California: Research Shows Neighborhoods Where AIDS Treatments Lag
November 20, 2009
A project to map HIV viral loads in San Francisco shows that while more HIV cases are in the largely gay Castro neighborhood, residents with HIV in poorer neighborhoods tend to be sicker or untreated. The city's health department is combining medical data with epidemiological tools to help target treatment in a groundbreaking effort to lower viral loads and reduce the chance of transmission. In the future, the strategy may be employed nationwide.
"These hot spots are perpetuating themselves, increasing infection in marginalized communities," said Dr. Julio Montaner, president of the International AIDS Society. "As long as we don't deal with that problem, the reservoir of HIV will ensure that we're promoting the continued spread of HIV in perpetuity." In San Francisco, "you can identify hot spots where, in all likelihood, most transmission is occurring," he noted.
"If you're monitoring the epidemic by just following the number of cases there are, you haven't prevented new cases," said Dr. Moupali Das-Douglas, lead investigator on the project. "If you have a marker upstream that may predict new cases, you can know where to target your services to prevent transmission." "The more people I start on medication, the more people will be virologically suppressed and the less likely they will be to transmit HIV," he explained.
"If any place is able to reduce infections by treating people effectively, San Francisco should have the best chance. We're hoping it will be a model," said Dr. Grant Colfax, director of HIV prevention and research at the city's Department of Public Health.
All involved agree that acting on such mapping will be controversial. Officials still have to decide on responses, such as whether to shift services, conduct highly targeted campaigns, or directly contact patients with the highest viral loads. Approaching patients could be seen as acting like a "police state," scaring some away, Montaner said.
CDC applauds the city's "novel approach" and is considering expanding it nationwide, said Dr. Irene Hall, chief of HIV surveillance at the agency.
New York Times
11.06.2009; Carol Pogash
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.