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The first cases were reported in 1981. Two years later, scientists discovered the retrovirus causing the disease. And in November of 1983, the World Health Organization began international surveillance.
Since the HIV epidemic began, more than 85 million people have been diagnosed worldwide. Now, four decades later, advances in prevention and treatment hold the promise of ending the epidemic altogether.
“We’ve got the tools in our hands to get to the end of the epidemic,” said Dr. Kimberly Smith, chief scientific officer, senior vice president and head of research & development at ViiV Healthcare. “We just need to use those tools in an equitable way, get the tools to the folks who need it the most, very aggressively, and consistently bring these messages to communities that are impacted.”
Smith is a career-long clinician and researcher specializing in HIV, with the last decade at ViiV Healthcare, the only pharmaceutical company 100% focused on discovering and developing innovative medicines to treat and prevent HIV. She outlined five steps to ending the epidemic at the 2023 STAT Summit in Boston.
#1 Know your status
Most basic is to determine HIV status. The U.S. Centers for Disease Control and Prevention (CDC) recommends that everyone aged 13-64 should get tested for HIV at least once. This can be done at home with a self-test with an oral swab or a specimen collection kit.
Knowing HIV status is crucial for two reasons. The CDC says about 158,500 people in the U.S. do not know they are HIV positive and unknowingly transmit the virus, accounting for almost 40 percent of new diagnoses. In addition, early diagnosis can lead to early treatment.
“You can have a tremendous impact on the course of your disease,” said Smith. “The sooner you’re treated, the better you do, the better your prognosis. You don’t want to get to the point where the disease is more advanced.”
She highlighted two high-profile cases. Rapper Eric Lynn Wright, known professionally as Eazy-E, died at age 30 in 1995, a month after an AIDS diagnosis. Basketball player Earvin “Magic” Johnson Jr., revealed he was HIV positive in 1991 at age 32. He began therapy quickly and is now 64 years old.
Early diagnosis is important, but HIV testing fell during the global pandemic.
“We had a big setback as a result of Covid-19, no question. So, we need to get together with community organizations and really ramp up and reach the individuals that aren’t being tested, in urban settings, in rural settings, really across the country.”
#2 Access health care
There were approximately 39 million people living with HIV worldwide in 2022. Of that, 28 million people globally are on treatment, and Smith said 23 million are prescribed a regimen containing dolutegravir, a medicine first developed by ViiV Healthcare.. Treatment is key to allowing people living with HIV to live long healthy lives and reduce the likelihood that they will transmit to sexual partners.
“People who have an undetectable viral load actually can live a lifespan that is comparable to individuals who don’t have HIV,” said Smith.
Ideally, diagnosis links an individual to quality health care and treatment with antiretroviral therapy to suppress the viral load. Antiretroviral therapy has advanced from several pills throughout the day with considerable side effects, to one pill a day, or long-acting injections six times per year. Patient assistance programs and not-for-profit licenses to generic manufacturers ensure these medications are available and affordable.
Treatment also benefits the larger community because of a simple formula: U = U. An undetectable HIV viral load equals HIV that is untransmittable to sexual partners.
One of the UNAIDS targets is for 90 percent of individuals that are HIV-positive to be on antiretroviral therapy. At the end of 2022, it was 76 percent worldwide. The United States lags behind as well.
“We’re not doing so great,” said Smith. “Depending on which state you look at, it’s anywhere from 50 to 70 [percent]. So, we have a lot of work to do getting people into care.”
#3 Get PrEP
Preventing HIV in the first place is also key to ending the epidemic.
Pre-exposure prophylaxis (PrEP) greatly reduces the likelihood of becoming HIV-positive if exposed. In the United States, 1.2 million people could benefit, but only 36 percent are on this therapy, according to the CDC.
Smith believes that education would help increase these numbers since “many health care providers are still back in the old days of having a stereotype about who might be vulnerable to HIV.” She said vulnerability is not only a result of lifestyle, but also includes factors such as geographic prevalence, particularly in “hotspots” around the United States such as the Southeast.
Multiple options are available for PrEP, including daily oral pills or a long-acting injection administered once every two months.
Smith visited Cape Town, SA last year, a country where 4,500 people contract HIV every week. During her visit she met some of the people who participated in a study of PrEP medicine. She recalled a conversation with a young woman who said the medication made her feel empowered.
“Particularly when we think about young women, they’re no longer dependent on their partner to use a condom,” said Smith. “They’ve taken control of their own sexuality, their own HIV risk. If we can do that around the world and empower folks to protect themselves with PrEP, then I think that’s what we need to do to get us going in the right direction.”
#4 Address inequities
In the United States, 70 percent of new cases are among Black and Latino individuals, and disproportionately affect men who have sex with men (MSM) in these groups.
Yet, they are least likely to be on PrEP. Smith said. Doctors prescribe PrEP for 94 percent of white men who should be on preventive treatment. But the numbers are staggeringly lower for Black (13 percent) and Latino (24 percent) people.
“The trajectory [of HIV] for white men who have sex with men has actually already been going down, and that’s great news,” said Smith. “But for Black men who have sex with men, it actually is either flat or still increasing. And I think there are a lot of reasons for that. But PrEP [adoption] is one of those.”
She continued: “What would be a horrific thing for the world is for us to get to the end of the epidemic for some populations and leave other populations behind. We have to address inequities in order to really give us a chance to get to the end of the epidemic. So PrEP is really important.”
#5 Eliminate stigma
HIV has been marked by intense stigma, rooted in fear and misconceptions that persist from the epidemic’s early days, according to the CDC.
Smith said stigma prevents individuals from getting tested, starting PrEP, and seeking treatment, and can lead to isolation, depression, and substance use. So how do we address it?
Earlier this year, ViiV Healthcare created an immersive virtual reality experience called “Chapters of Stigma.” It helps health care providers recognize their own role in causing stress or discomfort.
And Smith said talking about HIV like any other disease can help end stigma.
“We should be talking about this all the time,” Smith said. “I always say we should talk about HIV at the dinner table, normalize living with HIV like other illnesses, like hypertension, like diabetes. If we get rid of the stigma and have more people come into care, that takes us a long way towards getting to the end of the epidemic.”
For more, visit www.viivhealthcare.com.