“Atlanta Principles” Demand Better HIV Prevention Efforts
ACT UP, the Treatment Action Group (TAG), and local Atlanta advocates this week met with officials from the Centers for Disease Control and Prevention (CDC) and unveiled the Atlanta Principles, a new set of demands calling for stepped-up HIV prevention efforts, including treatment-as-prevention, PrEP, and PEP.
The activists held a press conference on June 10, followed by a banner drop the next day, accusing CDC director Tom Frieden of being “missing in action” as HIV incidence (new infections) increases in heavily affected groups such as young black gay men and transgender women, despite the emergence of these new prevention tools.
Widespread behavior change—including condom use by gay men and needle exchange programs for people who use drugs—dramatically reduced HIV incidence from its peak in the late 1980s. But the old strategies have reached their limit, as indicated by the stubborn figure of 50,000 new infections per year over the past decade. What the overall number doesn’t show is that while incidence continues to decline in some groups, including women, it’s on the rise in others. One of the hotspots is the Southeast, in the CDC’s backyard.
“There are more means of preventing HIV than there have ever been. And yet in a single year the young black gay men of Atlanta become infected with HIV at a rate of 12%,” said Jim Eigo of ACT UP/New York. “This is a rate higher than any we find in any wealthy nation. Atlanta is the home of the CDC. Someone has been fiddling while Atlanta burns.”
Fortunately, the new tools in the prevention toolbox are highly effective. The risk of infection dropped by more than 90% when HIV-positive partners in serodiscordant (mixed-status) heterosexual couples promptly started combination antiretroviral therapy—dubbed treatment-as-prevention or TasP. Pre-exposure prophylaxis (PrEP) using Truvada may provide nearly complete protection when used daily, while antiretroviral post-exposure prophylaxis (PEP) can stop HIV from establishing itself in the body if taken within 72 hours after exposure.
“Without real leadership and promotion from U.S. public health officials, these prevention methods will remain underutilized,” the advocates said in a press release. “Without a concerted effort to address the HIV prevention needs of marginalized communities affected by high levels of homelessness, job insecurity, and HIV-related stigma, it will not be feasible or safe for individuals to access the resources they need to protect themselves.”
“Ending the HIV epidemic in America and in the world will not happen without the robust and dedicated inclusion of women’s and girls’ prevention, treatment, care, and protection of human rights,” stressed SisterLove president Dazon Dixon Diallo.
“Community members have been subjected to a huge amount of HIV-related research over the past 30 years,” according to the principles. “Now that this research has shown just how crucial TasP, PEP, and PrEP could be for lowering the number of new infections, this knowledge must be translated quickly into policies and programs that could help relieve our communities of the massive burden of disease into the foreseeable future.”
The Atlanta Principles follow in the tradition of the Denver Principles, which heralded the self-empowerment of people living with AIDS in 1983. The new manifesto offers a set of steps the CDC can take now to improve HIV prevention in the U.S., including:
- HIV prevention messaging and education materials that deal frankly with sex;
- Using the Affordable Care Act to plug leaks in the HIV treatment cascade;
- A TasP information campaign for the general public to de-stigmatize HIV and dispel misinformation about its transmission;
- PEP and PrEP information tailored to groups historically at risk for HIV;
- CDC seminars, webinars, workshops, and conferences to train medical providers about PEP and PrEP;
- More prevention funding—targeted to populations at highest risk—to promote TasP, PEP, and PrEP, while continuing to fund useful older efforts like condom distribution.
- Revised HIV testing guidelines, expanded testing beyond traditional points of care, and encouragement of next-generation tests that better detect acute HIV infection, when viral load is highest;
- More sensitive HIV epidemiology and precise data about key subgroups such as transgender women (now classified with gay men), trans men, sex workers, homeless people, young heroin injectors, and sexual networks of gay and bi men;
- Reforming the National HIV Behavioral Surveillance (NHBS) system;
- Comprehensive sex education for young people in schools;
- Focused surveillance of subpopulations now living with HIV, including seniors and women, so the information gathered can help improve care;
- Real partnership between the CDC and the communities most affected by HIV.
Due to the 1987 Helms Amendment (which prohibited federal funds being used to promote homosexuality) and other conservative criticism, CDC guidelines have banned producing or funding local production of materials that deal openly with sex or drug use. “In silencing itself and its partners, CDC has abandoned its mandate to keep the nation healthy,” according to the principles. “CDC has an ethical responsibility to promote the health of its constituents and their rights as individuals, even when this proves inconvenient, controversial, unpopular, or difficult.”
“Teachers and administration staff must be accountable for creating safer spaces to talk about sex, harm reduction and HIV/AIDS on a regular basis,” Alan Guttirez, a case manager at Lyric, told BETA. “Parents and school staff must accept that middle and high school students have varied sexual desires for people of all genders.”
On the PrEP front, community activists, service organizations, and city health departments have had to set up local PrEP efforts without much guidance, funding, or technical assistance from the CDC, the activists charge. And despite the fact that it has been a standard of care for years, many community members and providers are still unaware of PEP. But the CDC did step up to the plate last month, releasing guidelines stating that people at risk should consider PrEP.
“It’s time to hit the reset button on our HIV prevention efforts and the CDC must also make rapid change to confront an epidemic that is out of control in certain populations,” David Evans of Project Inform told BETA. “Most of what is being sought through the principles is common sense. We must track the epidemic more carefully and we must use and promote the new tools that we have, such as TasP and PrEP, to reverse upward trends.”
Liz Highleyman (liz (at) hivandhepatitis.com) is a freelance medical writer and editor-in-chief of HIVandHepatitis.com.