What Preventing HIV in Babies Can Tell Us about Preventing HIV in Adults
Between 1991—the peak of the HIV epidemic—and 2010, a massively successful public health strategy reduced the number of babies born in the U.S. with HIV from over 1500 in a year to just over 150. Now, less than 2% of the new HIV infections that happen every year are perinatal transmissions.
“It’s such a beautiful story, that there are so few babies being born with HIV now,” reflects Shannon Weber, M.S.W., director of the sexual and reproductive health organization Hive. She goes on to explain that this more than 90% reduction in perinatal HIV transmissions is considered, by most accounts, to be one of the greatest U.S. public health success stories. Universal screening protocols, better engagement of women in care, and scale-up of early antiretroviral therapies have gotten us to a place where perinatal transmissions are the exception, not the rule.
But Weber’s not interested in resting on her laurels to celebrate successes of the perinatal HIV field just yet. In an op-ed published in the Huffington Post and an article published in the Journal of American Nurses in AIDS Care, Weber, and co-author Robert Grant, M.D., of the Gladstone Institutes, the University of California at San Francisco and chief medical officer of San Francisco AIDS Foundation request that practitioners, public health folks, researchers and others engaged in the fight against HIV look to and learn from the successes and experiences of perinatal HIV transmission prevention efforts.
“With perinatal HIV transmission, we had to shift our lens and think about every opportunity that the mother interacted with the health care system. Whether that was at an emergency room, a primary care office, maybe during a partner’s health care visit, or her kid’s care—so we could figure out how to serve her. To prevent sexual HIV transmission, we need to have a model of care that catches people and helps them reduce their risk no matter how they come into contact with the system. Whether it’s for HIV testing, to get a pap smear, or because they’re getting treated for depression. I think this is one of the shifts we can make.”
One of the push-backs she anticipates hearing from critics is that perinatal HIV prevention was highly successful, because “people care about babies.” She worries that some might think public health won’t get the same support to prevent other types of HIV transmission.
“But I think to myself, well, that’s our problem. That’s a fixable problem. We need to create a story about inclusion, about what’s possible. That’s just as important as the work to get the science to make it possible.”
And speaking of science—Weber and Grant are invigorated by the opportunities presented by powerful biomedical advances in HIV prevention. Five years ago, Weber says, it wasn’t possible to adopt anything other than a risk-reduction stance in HIV prevention efforts. By expanding the paradigm to help people think about their overall sexual health and wellness—using new biomedical strategies in addition to condoms—she believes sexual HIV transmission prevention is approaching a new frontier.
“We can now have a conversation with someone where we can lay out a whole slew of options. And really help them figure out what option works best for them. With PrEP, and treatment as prevention, and really sensitive HIV testing, we have so much to offer people—and we can do it in a really inclusive, welcoming way.”
For more information about biomedical HIV prevention strategies, visit prepfacts.org, look through BETA’s virtual library on PrEP and read about treatment as prevention and how to get to “undetectable.”