CHICAGO – While basic science discussed here lays the ground work for steps through laboratories and clinics that are hoped to lead eventually to lasting control of HIV, a starting session today explored the realities that, confronted immediately, will slow the pandemic’s momentum, and lower its toll.
From the hardest hit countries in Africa to the hardest hit ZIP codes in the United States, presenters reiterated that access to health services remains an elusive and essential intervention.
This is true in South Africa, where, Deenan Pillay, an epidemiologist with the Africa Centre for Population Studies showed, the role of “sugar daddies” or “blessers” — older men who give money, gifts — and HIV — to young girls has been overstated, and met with responses disproportionate to actual risks. With 20- to 24-year-old men likeliest to be transmitting the virus to 15- to 19-year-old girls and women — not the sugar daddy stereotype, Pillay noted. “There are more nuanced ways of prevention,” he said, “that are needed.”
Pillay also examined incidence among migrants, showing mobility requires informed local interventions.
And he looked at on-the-ground realities that compromise the power to prevent HIV transmission that antiretroviral treatment has demonstrated. He compared data from a recent study that followed household HIV testing with randomized access to treatment for those diagnosed with HIV either immediately, or by South Africa guidelines according to immune system damage (that shifted during the study from 300 or less immune, or CD4, cells per measure of blood to 500 or less). “Disappointingly,” Pillay said, the study found no significant difference in HIV incidence among the uninfected partners, as the more structured HPTN 052 trial, which proved that treating HIV also prevents transmission, had. A loss to follow-up care between diagnosis and treatment was the reason, Pillay added, reflecting the importance of translating research findings not only into policy, but into responses that address conditions on the ground.
“The undiagnosed and untreated are still the key drivers of the epidemic,” he said.
Researchers are continuing to find new reasons that catching and treating infections early can help control both individual illness and epidemic, Julie Overbaugh of the Fred Hutchinson Cancer Research Center showed, in a talk titled Mechanisms of Transmission: Implications for Prevention.
And in the United States, where some counties rival or exceed HIV incidence and prevalence of some of the hardest hit African and Caribbean countries, data is highlighting how gaps in health services fuel the epidemic, and spurring measures to fill those gaps, Patrick Sullivan of Emory University showed. He reviewed data from AIDSVu showing the intersections of race, age, inequities, service access and other factors and HIV rates on a ZIP code level, and HIVContinuum.org, which maps both HIV rates and shortages in health services and providers. A home-testing kit — for HIV as well as other sexually transmitted diseases has been one answer, and been found acceptable by those who used it in a pilot project, he said.