The Beginning of the End of AIDS

Kevin Fenton of the CDC says new federal strategies and advances in HIV prevention will turn the tide.

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KF: There are some parts of the country that have already started to see declines in new HIV infections over the past couple of years. San Francisco has seen a downturn after an aggressive campaign of educating their local community -- especially gay men -- scaling up HIV testing so that more men are testing more frequently and ensuring that those who test positively are linked to care. Over the last couple of years, San Francisco has said, "If you're diagnosed HIV positive, we're going to offer you treatment. It doesn't matter who you are, whether they have private or public insurance, how high your CD4 count is; we're going to put you on treatment."

Treatment is effective in reducing the risk of transmitting HIV by 96 percent. It's one of the most powerful tools we have, and San Francisco has gone on record as being very aggressive. New York City has also been scaling up HIV testing and most recently has said that they will put more people on treatment as well.

At the national level, we're still holding the epidemic at bay. We're still seeing stable incidence at a time when more and more people are living with HIV -- that's stable incidence when, theoretically, there are more opportunities for more HIV to be spreading. And that's good news. But we want to do better than holding it steady. I think we will begin to see declines occurring in cities and states which have more aggressive programs, and over time we will see more changes occurring nationally.

KF: In those first 10 years the conversation and awareness about HIV was much greater. The proportion of the American population who viewed HIV as a serious and urgent threat was much higher. Schools had lots of programs educating young people on HIV and sexual-health issues. And remember, in those 10 years we didn't have the sort of effective treatments that we have now. So there was a lot of fear there.

Over the past 10 years we've seen a number of changes. In our society we're not talking about HIV the way we used to. Data from the Kaiser Foundation suggest that only 6 to 8 percent of Americans view HIV as a serious public health threat.

Also in many schools across the country, we're seeing fewer with strong HIV-education programs and sexual-health programs. So that whole issue of sex education as well is changing in the U.S. as there's more pressure on school curriculum, and some states and jurisdictions have preferred to go with abstinence-only versus more comprehensive sex-education models. It's not my role to say which is better or worse, but it's clear that many of these changes can have an impact on whether we're able to give young people the skills they need to protect themselves.

TR: Going back to the government's new, more targeted and comprehensive approach to fighting HIV -- do you feel confident that these will actually turn the tide on the epidemic?

KF: I took over leading this center seven years ago. I remember thinking about the importance of us having a national strategy, of working across the U.S. government together in a more focused way. I envisioned a future in which there were new resources, new partnerships, more effective ways of delivering the tools we have for combating HIV. Now I feel like we're moving in the right direction.

We have a lot more to do. But now we have a road map and new resources. The Food and Drug Administration has been on a roll as well. They approved the first over-the-counter HIV test, and they recently approved the use of Pre-Exposure Prophylaxis, which is a drug you can take if you're HIV negative to prevent yourself from getting the virus. The landscape is changing very rapidly.

President Obama said last year that we're now at the beginning of the end of AIDS, and I firmly believe that we are. The key thing is to keep focused, renew that sense of urgency and continue to drive toward impact. And if it's not having an impact, let's use our resources differently until they do.

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