HIV treatments stem transmission, but stigma, barriers to access persist

By Cecilia Nowell, California Health Fellowship

Following a screening of the PBS NOVA documentary "Ending HIV in America" at Health Journalism 2024, panelists discussed the revolutionary treatments now available to prevent transmission of HIV, as well as the challenges advocates still face in making those treatments available to all Americans.

Attendees first watched a selection of clips from "Ending HIV in America," directed by panelist Shayon Maitra, focusing on clinics based in Birmingham, Ala., Chapel Hill, N.C., and San Francisco, Calif.

Researchers at the University of North Carolina Chapel Hill have led work to focus on "prevention in the absence of a vaccine," said Myron Cohen, a leading HIV/AIDS researcher. That includes work on pre-exposure prophylaxis, or PrEP, medications, which cut the risk of someone contracting HIV from sexual contact by more than 99%.

Research shows that a person who maintains an undetectable viral load cannot sexually transmit the virus to another. The finding has led scientists and advocates to name HIV education campaigns "undetectable equals untransmittable," or "u=u."

In Birmingham, staff of the University of Alabama's 1917 clinic bring care to Black men and women, who are the most likely to contract HIV in the United States, through culturally sensitive support services led by HIV-positive employees. Meanwhile, in California, advocates at the San Francisco Community Health Center focus on outreach to unhoused and LGBTQ+ residents of the city.

But physicians and advocates across the country are still trying to bring those treatments, which could end the transmission of HIV in the United States, "the last mile." That is, to those who face the greatest stigma and barriers to medical care.

After the film screening, panelists further discussed efforts to end HIV transmission in the US.

From left to right: Tara Haelle, Bruce Richman, Shayon Maitra, Barry Zingman. Photo by Zachary Linhares

A person with HIV is more likely to be on treatment in Cambodia, Laos, Uganda, Rwanda, Zimbabwe, Botswana and South Africa than in the US, said Bruce Richman, founding executive director of the Prevention Access Campaign.

"There's 1.4 million people with HIV living in Uganda, and 300,000 of them are not on treatment to be virally suppressed," Richman said. "There's 1.2 million living in the United States, and over 500,000 of us are not on treatment."

Alongside policy work to expand Medicaid and access to mental health care and housing, "the biggest advances that are going on right now both in HIV treatment as well as in HIV prevention are enabling people who are having difficulties taking the current medications to be able to have them in their system," said Barry Zingman, medical director of the Montefiore Health System.

Those include long-acting products currently under development like injections, implants and a vaginal ring. The aim is to make having medication in one's system every day easier for patients who may struggle with remembering to take or have a place to store a pill every day.

Cecilia Nowell is an independent journalist based in Oakland, Calif. She is a 2024 AHCJ-California Health Journalism Fellow.