While there are encouraging trends in the long fight against HIV/AIDS, the epidemic today continues to affect some groups disproportionately and despite years of concerted efforts, new infections occur.
Some 180 health professionals, advocates and HIV/AIDS scientists who gathered this week in Mystic for the inaugural New England HIV Implementation Science Network all agreed on one thing: more needs to be done.
“We have the knowledge we need to get to zero [infections]. Why can we stop smallpox and not HIV?” Yale School of Public Health Dean Paul Cleary said to the gathering in his opening remarks. “We’ve got to do better than we have. We can really challenge this epidemic in a way that we haven’t before.”
While the overall epidemic and the deaths associated with it are declining throughout the six New England states, wide disparities remain in who and who does not get the disease. In 2014, men who have sex with men are much more likely than their peers to get infected, and race is another important variable, with African-American and Hispanic men having proportionately higher infection rates than white males. There are also persistent concerns about disparities in HIV incidence and prevalence among African-American and Hispanic women.
While syringe exchange programs have been successful in reducing the spread of the disease among people who inject drugs, HIV remains concentrated in smaller urban areas, said Christian Andresen, who works on HIV and other diseases for the Connecticut Department of Public Health. In Connecticut, he said, 44 percent of the disease burden is in the state’s three largest cities: Hartford, Bridgeport and New Haven.
Public Health officials from other New England states described similar situations. In Massachusetts, for example, the disease burden is heaviest in Boston and areas such as Worcester and Springfield. Poverty remains an important factor, among others, in the spread of the disease, said H. Dawn Fukuda, who works on HIV/AIDS for the Massachusetts Department of Public Health. “There is tremendous disparity.
A better knowledge of who gets the disease and where it is most prevalent is helping policymakers and health professionals make more informed decisions about how to best allocate their limited resources to prevent new infections. “We really need to get to where the epidemic is,” said Megan Hannan, executive director of the Frannie Peabody Center in Maine.
Wednesday’s event was sponsored by the Center for Interdisciplinary Research on AIDS (CIRA) at Yale and the Lifespan/Tufts/Brown Center for AIDS Research.
Charles Carpenter, director of the Lifespan/Tufts/Brown CFAR, told the gathering that a vaccine for HIV/AIDS, should one ever be developed, could be 25 years away. It is incumbent on the health community and policymakers to ensure that everyone with the disease receives effective treatment as soon as they are infected.
During morning breakout sessions, participants deliberated on ways that they could further leverage the network of New England health professionals to combat the disease, as well as how to handle specific issues such as misinformation about medications, transitioning to the Affordable Care Act, addressing stigma associated with HIV/AIDS and harnessing the power of social media to promote prevention.
During afternoon sessions, Philip Chan, director HIV/STD Testing and Prevention Services at The Miriam Hospital Immunology Center in Providence, R.I. explained how molecular epidemiology is being used to better understand social networks and who becomes infected.
His clinic has also started using Pre-exposure prophylaxis, or PrEP, to better protect people who do not have HIV, but are at risk of getting it. He said that PrEP could be a viable alternative to condoms, especially for people who are resistant to using condoms.
“For a number of people, PrEP is an extra layer of protection,” Chan said. Many people remain unaware of the medicine and his clinic is educating people about its availability and proper use.
John Pachankis, associate professor at the Yale School of Public Health, described his current research on how HIV is transmitted in smaller urban areas. Pachankis is seeking to understand the role of social and sexual networks in the spread of the disease along with factors such as stigma. “How it works is largely unknown,” he said.
The symposium was the launch pad for CIRA’s new focus on implementation science in small urban areas, said Elaine O’Keefe, CIRA’s executive director. The Network aims to improve HIV prevention and treatment in small urban centers with high prevalence of HIV.
“This first Network meeting brought together a room filled with powerful energy and wonderfully committed, smart people. We will now work with our partners to utilize the momentum and ideas from this meeting to create action steps to foster relevant HIV research collaborations across New England,” said Jim Pettinelli, assistant director of the Community Research and Implementation Core at CIRA, who helped organize the daylong conference.