The journey of those who live with HIV, both locally and across the world, has been trod by the more than 35 million men, women and children who’ve died of AIDS. It’s been one of living in fear of the unknown and being feared by others; of searching for cures and facing the constant stigma of not being accepted for who you are or who you love.
This was brought home last month when the Washington State HIV conference was in Spokane for the first time in its history. The positive message that living with HIV was no longer a death sentence with diagnosis was the emphasis of the 2-day event. Keynote speaker Bruce Richman, the founding executive director of Prevention Access (https://www.preventionaccess.org) and the Undetectable=Untransmittable campaign(#UequalsU), highlighted the global changes bringing hope to the estimated 37 million people around the world living with HIV/AIDS, of whom 1.8 million are children.
This is in sharp contrast to the ’80s and early ’90s, when those infected either succumbed to the ravages of AIDS – lives cut short – or somehow survived while watching friends and families die. But in the mid-’90s, the number of AIDS-related deaths slowed when the first highly active antiretroviral medications (ARVs or ART) were introduced. Use of these ARVs in “drug cocktails” brought about a rapid decline in the rate of AIDS-related deaths and hospitalizations. The standard of care, no more difficult than for other chronic conditions, has now become rapid initiation of ART, typically 1-2 pills a day, and regularly monitoring the viral load. When the amount of circulating virus drops below detectable levels on a lab test, it’s termed an undetectable viral load.
The rapid initiation of medications at diagnosis is not only successful in preserving the immune system, but it’s also been found to dramatically decrease transmission rates and new HIV cases. This observation has led to a new paradigm in HIV medical management - “Treatment as Prevention.” Confirmed by research, people with HIV who take their medications as prescribed and maintain an undetectable viral load can’t sexually transmit HIV.
Undetectable = Untransmittable, simply “U=U,” is a transformative message changing the narrative of people living with HIV. It means someone living with HIV can live their life without worrying about transmitting HIV. It bolsters advocacy with a public health argument for universal access to HIV testing, treatment and care. U=U has unprecedented potential to dismantle HIV stigma and improve the health and lives of people living with HIV, including the hundreds of individuals here in Spokane.
And yet, in communities where stigma persists and the standard of HIV care is lacking, rates continue to soar, with the highest of new HIV diagnoses in black and Latinx populations, 43% and 26%, respectively. Blacks also disproportionately represent the greatest number of the estimated 1.1 million Americans living with HIV, and are more likely to die of AIDS. Ten states, mostly in the South, account for two-thirds of HIV diagnoses among adults and adolescents in 2017, with the rates in Washington, D.C., four-times greater than the national average. Serious focused work is required to impact the social structures and relentless marginalization at the root of health inequities in communities where HIV continues to thrive.
Additionally, there are legislative obstacles that reinforce and create barriers to testing and care. In 2016, the End AIDS Washington Report called for modernization of the 1980s-era statutes dealing with HIV and STDs. The ensuing push for legislative overhaul, led by the Department of Health, reflects the work and expertise of many individuals and organizations across the state. The goal is to replace an outdated and highly stigmatizing statute with one that reflects current science and best practices. Unfortunately, it didn’t pass during this year’s legislative session, so more work is to be done.
HIV remains one of the world’s greatest public health challenges – 5000 people are newly infected every day. And yet there’s hope – ensuring universal access to HIV testing, daily adherence to medications, and on-going care can bring about an end to AIDS. Promoting U=U, a global health movement endorsed by more than 850 organizations around the world, including SRHD and the State Department of Health, will go far in eliminating the stigma and improving the lives of people marginalized by their diagnosis – one to live with, not die by.
Maryellen Cooley is a HIV Health Program Specialist at Spokane Regional Health District.
Dale Briese is a long-time HIV survivor and leader of the HIV/AIDS Advisory Board.
Bruce Richman is the founder and executive director of Prevention Access.
Bob Lutz is the Spokane County Health officer.
Subscribe to the Morning Review newsletter
Get the day’s top headlines delivered to your inbox every morning by subscribing to our newsletter.