Exclusive Q&A: IAS President Chris Beyrer on World AIDS Day

In recognition of World AIDS Day, International AIDS Society president Chris Beyrer, MD, MPH, shares his thoughts on the top priorities for 2015, key affected populations, PrEP (pre-exposure prophylaxis), the impact of the AIDS conference in Melbourne last July, and other issues.

35 million people are living with HIV worldwide, according to UNAIDS.  Although new infections have declined by 38% since 2001, about 2.1 million people were newly infected with HIV in 2013.

Beyrer, MD, MPH, is an Epidemiology professor at the Johns Hopkins Bloomberg School of Public Health. Interview by Brian W. Simpson, MPH, Editor-in-Chief of Global Health NOW.

What should be the top priority in fighting HIV/AIDS in 2015?
Less than half of people worldwide living with HIV have access to antiviral treatment. That is both a clinical concern for those individuals and their families, and a prevention concern, since undiagnosed and untreated HIV infections are at the core of ongoing transmission. So truly getting to universal access is a priority, and donor support has largely flatlined. While so many go untreated, we also see sustained incidence, particularly in the key populations such as men who have sex with men, sex workers of all genders and injecting drug users. These infections are largely failures of primary prevention policy and programs. So we need to do better at both primary prevention for those at most risk and expanded treatment access.

What’s been the most important result from last July's International AIDS Conference in Melbourne?
Melbourne will likely be remembered as the conference where key populations were really understood to be at the center of the HIV epidemic globally. We had the launch of the first WHO consolidated guidelines for prevention, treatment and care for key populations, and critical data on impacts of new prevention tools which could reduce infections in these hard hit communities, including PrEP (pre-exposure prophylaxis).

What’s the best strategy for addressing HIV in key affected populations?
We have a powerful new tool for HIV prevention, PrEP, which has to be delivered for those who want and need it as part of a package of services that includes regular HIV testing, adherence counseling, and other supportive services. But used correctly, it works, and this is the first new prevention tool with efficacy for gay and other MSM since the condom. The challenge ahead is to now implement PrEP and to understand what roles it can play in reducing HIV infections at community levels. The Baltimore Mayor’s Commission, on which I now serve, has taken this on and begun a campaign called Baltimore PrEP Ready, working across sectors, the community, providers, insurers, and the City, to start making this new tool available. It’s not a magic bullet, and it has to be part of prevention package, but it’s new and approved tool we now have to start using.

The CDC reported last Thursday that only 3 in 10 people in the US living with HIV achieve viral suppression. How can that be improved?
This was actually a slight improvement from earlier estimates by the CDC and others that only about 25% of Americans living with the virus were fully virally suppressed. So this is not surprising, but of profound concern. The U.S. is by far the most affected high income country, and our epidemic is stubbornly sustained, a reality which is at least in part due to the large number of people living with HIV who have not been diagnosed, and the even larger proportion who are not successfully linked into care and on life-saving therapy. These numbers look substantially worse by region, with the South a real outlier in terms of poor outcomes and high new infection rates, and by race, where HIV is among the most of health disparities for Black Americans. One ray of hope is the Affordable Care Act, and further expansion of Medicaid, particularly in the South, could be critical to getting more people access to care. But it’s also clear that we are not reaching many in need of HIV testing, and that too has to be priority going forward.

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