July 19, 2012 | by Ray Martins
The state of HIV in Washington: 29 years later

On April 4, 1983, AIDS entered the public arena of the District of Columbia.

On a Monday evening 29 years ago, Whitman-Walker held the first public forum on AIDS in D.C. At that time, Cabbage Patch dolls were a hit, people were watching M*A*S*H, and AIDS was destroying the gay male community. A panel of public health experts and advocates spoke to a full house at Lisner Auditorium of The George Washington University. The audience of predominantly gay men was driven to the forum after watching friends, lovers and colleagues die quickly and horribly from AIDS. And they were in a state of fear bordering on panic.

The forum that night probably did little to calm that fear. Think about what was happening in 1983. AIDS had only been recently named. The HIV virus had not been discovered yet. There was no test to see if someone was infected and there was no treatment. In fact, people were unsure if you could catch AIDS from a simple kiss. In short, there was almost no good news that night; only fear and despair for the future.

Today, on the eve of the 2012 International AIDS Conference, there is far more good news in the world of HIV/AIDS.

Since that forum in 1983, HIV testing has become standard operating procedure for many Americans, particularly those in groups at high risk for HIV, like gay or bisexual men. Successful treatments are keeping people with HIV healthy and alive for many years. And people are more knowledgeable about condom use and other safer sex practices.

Over the last few years, even more developments have brought new hope and optimism in the fight against HIV/AIDS, including the idea of using HIV medications to prevent HIV transmission, also known as “Treatment as Prevention.”

One of the best ways to reduce new HIV transmissions is by diagnosing people with HIV, getting them into care and on medications. These HIV medications can suppress the amount of virus in the person’s blood to very low levels, which make it much less likely for that person to transmit the virus. In fact, studies have shown successful treatment to reduce the risk of transmission by up to 96 percent. This same strategy is used to prevent the mother’s HIV from transmitting to the baby.

Another way HIV medications are used to reduce transmission is through HIV “post-exposure prophylaxis” or “PEP.” If a person has a needle stick at work or an unsafe sexual encounter they can take HIV medications for a month to prevent infection. This method is at least 80 percent effective if used within 72 hours of the potential exposure.

Recently, studies have shown HIV medications can be taken by individuals at high risk for HIV before they are exposed to the virus to protect them from infection. “Pre-exposure prophylaxis” or “PREP” is still undergoing clinical trials but seems to be very effective for certain populations at high risk for HIV, such as men who have sex with men and serodiscordant couples (where one partner has HIV and the other is HIV-negative).

All of these new “Treatment as Prevention” tools add to weapons in the fight against new HIV transmissions, but none are a magic bullet. Currently, in the District of Columbia, 70 percent of people diagnosed with HIV do not have a suppressed viral load. Why is this number so high? A large number of people in D.C. have HIV and do not know it. Others have been diagnosed with HIV but have not seen a doctor yet (often due to denial, stigma, etc.). And lastly, a good percentage of HIV-positive people on medication do not have a suppressed HIV viral load due to poor adherence to their medication regimen (often due to depression, addiction issues or competing priorities). We are lucky at Whitman-Walker to have comprehensive health care on site, including care teams, mental health practitioners, a pharmacy, and nurses that focus on patients’ barriers to care. Through this team model, 85 percent of our HIV patients on medications have a suppressed viral load.

Now that the health care community has more options in our fight against HIV, we have to figure out a comprehensive way to prevent new HIV transmissions from occurring. But the good news is that we are more knowledgeable about HIV transmission and there are more prevention options with known effectiveness.

So come join us in a Return to Lisner Auditorium on Tuesday, July 24, at 7 p.m. You will hear from leaders in the field that reducing the number of new HIV infections in Washington, D.C. is possible. You will learn about “Treatment as Prevention.” And we will all reflect on how far we have come in the past 29 years.

Dr. Ray Martins is chief medical officer of Whitman-Walker Health.

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