Rethinking HIV: After Five Years of Debate, a New Push for Prevention

After decades of focusing almost exclusively on treating HIV, public health experts are finally able to add more effective prevention strategies to curb spread of the disease.

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After decades of focusing almost exclusively on treating HIV, public health experts are now considering a new approach, moving to establish more effective prevention strategies to curb spread of the disease. Recent tests show that anti-HIV drugs that can hamper the growth of the virus responsible for AIDS may also prevent progression of the disease if given to infected individuals soon after their exposure to HIV. The same drugs can also prevent infections from taking hold among healthy people who are exposed to the virus; both approaches would be critical ways of controlling spread of the virus and keeping new cases of HIV to a minimum.

With this potential in mind, the U.S. Preventive Services Task Force (USPSTF) issued a draft recommendation urging that all people between the ages of 15 and 65 be tested for the virus as part of routine health screening, even if they are not at  high risk of exposure to HIV.

(MORE: Treatment as Prevention: How the New Way to Control HIV Came to Be)

The independent panel of health experts examined recent scientific evidence, including trials that aimed to use anti-HIV drugs to prevent the disease (so-called pre-exposure prophylaxis), and concluded that prompt diagnosis leads to earlier use of effective treatments — and more promising outcomes. Their conclusion: Making HIV screening as routine as cholesterol testing will allow more people to know their status and take advantage of favorable therapies. One in five people living with HIV in the U.S. are not aware of their positive status, and even among those at higher risk, such as gay and bisexual men, testing rates are low: nearly 75% had received medical care but 48% were not tested for HIV, according to the Centers for Disease Control (CDC).

(MORE: Early Treatment With Anti-HIV Drugs Stops Transmission Between Partners)

The task force released a draft of their recommendation proposal, which is open to public comments through December 17. The new guidelines recommend doctors screen individuals over age 15 and under 65 as well as all pregnant women. “Screening individuals between ages 15 and 65 is likely to improve the health of the population because it’s going to find people that don’t know they’re positive,” says Dr. Virginia Moyer, the chair of the task force and pediatrics professor at Baylor College of Medicine. “What we didn’t know when we made our previous recommendation that we know now is that treatment earlier in the course of the infection can substantially improve outcomes.”

(MORE: HIV Drugs May Prevent Infection In Health Individuals)

That knowledge is helping public health campaigns to adopt more prevention strategies and shift away from focusing primarily on treatment as the way to stop the spread of HIV. And it provides campaigns leverage to promote  measures beyond safe sex and abstinence, which have only been marginally effective in reducing new infection rates. “The fact is that the best way to deal with HIV is don’t get it in the first place,” says Moyer. “Yes, we can screen and treat, and it makes a difference, but it still involves treatment that if you could avoid it, you wouldn’t want to have. If we can really focus on prevention, that would be great.”

(MORE: U.S. Panel Recommends More Routine HIV Testing)

Since 2006, the CDC has pushed for more widespread HIV testing for patients as young as 13, citing the fact that many are unaware they are living with HIV, and that available therapies can extend their lives, especially if begun early. In 2005, the task force recommended screening for adolescents and adults who were at a high risk for HIV. But it wasn’t until 2011, when the latest studies on the power of AIDS drugs to prevent infection were released, that health officials could begin devising practical ways of making prevention a priority. “We started looking at getting treatments before symptoms and it turns out it does improve things,” says Moyer. “Our treatments have gotten better and they’ve gotten easier. All those things have worked together to change the balance so that it now appears that general screening makes it likely that across the whole population we will have healthier people.”

(MORE: AIDS Trial Halted: Anti-HIV Pill Fails to Protect Women)

According to Kali Lindsey, director of legislative and public affairs for the National Minority AIDS Council (NMAC), which provides information and research to public health clinics, the recent trial results, and the USPSTF recommendation represent a critical change in managing HIV. “Despite decades of behavioral interventions, infection rates have remained relatively stable, and are increasing among gay and bisexual men, especially young black gay men,” says Lindsey. “Treatment as prevention, pre-exposure prophylaxis, and microbicides offer exciting new ways to slow the spread of HIV. But no prevention strategy can truly be effective without an expanded push for scaled-up HIV screening.”

The shift in emphasis toward prevention is timely as well, since combination drug therapies have created a sense of complacency about the disease that continues to fuel 50,000 new infections each year even in the U.S. About 20% to 25% of people living with HIV are unaware they are HIV positive.

