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Prepping the World: There’s Still Progress to be Made in HIV Prevention

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By Russell Etherton

Since 1988, when it was first recognized by the World Health Organization, the December 1 World AIDS Day observance has helped us unite around the fight to end AIDS and commemorate those whom we’ve lost worldwide since the beginning of the crisis. In the years since, medical science has made serious advances in treatment and prevention medications that have been proven to block disease transmission about 90 percent of the time. This has prompted some to ask if these advances—especially with Pre-Exposure Prophylaxis (PrEP), the single Truvada pill taken once daily to help prevent HIV transmission—will eventually eliminate the need for World AIDS Day. The answer, unfortunately, is no.

Over the last decade, the annual number of new HIV diagnoses has declined by 19 percent in the United States, according to the Center for Disease Control. Globally, the cases of new transmission have remained static, giving hope for an AIDS-free generation within our lifetime. But at the local level, Houston’s transmission rate has slowly increased, and we now have over 22,000 people living with HIV in Harris County.

With condoms and access to powerful prevention medications like PrEP, we now have the tools necessary to combat the spread of the disease and, in theory, to eliminate the need for an annual day of awareness to beat the drum for HIV prevention. But three key issues still stand in the way progress with global disease prevention:

Stigma: The “Truvada whore” label is real. Be it in conversation among friends at a bar, or a doctor making a snide comment, the stigma around HIV and the Truvada PrEP regimen is real. Some of this can be attributed to a lack of education and training on the part of the prescribing physician, but most of the problem lies with the misinformation regarding what it means to be positive, or how to stay negative. Fear and shame foster stigma, and not having open, educated conversations where a person can ask questions related to sex and HIV creates a closed environment. Fortunately, a bigger conversation around stigma has begun nationally, as evidenced by the fact that articles like this are being published
regularly.

Education: Let’s talk about sex. No, really . . . let’s talk about sex. And let’s also be honest: current sex education is a joke. In Texas, over 90 percent of Texas school districts use “abstinence only” as their sex-education message—discouraging the use of condoms and other forms of contraception. Since 1997, the federal government has spent some $1.5 billion dollars on abstinence-only, leaving a huge void of information at a time when we—and especially young students—need it the most. Texas ranks third in the nation for teen pregnancy, and second for repeat teen births. And Texas teens are reporting more frequent participation in high-risk behaviors, as well as not using a condom during their last sexual interaction.

Access: PrEP is not widely available. Pending regulatory measures and cost barriers for the consumer put PrEP out of reach for large populations. Currently there are only a handful of countries where Truvada is approved for HIV treatment, and even fewer where it’s approved for prevention. Unfortunately, areas with the highest transmission rates and HIV-positive populations (Sub-Saharan Africa, Latin America, and the Caribbean) also have little or no access to PrEP.

With this situation in mind, Houston’s local leaders are beginning to take action. Working with state and national leaders, advocates, public officials, and the Ford Foundation, Legacy Community Health is leading a groundbreaking five-year strategy to dramatically reduce new HIV cases in Houston. This “End New Diagnoses” (END) campaign is the first of its kind in Texas.

We have the science and the tools to treat and prevent the spread of HIV. What we don’t have is the collective national will to end the epidemic. Social factors like stigma and shame hinder conversation and prevent us from eradicating HIV. It’s time for this country, the State of Texas, and the City of Houston to get serious about ending the spread of HIV—and there’s no better time to start than on Thursday, December 1.

Russell Etherton is a community-relations manager for Legacy Community Health.

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