Centers for Disease Control

(The Root) — For two decades, the International AIDS Conference has played a vital role in assembling the global community to discuss new scientific advances and to mobilize action around fighting the devastating disease. Taking place in Washington, D.C., this week — the first time in 22 years that the conference has been held in the United States — the event also creates renewed urgency around the national epidemic.

Despite the staggering 1.1 million people living with HIV in the U.S., Kevin Fenton, director of the Center for Disease Control and Prevention's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, is optimistic that government and community-based partners are now on the right track to stem HIV's tide.

In an interview with The Root, Fenton discussed the importance of finally confronting the reality that "not everybody is equally affected by the epidemic," new research that underscores the major impact of basic public-awareness campaigns and why he believes that, after decades of merely stabilizing the number of new HIV infections, a new federal strategy and new medical breakthroughs will get the country much closer to an AIDS-free generation.

The Root: Over the past couple of years, CDC has rolled out a range of new HIV initiatives. How do these efforts differ from past approaches?

Kevin Fenton: Everything that you're seeing now is rooted in the National HIV/AIDS Strategy, which was released two years ago. That was the first time that the United States had a documented vision, strategy and plan for addressing the HIV epidemic in a coordinated way in this country. The strategy was clear about what we needed to do: Reduce the number of new infections, improve access to care, address health inequities and work more collaboratively across government and with external partners.


It challenged us to not see the epidemic as "business as usual." We needed more focus, more targeting, more scale and impact. For example, our Enhanced Comprehensive HIV Prevention Planning program focuses on 12 high-burden cities that account for 44 percent of persons living with HIV in the United States. Our new social-marketing campaigns are geared toward raising awareness and addressing stigma and discrimination — all of which were in the national strategy.

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.

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.


Cynthia Gordy was The Root's senior political correspondent.