Why is the U.S. conference on AIDS in Orlando? To stand in solidarity

NATIONAL VIEWPOINT

Today, more than 3,000 advocates, educators, and providers gather in Orlando for the 22nd annual United States Conference on AIDS. They’ll share information, develop partnerships, and return home better equipped to fight HIV.

USCA has returned to Orlando to stand in solidarity with everyone who lost a loved one in the Pulse massacre. We are unfortunate allies in the trauma of loss and grief.

Since that commitment, NMAC has talked extensively about the need for a federal plan to end the HIV epidemic in America. Ending the HIV epidemic can only happen when we are able to lower a city’s HIV prevalence. Unfortunately, four of the top 10 cities with the highest HIV prevalence are in Florida. And Orlando sits at sixth highest on the list.

As a resident of the state of Florida who calls Miami Beach home, the data has me concerned. Not only are four of the top 10 cities in Florida, but nine of the top 10 cities are in the South.

Florida is a tourist mecca for people from all over the world, an industry that could be vulnerable to high HIV rates. The solution is to have meaningful biomedical HIV prevention efforts that reach those communities with the highest viral load.

But what do we mean by that? Let’s explain.

NMAC believes that Uz=U (Undetectable = Untransmittable) is vital to end the HIV epidemic in America. It’s a simpler name for “Treatment as Prevention,” where someone living with HIV is on consistent medication and treatment and is unable to transmit the virus because they have so little of it in their system. It’s a game changer because it makes people living with HIV an essential part of any successful prevention effort. However, it’s not enough to bend the curve alone.

Pre-Exposure Prophylaxis is the tool we need to make real progress. PrEP gives HIV-negative individuals a daily pill to protect them from getting HIV. Large urban cities like New York, San Francisco, Boston, and Washington, D.C., have shown real success with this combination.

Together with Post-Exposure Prophylaxis, where someone who may have been exposed to HIV immediately starts HIV medication to prevent infection, they are known as Biomedical HIV Prevention.

Initially, there was lots of skepticism. But, with time and real research, biomedical HIV prevention has been shown to be effective. Is it time to move to a medical model of HIV prevention? While the answer may seem obvious to some, it is not that simple.

Biomedical HIV prevention works when a community gets invested in the solution. NMAC is very concerned that it may not work in all of the communities that are highly impacted by HIV.

Can PrEP and U=U work for people of color? Scientifically, we know it works. But can it be successfully implemented in communities that have generational mistrust of the health-care system? If we can’t get people into health care and on medication, then these solutions are meaningless to the communities in most need.

That’s why this year’s USCA is so important and why going to Orlando matters. USCA is the place where the HIV movement can have the difficult conversations about race, gender, gender identity, and sexual orientation. Understanding those factors is key to make biomedical HIV prevention work. These conversations are how we’re going to figure out solutions for communities that don’t trust doctors, even when they have access to health care.

We can end the epidemic, but it’s going to take more than the current science. There needs to be significant research into the implementation of biomedical HIV prevention in communities that are highly impacted by HIV and have a significant mistrust of healthcare providers and the medications they prescribe. Without this understanding we will never end the HIV epidemic in America.

There are other things we must do. We must overcome HIV stigma. We must allocate resources where needed. We must base public health policies on science, not ideology. And we need to talk about health inequities based on race, gender, sexual orientation, and gender identity.

It will take all of us to finally end nearly four decades of HIV. We can and will make it to the end together.