Treatment Cascade: A Spotlight Series

Treatment Cascade: A Spotlight Series

Whether or not you have heard of the treatment cascade, if you are living with HIV, then you are represented on it. The treatment cascade is a powerful visual reminder of the state of the HIV epidemic in the U.S. in terms of how many people have a fully suppressed viral load -- and how many people are at each stage of getting toward that health goal.

The treatment cascade relays to the viewer the idea that everyone's HIV diagnosis is the beginning of a journey -- and it's a reminder that a lot of work must be done in order to make the health care system serve more people, more effectively. With this Treatment Cascade Spotlight Series, has set out to mix the medical statistics that comprise the cascade with personal stories from our community about each of the unique steps of this journey.

Our series is split into groups to reflect the different steps of the treatment cascade: those who are newly diagnosed, or know their HIV status; those who have been linked to and stayed in HIV care; those who have started HIV treatment; and finally; those who have achieved an undetectable viral load, meaning that their HIV is suppressed.

Understanding the Cascade

What the Heck is the HIV "Treatment Cascade" -- And Why Does It Matter?
Need an introduction to the "treatment cascade"? You can find it here. It's OK, we all didn't know what it was at one point!

HRSA HIV/AIDS Bureau Releases Preliminary Data on the Continuum of HIV Care Among Ryan White Clients at CROI 2013
Engagement in HIV care reduces morbidity and mortality among people living with HIV, and the treatment cascade or "continuum of care" provides a framework for understanding the status of HIV care and treatment in the U.S.

Linked to / Retained in Care

David Fawcett, Ph.D., L.C.S.W.Patching the Leaky Cascade: Report From the 2015 Adherence Conference
David Fawcett, Ph.D., L.C.S.W., reports on the conference with the snappy moniker Adherence 2015, at which delegates shared a variety of promising findings and strategies for engaging those living with HIV who are not on treatment, have fallen out of care or do not have an undetectable HIV viral load.  Delegates also addressed the issue of stigma, which is widely seen as the most challenging obstacle to HIV prevention and treatment worldwide.

 Lisa Fitzpatrick, M.D., M.P.H.Enough With the HIV Treatment Cascade Research, Let's Do Something About It Already
"I know addressing community and provider HIV literacy is not as sexy as an observational or randomized study," writes Lisa Fitzpatrick, M.D., M.P.H. "But if we really mean and believe what we are saying, we have to change and operationally address these challenges."

 Ed PerlmutterMy Shifting Seat on the HIV Merry-Go-Round
"Regarding HIV clinical care, my friend James always says, 'stay close to the center of the merry-go-round.' And it's great advice. Stay close to the center and gravity keeps you balanced and secure, in the right spot, even though you're spinning fast, round and round. Shift out from the center and all bets are off. For the past six and one-half years, I've had my ass firmly planted at the center of the merry-go-round, right where I need to be. And I've been holding onto that spot for dear life, and there I've received the best HIV clinical care I could possibly imagine."

Starting Treatment

When Did You Start HIV Meds? Stories Spanning Several Decades

When Did You Start HIV Meds? Stories Spanning Several Decades
One thing is certain: Whether you took your first fistful of pills in the late 1980s or began last week with one of several single-pill regimens, starting HIV meds is a life-changing event. Many of our bloggers and community members have told their stories of starting treatment; here's what some of them had to say about it.

Rev. Andrena Ingram

Rev. Andrena Ingram: I'm Swallowing as Fast as I Can!
"What I began doing after the AZT, and as I was going to begin, what would become known as 'the cocktail,' I began the practice of 'talking to my body,' telling it and myself that 'we were going to begin this new regimen and we were going to do it as painlessly as possible.'"

Bob Leahy

Changing My Mind on Treatment as Prevention
"One hundred and eighty degree turns happen in a variety of ways. Sometimes we seize the steering wheel of our lives and in one fell swoop travel along an opposite path. Other times, we take the turn slowly, one degree at a time, gradually realizing the path we are on leads nowhere and we need to go off in radically new directions. That's been the case with my realizing that most of my once fervently held objections to treatment as prevention, in 2013, make much less sense than they once did."

Viral Suppression

Getting to Undetectable: People Living With HIV Share Their Stories

Getting to Undetectable: People Living With HIV Share Their Stories
An undetectable viral load: It's a powerful concept with profound implications to the life of a person living with HIV (and his or her partners). However, according to the treatment cascade, for a host of complex reasons, 75 percent of people living with HIV in the U.S. have not reached the point of viral suppression. We asked people living with HIV to contribute thoughts and stories about getting their own viral loads to undetectable.

Rev. Andrena Ingram

Rev. Andrena Ingram: Undetectable? Whaaaat?
"And then she said: Guess what Andrena? Your viral load is under 50 copies! She was cheesin'! Grinning from ear to ear! I still didn't understand what that meant, until she stopped grinning long enough to tell me."

Bernadette Berzoza

Bernadette Berzoza: Getting My Viral Load Down
"In October 2012 I began my new regimen. Within a few months, when my blood was drawn, my viral load was 50. It was the best news ever. It wasn't completely undetected, but it wasn't in the high numbers it had always been."

Joe Ohmer

Joe Ohmer: A Surprising Undetectable
"I didn't even really understand the significance of an undetectable viral load, because when those topics were being broached to me, I'd been diagnosed maybe six months earlier, I had no idea what the numbers meant."

Shannon Southall

Shannon Southall: I am Here, 21 Years Later, Because of These Medications
"My viral load was 159,000 and these new meds had shown that they could reduce the virus in my system, therefore prolonging my life. So of course I said yes."

Masonia B. Traylor

Masonia B. Traylor: Reaching Undetectable While Pregnant
"I was proud of myself. It was a struggle mentally, emotionally and physically, especially because I was pregnant. But I must say that having an HIV-negative baby was the best result of my undetectable viral load."