BEYOND AIDS CELEBRATES GAINS AS VICTORY AGAINST HIV WITHIN REACH; PLANS FOR 2013

Beyond AIDS held its Annual Meeting in Redlands, California on November 17, 2012, the first time the organization had held a major event in the "Inland Empire." (See separate report on the associated educational seminar on the morning of the meeting day.) There was considerable excitement because of the organization's progress in the development and promotion of a viable strategy to control the U.S. HIV/AIDS epidemic. If this strategy is vigorously implemented nationwide and promoted by federal health agencies, there is a potential for significant decreases in HIV incidence, something that has not been achieved in the U.S. since the disease was discovered in 1981.

President Ron Hattis reported that the subsidiary Beyond AIDS Foundation had been especially active and successful during 2012. In addition to development of the control strategy, the foundation had sponsored meetings in Washington, D.C. with key federal leaders during the International AIDS Conference, to review Beyond AIDS recommendations for HIV control. The internship/fellowship program had been reactivated, and a fellowship project was underway to survey local California public health agencies on their partner services activities. Consultations had been held with leaders of the California Office of AIDS, and the foundation was conducting continuing medical education programs. The Web site had been updated, and the changes were demonstrated at the meeting by our current Web designer, Heather Rinne.

Beyond AIDS reaffirmed its interest in simplifying current laws in California for HIV testing and partner services/notification. In New York State, preliminary evaluation of a the effects of 2010 legislation to make HIV testing more routine indicate a 13% increase in testing. Beyond AIDS will watch for deficiencies that should be addressed in further legislation.

BEYOND AIDS COMMENDS NEW YORK CITY HIV/AIDS PROGRAM AS MODEL FOR COUNTRY

The following statement was released by Beyond AIDS on World AIDS Day, December 1, 2012:

The world’s HIV/AIDS epidemic could soon be controlled, if every community were to adopt the types of programs and policies now in place for New York City. That is the conclusion of Beyond AIDS, a national organization dedicated to reversing that epidemic through sound public health policy. Dr. Monica Sweeney, Assistant Commissioner at the New York City Health Department, gave a presentation about the New York City program at the organization’s annual meeting (and at its expense), in Southern California on November 17.

Dr. Monica Sweeney, Asst. Commissioner of Health, NYC

 “We are very impressed with what New York City is doing,” said Dr. Ronald Hattis of Redlands, California, President of Beyond AIDS. “Every new HIV infection represents a failure to prevent transmission from an existing case,” he continued. “The New York program gets more patients into treatment at an early stage, which suppresses their HIV and makes them much less likely to pass the virus on. If almost all infected persons could be effectively treated before they infect anyone, combined with regular condom use and safer sexual and drug behavior, the epidemic could be brought to an eventual end.”

In late 2011, results from multinational clinical trial with the code name HPTN 052 were announced, which showed that treatment that brought the virus down to an undetectable level in the blood could reduce transmission to sexual partners by 96%. New York City implemented this concept before it had been translated into policy elsewhere.

On December 1, 2011, Mayor Michael Bloomberg and Health Commissioner Thomas Farley released recommendations that healthcare providers offer antiviral drugs to any person living with HIV, regardless of the person’s CD4 count. At that time, the national recommendation was to delay treatment until that count (of a type of white blood cell critical to the immune system) dropped below 500, which could take years. That move, and similar action by San Francisco’s Department of Public Health, helped lead to similar recommendations for the entire nation, almost four months later. There has been little nationwide promotion or implementation of the strategy so far. As a result of New York’s head start, however, already 39% of persons infected in the city have suppressed levels of virus and are unlikely to infected anyone else, compared with 25% nationally.

Other things that impressed Beyond AIDS include the NYC condom availability program, which distributed 36 million male condoms in 2011 at more than 3,900 venues citywide. In addition, New York City distributed 1.3 million female condoms, which are not widely used in most other locations. There is even a NYC condom finder application for mobile phones. The city also has a successful marketing campaign for HIV/AIDS awareness, and a widespread HIV testing program.

