Originally posted by the Voice of America.
Voice of America content is produced by the Voice of America,
a United States federal government-sponsored entity, and is in
the public domain.


World 'Way Off' Targets of Getting Control of HIV Transmission

Carol Pearson

   WASHINGTON - Four years ago, governments around the world committed to
   achievingtargets in testing and treatingthe vast majority ofpeople with
   HIVto the point where theAIDSpandemicwould end.

   The tools to dothis have been availablefor20years. In 2010,the National
   Institutes of Health,underthe leadership ofDr. Anthony Fauci,found that
   HIV-negative men whose partners were positive, significantly reduced
   their chances of becoming infected by taking a daily pill that combined
   anti-AIDS medication. This has become known as [1]pre-exposure
   prophylaxis orPrEP.

   PrEPcan now be given as an injection. And peoplewith HIVcan take a
   single pill thatmakesthehuman immunodeficiency virus(HIV)in the blood
   undetectable.

   Under Dr. Demetre Daskalakis' direction, thegoalby theUnitedNationsin
   2016was achieved in New York City, but Dr. Chris Beyrer, an AIDS
   researcher at Johns HopkinsUniversity,saysitisway off
   trackelsewhere.Beyrer spoke to VOArecently. His questions have been
   edited for brevity and clarity.

   VOA:Where are we in achieving the universal goals of having 90%ofpeople
   withHIV diagnosed, 90%of those diagnosed on treatment, and 90%of those
   on treatmentbeing able to suppress the virus to undetectable levels?

   Beyrer: "The 90-90-90 targetswere based on the assumptionthat achieving
   those goals would also bring down the rate of new infections, because
   as more people are treated, and are successfully virally suppressed,
   they will be less infectious for sex partners or maternal-to-child
   transmission.

   "2020 was supposed to be the year in which we were going to see
   significant declines in new infections down under 500,000 worldwide,
   and we had more than 1.7 million new infections in 2019. So, we are way
   off the targets of actually getting control of HIV transmission."

   VOA: Why are we way off track?

   Beyrer: "We're still seeing people acquire HIV when they're relatively
   young'¦and then they are not starting therapy until quite a bit
   later.Sothere's that long period where they are living with HIV and not
   being treated and remaining infectious. That's the first problem.

   "The second problem is that we have seen a significantly lower
   engagement of men in HIV testing and treatment than women. The reason
   for that is that in much of the world, women have much more
   interactions with health carein early adult life and that isbecause of
   contraception, pregnancy,childcare.'¦but men from 18 to 45 have much
   less interaction with healthcare.

   "If we're going to really get control of the HIV pandemic, we have to
   do much better with engaging men in care.

   "Then I think we have to think about the key populations:peoplewho are
   most at risk forHIV. '¦ Peoplewho inject drugs, men who have sex with
   men, transgender women and trans men who have sex with men. We are
   talking about sex workers of all genders. '¦Theseare the folks who now
   account for 62% of all new infections, globally.

   "And'¦thatis because of stigma, discrimination against these folks and
   criminalization--laws against sex work, laws against being gay,
   punitive approaches to drug use instead of drug treatment. And this has
   been true for many years, but now It is so starkly clear that with 62%
   of all new infections worldwide happening[in this]population, we are
   failing to do the basics that are needed to control HIV."

   VOA: To get men into health care, there are some barber shops where men
   can have their blood pressure taken. Are there similar ideas to get men
   into HIV treatment earlier?

   Beyrer: "Yes. One great example was a large project that was joint U.S.
   with Kenya and Uganda, a large collaborative study called the Search
   Study, and Search really tried to provide services screening for things
   like blood pressure for diabetes, diseases that men care about and that
   are much less stigmatized than HIV and to integrate HIV services into
   those services, and to do so in ways that also work for men.

   "So mobile vans going to workplaces, having evening and weekend
   hours.'¦ It's very difficult if you ask men, particularly in low- and
   middle-income countries, to take daysoff ofwork and sit in the clinic
   all day. It's just not an option."

   VOA: Has COVID-19in any way prevented people from going in and getting
   tested or getting treatment?

   Beyrer:"We're just really starting to understand the impacts that COVID
   has had on HIVand alsoon TB. The leading cause of death worldwide for
   people living with HIV infection is tuberculosis.'¦What we've
   seen'¦isthingsthat were not an emergency,like HIV testing for example,
   were postponed or those clinics were closed all together. That had a
   very big impact on HIV testingand alsoon prevention.

   "We have, from the medical perspective, a powerful tool kit now to get
   control. But what we haven't done is get these essential tools and
   services to the people who need[them]themost.Andas long aswe continue
   to have this level of stigma and discrimination, criminalization of the
   people who are most at risk, we're not going to achieve our goals."

References

   1. https://www.niaid.nih.gov/diseases-conditions/pre-exposure-prophylaxis-prep

.