by Dwain Hebda
Dr. Robert Redfield, director for the Centers for Disease Control and Prevention (CDC), pulled no punches on June 27 during a press briefing unveiling a new federal HIV initiative. Redfield locked eyes with those in the room and said what just 20 years ago would have been unimaginable: the United States is poised to eradicate new HIV cases, the beginning of the end of the epidemic.
“President Trump announced in his State of the Union Address the goals of reduction of new infections by 75 percent in the next five years and 90 percent in the next 10 years,” he said. “We’re going to accomplish it.”
“As someone who has spent my life in this space, one of my hopes and dreams when I became CDC Director was to see the nation use the tools that we have to bring an end to the epidemic. But I will tell you it was always used as an aspirational goal. I can tell you, this is not an aspirational goal.”
Redfield was in Little Rock to meet with a blue-ribbon roundtable of health and government officials on the subject, one of several such stops on the topic of the new HIV program. Arkansas was selected for a stop on this tour by virtue of being one of seven states where incidence of HIV in rural areas was highest.
Dr. Robert Redfield
“We realized that some of the challenges of HIV weren’t all in cities,” Redfield said. “There really is a unique challenge to deal effectively with HIV care, treatment and prevention in rural areas.”
“Bringing new HIV infections to an end in rural America is, in my view, even more complex than urban areas.”
According to the state Enhanced HIV/AIDs Reporting System (eHARS), Arkansas had 291 new cases of HIV in 2017, ranking it 20th in the nation. More than 61,000 HIV tests were administered that year, but overall, 15 percent of HIV-positive people still don’t know they have the disease. In Arkansas, that translates to roughly 900 individuals.
Redfield said the bold four-step plan of improved early diagnosis, access to treatment, pre-infection intervention and quick response in the wake of diagnosis is made possible by the advancement of technology and effective new medicines.
“We have the scientific tools that can be applied today that can bring an end to new HIV transmission,” he said. “Those tools are to diagnose individuals, to get them into treatment and have that treatment be such that one gets virally suppressed. When one gets virally suppressed … you can live a normal lifespan. Your life expectancy at 20 years of age with HIV infection is another 53 years.”
“But also, when you’re virally suppressed, you’re no longer able to transmit the virus from one person to another That’s one of the most important prevention strategies that we have is to stop new transmissions.”
Most significantly, Redfield said, individuals at risk now have a means for preventing infection in the first place, via pre-exposure prophylaxis (PrEP). Taken daily, the pill can block HIV and according to CDC statistics, could potentially benefit more than 4,600 individuals in Arkansas.
Such advancements have played a major role in a flattening of the number of Americans infected with HIV, albeit still at a rate of roughly 40,000 new cases per year. Half of new infections every year happen in just 50 out of about 3,000 jurisdictions across the U.S.
“It’s a very geographically concentrated epidemic, that provides the opportunity to say this is not just an aspirational goal to bring an end to HIV in America, new infections. But actually, this is something very doable,” Redfield said.
Dr. Nate Smith, director and state health officer of the Arkansas Department of Health, said the department’s first steps in the execution of this initiative is to create a workable plan for implementation. The department is completing a grant proposal to help fund additional efforts and that grant process is expected to be completed this summer.
Like Redfield, he said unequivocally that the goal to eliminate new HIV cases in 10 years would be met.
“I’d had conversations with my chief medical officer Dr. Gary Wheeler several years ago, before this was a national focus, about getting to zero in Arkansas,” he said. “And we sat down, we looked at it; this is something that we could do. We needed a few more resources than we had, we needed to get some things in place.”
“This is very doable in Arkansas and I’ll just go on the record here: If we can’t get it done in ten years, I will consider it a personal failure.”
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