July 21, 2010
Greetings from the XVIII International AIDS Conference in Vienna! It is invigorating to once again be among the more than 20,000 HIV/AIDS scientists, public health officials, advocates, and front-line workers in the fight against this disease. The International AIDS Conference always provides a platform for the world's HIV/AIDS leaders to share the latest information and science on HIV prevention, treatment and care.
From this exciting venue, I want to update you on two important new studies:
A first-of-its kind CDC study presented at the conference finds that roughly 2% of heterosexuals living in high poverty areas of 23 major U.S. cities are infected with HIV -- more than four times the national average (0.45%).
The study reveals a very strong link between low socio-economic status and HIV, finding that heterosexuals in these areas living below the poverty line were twice as likely to have HIV (2.4%) than those living above it (1.2%), though both rates were significantly higher than the national average. In addition to income, the study found that other social determinants of health -- including homelessness, unemployment, and low education level -- were independently associated with HIV infection.
While gay and bisexual men continue to be most affected by HIV in the United States, this study provides important insight into the determinants that may be driving the heterosexual epidemic in the United States.
The study found no statistically significant differences in HIV prevalence among heterosexuals in poor urban areas by race (2.1% among blacks/African Americans, 2.1% among Hispanics/Latinos, and 1.7% among whites). Because HIV is so common in these areas, individuals of all races living in these communities are at greater risk for HIV infection with every sexual encounter.
However, we must remember that poverty is not evenly distributed in this nation -- and blacks and Hispanics are much more likely to live in these disadvantaged communities than whites. Available U.S. Census data show that 46% of blacks in this country, and 40% of Hispanics, live in poverty areas, compared to just 10% of whites. Poverty may therefore play a key role in the severe racial/ethnic disparities found in HIV rates nationally. African Americans have an HIV prevalence rate that is eight times higher than whites, and Latinos have an HIV prevalence rate three times higher than whites.
These findings have significant implications for how we think about HIV prevention, pointing to an urgent need to prioritize HIV prevention efforts in disadvantaged communities. This study also underscores why we need to focus on the social determinants of health and not look at HIV in isolation from the environment in which people live, and the socioeconomic forces driving the HIV epidemic.
Perhaps the biggest news of the conference is a much-anticipated HIV prevention study among women in South Africa. It finds that a vaginal gel made from a highly effective drug commonly used to treat HIV can reduce the risk of HIV infection, when applied before and after sex. The gel, called a microbicide, reduced HIV infection by 39% -- and by 54% for women who used it consistently. It is also encouraging that women who used the gel had a 51% reduction in the risk of developing genital herpes -- a lifelong, incurable infection that can also increase the risk of HIV infection.
For many years, the world has sought new HIV prevention tools that women can control. This is the first time we have seen a significant benefit. While the study may need to be confirmed by other clinical trials before it is approved for use and available, this is a very exciting development. The gel could have the biggest impact in developing countries, where women represent the majority of new HIV infections.
The results of this tenofovir-based vaginal gel also give us reason to be very hopeful about the potential of oral HIV medications to prevent HIV infection. CDC and other research institutions are studying the safety and efficacy of antiretroviral pills to prevent infection, an approach called pre-exposure prophylaxis, or PrEP. This approach is being examined among several at-risk populations, including men who have sex with men, injection drug users, and heterosexual men and women. PrEP study results are expected in 2011.
With advancing knowledge of how to most effectively target HIV prevention efforts to those at greatest risk, the promise of new prevention tools on the horizon, and for the United States, the recently released National HIV/AIDS Strategy, this is indeed a time for renewed optimism and resolve to intensify our collective efforts -- and take prevention to the next level. There is within our grasp the potential to decrease new infections, increase the number of people who are tested for HIV, and ensure treatment and care for those living with the disease.
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