TR: In contrast, how would you describe the “business as usual” prevention approach that CDC used before?
KF: There was a feeling that we had to view everyone as being equally at risk, and we had to cover everybody in the response. The reality is, we don’t have the resources to do everything for everyone. And the reality is that not everybody is equally affected by the epidemic. The disease is not randomly distributed in the population, and we need to focus on those communities who are hardest hit. We know that those are gay and bisexual men of all races, African-American men and women, Hispanic and Latino men and women, injection-drug users and the transgender population.
All Americans need the basic tools about HIV to protect themselves. Everybody should know about HIV testing and how HIV is transmitted, and that is work we will always have to do. But you can target some messages to people who are HIV positive and people who are at high risk of acquiring HIV — the fact that we have very good treatments which are now available, that people who are living with HIV should be on treatment, suppress their virus and practice safer sex to reduce onward transmissions. There’s a balancing act. And that balance is the reality of HIV 30 years into the epidemic.
TR: How is the National HIV/AIDS Strategy tracking so far in terms of results?
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.