“The general sense of urgency around HIV/AIDS seems to have dissipated,” says Lindsey. “Much of this has to do with improvements in treatment that have made it possible for those who can access it to live long, relatively healthy lives.  But some of this also has to do with a perception that has persisted since the onset of the epidemic–that HIV is a disease of ‘others.’ That it only affects gay men or injection drug users. Too many people underestimate their own vulnerability to infection.”

(MORE: How the Global War on Drugs Drives HIV and AIDS)

That might change if testing for HIV became routine. “I don’t think most Americans realize how serious this epidemic remains,” says Chris Collins, vice president and director of public policy for amfAR, The Foundation for AIDS Research. “The good news is we have the tools, including testing, treatment and targeted prevention that could really begin to end this epidemic in America. The question is whether we get those interventions to the people who need it.”

Testing for HIV is the first step toward expanding those interventions. “This recommendation and its approval will be one more important step towards reducing the stigma of HIV testing both for people in the general public so they are more likely to get a test, and for healthcare providers who currently don’t offer the test automatically because they don’t perceive their client to be at risk, or they don’t want to talk about sex and sexuality,” says Collins.

Collins say normalizing testing and making it an active part of quality medical care will greatly expand the reach of testing and identify more people in need of treatment. As part of a preventive health care strategy, the routine HIV testing would be reimbursed by insurers under President Obama’s proposed health care program; currently only those at highest risk are not required to provide a co-pay for the HIV test. “We have to make sure it is reimbursed in all cases so that financial concerns never stand in the way of a doctor offering a test and person accepting it,” Collins says. “This proposal is an important step towards that.”

(MORE: Truvada: 5 Things to Know About the First Drug to Prevent HIV)

Recent developments, like the first at-home HIV test OraQuick–which can identify antibodies that signal HIV infection from saliva in 20 minutes–also helps reduce stigma around the disease. “Any development that normalizes HIV testing is exciting,” says Lindsey. “The last couple of years have brought a number of exciting developments in our fight against HIV. From health care reform and the National HIV/AIDS Strategy to treatment as prevention and pre-exposure prophylaxis, science and policy have aligned like never before, making it possible to realistically envision an end to this epidemic.”

Collins agrees that the recommendations represent a first step toward turning around the AIDS epidemic in the U.S. “These policy changes mean we can really can start to talk about the end of AIDS,” he says.

21 comments
CluadiaMorgan
CluadiaMorgan


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MarkWilliams4

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Glory
Glory

How fortunate we are that we now have Obamacare !!!  Free HIV testing.   I bet the homosexual communities will be so thankful.   Now the government will have more useful information so that they can make the hard decisions they will be making to fairly prioritize apportioning the free medical care we are all so fortunate to now have.   Hopefully ALL std's will be tested too.  Thank you BO .... what would America do without your caring and concern for us.  

happytalk9
happytalk9

Suggest you review Aethlon Medical of San Diego, CA as they can filter HIV, Hepatitis C, other viral diseases plus cancer exsosomes. Testing all above in India's hospitals. Also can filter Ebola, Anthrax, Marburg and Bird Flu.....awaiting patent approval in Europe...will probably sell filtation units in Europe and Asia first as the FDA requires extensive clinicals....

LarryButler
LarryButler

Hmm..30 years of propaganda and "HIV", or whatever you call a non-existant retrovirus to make billions in grants, has never been ISOLATED from an AIDS patient.  Google Image HIV photomicrograph and find me a PICTURE from an electron microscope, not a cartoonist's drawing board, of ISOLATED HIV grown in the lab like other virus weapons.  Save ya some time, there ISN'T ANY!  Even the French doctor that "discovered" it says it doesn't exist, now.

The world owes Dr Peter Duesberg an immense pile of cash compensation and any new funding he needs for ruining his career.  Damn this religion sold as science.

CriticalPatriot
CriticalPatriot

@ShawnArscott "We live in a sad PR world. This is more dangerous than anything else that is facing us."

Well, in the context of THIS article, a gay black man attempting intercourse with a bleeding cut on his genitals might be a more direct and dangerous threat, but I do see your point! :-) The media's primary function today is to tell their readers what they should believe, how they should think and what should be important to them.

abelinone
abelinone

I see someone in Washington got a visit from a PharmCo lobbyist.  LOL!

