National HIV Testing Day: End AIDS. Get Tested.
In June 2014, New York Governor Andrew Cuomo announced an initiative to reduce new annual HIV infections from an estimated 3,000 to 750 and end AIDS in New York state by 2020—making New York the first state to set such an ambitious goal. The governor’s three-point plan for achieving this is to, one, ensure that all HIV-positive New Yorkers get tested and know their status; two, retain all New Yorkers who have tested positive in health services and treatment; and three, link all those who have tested negative who are at higher risk of HIV infection to pre-exposure prophylaxis (PrEP)—a daily antiretroviral treatment (ART) regimen taken to prevent infection. In anticipation of National HIV Testing Day, June 27, amfAR talked to Dan O'Connell, director of the New York State Department of Health AIDS Institute, about how New York plans to get people tested and end AIDS.
amfAR: Why is testing a key part of Governor Cuomo’s—or any—plan to end AIDS?
Dan O’Connell: We need people who are HIV positive to know they are positive, so they can take advantage of the therapies we have today. Viral suppression is achievable for most people once they are on ART if they are retained in care. It used to be recommended that people wait until they started to get ill before they initiated ART due to side effects and other concerns. But the medications have changed, and the recommendation now is that people initiate ART as soon as possible after they are infected, because even if they are not showing symptoms, HIV is still having a negative impact we can’t fix later. Also, it has been demonstrated that people with an undetectable viral load are pretty non-infectious, and, though there are exceptions, it is unlikely that they will transmit HIV to others.
We also need people who are negative to know they are negative, so we can talk to them about how to stay negative, which has even more relevance today than it used to because of some of the prevention advances we have, like PrEP—the third point in the governor’s plan. And it is important that people on PrEP continue to get tested every 90 days since the PrEP regimen is not indicated to treat someone who is infected.
amfAR: Approximately 15% of people living with HIV in New York —and the country as a whole—don’t know it. How does New York State hope to encourage those individuals to get tested?
Dan O'Connell, director of the New York State Department of Health AIDS InstituteO’Connell: In 2010, the state law changed to mandate that all people between the ages of 13 and 64 are offered an HIV test when they receive a primary care service or are in an emergency department or an inpatient hospital. Now we need to ensure that physicians offer it and that when people are offered the test, they agree to be tested. We are working to do that by normalizing testing for all physicians and patients. One way is through our campaign posters, all of which say “End AIDS. Get Tested.”
We hope that if we can make testing routine for everyone it will reduce the stigma. People have preconceptions about who HIV impacts, but the truth is that it can impact anyone who has ever had unprotected sex, which is an awful lot of people. So those preconceptions can be dangerous for people’s health because they will opt out of a test that can dramatically improve their treatment chances if they are identified early. People don’t say, ‘I don’t need a blood pressure test, I’m not overweight.’ We are trying to establish a similar dynamic with HIV.
We are also trying to ensure that people who are at higher risk of infection—like men who have sex with men (MSM), transgender individuals, and people who inject drugs (PWID)—get more targeted testing, because if they are only offered testing when they go to a primary care visit, it’s not going to be enough. They need to get tested more often.
amfAR: In October 2014, Governor Cuomo announced that he was creating an Ending the Epidemic Task Force to design a blueprint for achieving these ambitious goals. Why are the Task Force and blueprint an important part of the campaign?
O’Connell: The governor’s announcement was important in the history of the epidemic, because the state really put itself on the line and said we are going to be the first to end AIDS. But the governor’s three-point plan is just part of what it will take to get us there, so he created the Task Force and appointed 63 people who were representative of everyone in the AIDS community. There were members of AIDS activist organizations and service organizations and doctors’ organizations, as well as clinicians, members of the LGBT community, and people living with HIV, among others. And what was really remarkable was that all of these folks were able to achieve unanimous consensus on all of the recommendations in the blueprint, which was presented to the governor in a powerful event at the LGBT Center in Manhattan on April 29.
amfAR: Why was this campaign launched now?
O’Connell: There couldn’t have been a better time, and the reason is the advent of PrEP [which was approved by the FDA in 2012]. Currently, 70% of new HIV infections are among MSM, and we needed another harm reduction strategy for MSM for whom condoms and other safer sex practices don’t work. Back in the bad old days of the epidemic, 50% of infections in the state were among PWID. Now it’s gone down to 2% or 3%, and that’s because we took aggressive steps and led other states in approving syringe services programs. And we saw a similar thing with mother-to-child transmission. We gave pregnant women medication to ensure they didn’t infect their child, and we have seen cases drop from about 500 a year to two or three. I think we are at a similarly historic moment with PrEP, and with full implementation of the blueprint, there is absolutely no reason we can’t get down to 750 new infections a year.
amfAR: Do you think New York could inspire other states to adopt similar plans?
O’Connell: Yes. On World AIDS Day 2014, the governor of Washington state issued a proclamation that they too were going to end AIDS by 2020. And we’ve heard from other states that they are also planning on doing this. And Governor Cuomo has said that he is throwing down the gauntlet in the rest of the country and that he wants people to ask their representatives to do what New York is doing. We have the technologies we need to get this done, so if it’s not getting done, it’s because of a lack of investment or a lack of will from the powers that be.