HIV drugs for prophylaxis rather than treatment could increase the rates of other sexually transmitted diseases.
In an open letter to the U.S. Centers for Disease Control and Prevention, the foundation said the rapid rise in rates of STDs such as syphilis, chlamydia and gonorrhea indicate that fewer people are using condoms and suggesting the need to reinvigorate safer-s*x campaigns. The group asserts that such campaigns have received less attention as the CDC focuses on Truvada.
Loose and Staley said while the foundation is one of the most powerful advocacy groups in the nation, its stance against Truvada does not enjoy broad support in the community of gay and HIV support groups.
They said STD rates started increasing long before the FDA approved Truvada in 2012. They also said large studies of Truvada have not found an increase in STDs.
Source: http://www.sandiegouniontribune.com/news/2016/jul/29/truvada-hiv-infection-aids-county-supervisors/