ShawnArscott
ShawnArscott

There is now controversy about the legitimacy of HIV as an indicator of AIDS. Where is the report on this information? A person's body has to be autonomous or serious abuses could result. MAndatory testing is never the answer. Informed consent is the only way to prevent abuse. Informed consent means telling both sides of the story which the media and government does not tell the public. We all have to do our due diligence and make sure we know exactly what we are agreeing to. Blind trust sadly is no longer safe. The government, BigPharma and the media have broken their sacred trusts to people to tell the whole story. We live in a sad PR world. This is more dangerous than anything else that is facing us. How can we come up with good solutions if we don't have the whole story?

xinqizhou
xinqizhou

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Nothing_To_Say
Nothing_To_Say

Honestly, I don't know what to make of this....somehow I have this weird feeling that there is a religious/moral component to it...

According to the Center for Disease Control - their most recent stats from 2010 - showed that in that year 18,234 people in the U.S. and U.S. dependend areas died of Aids.

On the other hand in 2012 alone 1,683,910 cases of cancer have been reported, and the expected deads of cancer for this year are expected to be 577,190.

Cancer is the fastest spreading disease - let's call it a virus - and yet, I don't see anybody talkin about compulsory cancer screenings for earlie treatment, etc...

elotrolado8
elotrolado8

Routine screening for HIV is long overdue.  However, in order to treat all those who test positive as well as to provide preventative treatment for those at high risk of acquiring HIV, we need additional legislation that complements the ACA.  The state and federal health exchanges, as well as Medicare and Medi-Cal need to be able to bargain with pharmaceutical companies for reduced drug prices, otherwise widespread treatment and prevention will remain a fantasy.  HIV drug regimens are VERY expensive, typically costly more than $1000/month. Pharmaceuticals have, for years, remained among the most profitable corporations on the planet.  Just like increasing exceedingly low tax rates on incomes above 250K to pay for our nation's needs, we must find the resources to pay for better health outcomes from those who can afford it.  In this case, it's the drug companies.   

duke0518
duke0518

Making HIV screening compulsory for everying between 15-65  May seem like a good idea, however let's look at 15-17 (Chlidren) I would be hesitant to test my kids, and as far as being compulsory this would be overstepping a lot of bounds and would have repercussions.   Right now, we have freedom of choice, we can choose to be tested or not.  It is one more step towards losing rights to our own bodies.   Another note for individuals is that if you ARE diagnosed HIV positive, you have about a zero chance in hell of getting a new life insurance policy, and from what I've seen your existing policy may try every trick in the book to get you dropped.

New medical insurance will be next to impossible to obtain, and if you get it you will be paying out the ears because as a business, they don't want to lose money, they want to make money.  Last I checked, HIV treatment of any kind is costly, and you are asking them to pay for it.

If you have disability (I have) insurance, there is no chance whatsoever any sane company will take you on because you have increased your chances of being out of work for periods of time the longer you are infected.

However, although I am not a fan, the affordable care act(ACA) takes care of this.  For those people uninsured they can be guaranteed treatment however mediocre it may be after 2014.   If You are employed, and sick, and lose money paying for treatment, you too can jump on board and I'll pay for your medical coverage too, through the ACA.    Before you know it, there will be millions of new cases of HIV and all of them uninsured due to costs involved, so me, my spouse, and my colleagues got you, we'll pay for you.  Not because we elected to, but because we have to.

LarryButler
LarryButler

@Nothing_To_Say No, Dr Peter Duesberg blew that Cancer Is Caused By A Virus out of the water many years ago, just like he did the non-existant HIV religion.  They can't "cure" AIDS.  AIDS isn't a disease!  AIDS is an evergrowing list of old diseases that started off at 2 and now is over 40.  If you have any two of these on the list, you get counted as an "AIDS patient", are pumped full of the most toxic drugs BigPharma can produce, like AZT or what's now fashionable to destroy your immune system and the medical bloodsuckers sit around and wait for the drugs to kill you so they can say, "he died of AIDS".  When the numbers start to drop, they simply expand the list.

LarryButler
LarryButler

@duke0518 Dr Joseph Mengele will be very proud when they can force us all to submit to his doctors' "treatments".  Should be most profitable for the billionaire doctors.

Will they send in the medical Gestapo and pull us out of our homes in the night, the old fashioned way, or just take our bank accounts?