Opinion: Much progress made, much work remains on HIV/AIDS crisis

(Photo: Business Wire)

(Photo: Business Wire)

At the Aspen Health Institute Conference, I had an opportunity to share the stage recently with a trio of leaders who changed the course of public health history, Dr. Anthony S. Fauci, Dr. James W. Curran, and Dr. Mark Dybul. Speaking alongside them — and reflecting on their legacies as leaders in the early days of the AIDS epidemic — I found myself drawn back in time.

It’s been almost 40 years since a new disease that we would come know as AIDS was first recognized in the U.S.

In the 1980s, I was still in the early stages of my public health career, living in New York City and immersed in research on sex workers and HIV. Back then, AIDS was too often a death sentence — a disease deeply rooted in fear and confusion.

But over time, the contributions of leaders like Fauci, Curran, and Dybul helped set the terms of a new conversation for tackling HIV/AIDS. My own research found a home at Emory, an institution that would play a critical role in changing the larger story of efforts to confront this disease. Emory quickly rose to the helm of the national discussion by helping reshape perceptions and improve patient outcomes through bold new research, prevention strategies, education, and treatment.

Today, many people living with HIV in the U.S. – and millions more worldwide – are on lifesaving antiretroviral therapy, benefiting from one of several HIV/AIDS drugs invented by Emory scientists right here in Atlanta. Not merely surviving, those patients increasingly enjoy full, quality lives.

Looking back, it’s staggering to realize how far we’ve come. But it’s also clear how much farther we have to go.

According to the CDC, approximately 1.1 million people in the U.S. are now living with HIV. This year, with a pledge from President Donald Trump to eliminate the HIV epidemic in the U.S. by 2030, we are taking a hard look at what it will take to achieve that final push. Is elimination of HIV in the U.S. even possible? How do we maintain the necessary momentum?

The challenges are daunting, especially in our own Atlanta region. Today, Atlanta sits at the epicenter of the HIV epidemic in the U.S. Some metro area zip codes report HIV/AIDS rates six to eight times higher than the national average. By the time patients in Atlanta are diagnosed with HIV, a number already have AIDS or advanced disease.

Carlos del Rio, professor and chair of the Hubert Department of Global Health at Emory’s Rollins School of Public Health and co-director of the Emory Center for AIDS Research (CFAR), has found that downtown Atlanta has a generalized HIV epidemic that actually mirrors what is seen in some African cities.

It is my conviction that effective public health measures combined with outstanding clinical medicine can help turn the tide. But finding this pairing takes a commitment to long-term partnerships in our communities.

Under the medical direction of Emory infectious disease physicians, the Ponce de Leon Center at Grady Health System provides care in downtown Atlanta to more than 6,000 persons living with HIV, making it one of the largest and most comprehensive clinics in the country. There, active research efforts have shifted the paradigm for antiretroviral therapy and brought life-saving scientific advances and treatments to some of the communities with the greatest need.

And in a landmark study published this year in The Lancet Medical Journal, researchers concluded that the risk of transmitting the HIV virus can be eliminated when a partner living with HIV is on effective antiretroviral therapy with levels of virus in blood that are undetectable by standard tests. That’s another area where we can make, and are making, real inroads into the future of this disease.

But even the best medicines are useless if patients can’t access them. And often those who need them most are hard to reach — particularly low-income and uninsured people who struggle to pay for care in states that refused federal Medicaid expansion under the Affordable Care Act. That includes the state of Georgia.

According to the CDC, the annual number of new HIV diagnoses has remained relatively stable at about 40,000 in recent years. Yet, within some demographics, those numbers are on the rise. About one in seven people still aren’t aware they have HIV, close to 50% are not engaged in care, and less than 50% are virally suppressed.

The urgency of HIV/AIDS is ever-present. We cannot afford to be complacent, not in Atlanta, and not in any hard-hit community around the United States or globally.

It has been a remarkable journey. We’ve come very far. And we’re not turning back now.

Claire E. Sterk is president of Emory University.