“The combination of better control of infection at the source, that is, helping the infected person not to transmit, and also prevention programs including testing and condom availability aimed at entire populations at risk, makes New York City’s program the closest we have found to what we consider the optimal strategy,” said Hattis. “What we want is for every city and state, and every nation, to replicate the sort of things that New York City is doing to control this disease.”

Beyond AIDS’ recommendations on strategy to control the U.S. HIV/AIDS epidemic are published on the organization’s blog. The main Web site, which is integrated with this blog, is www.beyondaids.org.

EDUCATIONAL PROGRAMS ILLUSTRATE STRATEGY FOR BOTH TREATMENT AND CONTROL OF HIV

In November 2012, the Beyond AIDS Foundation conducted continuing medical education programs in Southern California, in conjunction with the annual meeting of the Beyond AIDS membership organization, and in observance of World AIDS Day. These programs both provided state-of-the art updates on HIV treatment, and explained the role that treatment now plays in the foundation's strategy for control of HIV transmission.

A November 17 seminar, conducted at the education pavilion of Redlands Community Hospital, featured Dr. Monica Sweeney, Assistant Commissioner of Health for HIV Prevention and Control, New York City; and Dr. Peter Kerndt, Chief of STD Control for Los Angeles County. Dr. Sweeney presented the model HIV/AIDS treatment and prevention program of the New York City Department of Public Health, including massive condom distribution, widespread HIV testing, and routine linkage of persons who test positive to treatment and partner services. Identification of new infections and onset of treatment are occurring earlier, with prospects for reducing HIV incidence. These are key elements for a comprehensive HIV control and treatment strategy as recommended by the foundation and its sponsoring membership organization, Beyond AIDS.

Dr. Sweeney demonstrates poster used to promote NYC testing

Dr. Kerndt reported on a recent multi-county syphilis outbreak in Southern California, associated with lack of condom use by the adult film industry.  This association was relevant in view of the approval earlier in November by L.A. County voters of a ballot proposal to require condom use by that industry. He also reviewed the diagnosis and treatment of syphilis, including new laboratory testing technology, and the association between syphilis and HIV infection.

Dr. Kerndt explains advances in testing methods for syphilis

Two other presentations at the seminar were provided by Dr. Ron Hattis, Beyond AIDS President. Dr. Hattis reviewed the most recent national guidelines for treatment of HIV/AIDS, which for the first time recommend offering treatment to all infected persons regardless of their CD4 counts. He reviewed the evidence that effective treatment, which suppresses "viral load" (the amount of HIV virus in blood) to undetectable levels, can reduce HIV transmission by up to 96%, a concept commonly referred to as "treatment as prevention." This is a cornerstone in the recommended strategy of Beyond AIDS for controlling the HIV epidemic (see http://www.beyondaids.blogspot.com/2012/07/normal-0-false-false-false-en-us-x-none.html). However, this strategy can only be effective if infections are detected and effective treatment is instituted much earlier than has been traditional, i.e.,  before transmission occurs. Dr. Hattis also provided information and a model checklist to help providers comply with California's unique legal requirements for testing without written consent, and similar information and a checklist for performing or referring partner services.

On November 30, 2012, Hattis was the featured speaker at Loma Linda University in advance of World AIDS Day. He reviewed the history of World AIDS Day, and delivered another update on the treatment and prevention of HIV/AIDS, again explaining how early onset of treatment and following the Beyond AIDS model could reduce national HIV/AIDS incidence by at least 60%.

Dr. Hattis presenting World AIDS Day lecture at Loma Linda University

Implementation of the 2012 guidelines from the U.S. Health and Human Services Panel on Antiretroviral Treatment for Adults and Adolescents (posted on the NIH Website), and from the International Antiretroviral Society-U.S., both of which recommend treatment of all infected persons, has lagged as this aspect of the new guidelines has not been actively promoted to providers and patients. The Beyond AIDS Foundation seeks to stimulate further education for both, to hasten implementation of earlier treatment which can benefit both patients and public health.