After a recent meeting between Atlanta AIDS activists groups, ACT UP/New York, Treatment Action Group ( TAG ) and the U.S. Centers for Disease Control and Prevention ( CDC )'s HIV leadership and Tuesday's community press conference, what should the CDC do next to ramp up the domestic HIV prevention response? Here is a partial but by no means exhaustive list of priority actions:
1. CDC should declare HIV an emergency among U.S. men who have sex with men and transgender persons ( actupny.com/actions/files/The_Atlanta_Principles.pdf ).
CDC should immediately convene a meeting of young black and Latino MSM and transgender leaders and community members to determine on an action plan to rapidly reduce new HIV infections in these most-at-risk populations.
CDC should immediately determine how to conduct accurate and timely HIV epidemiology, surveillance, and better prevention programs in partnership with and focusing on young MSM of color and transgender persons.
2. CDC should rapidly release a revised HIV surveillance algorithm to promote the use of 4th generation HIV testing assays which can help to close the window between HIV infection and seroconversion, enabling earlier diagnosis and treatment of newly-HIV-infected individuals, who may make up as many as 45% of new HIV infections.
3. CDC should, in partnership with community groups, develop, implement, and promote public education campaigns for health care providers, AIDS service organizations, and at-risk communities on:
a. Acute HIV infection warning signs, diagnosis, and referral;
b. Pre-exposure prophylaxis ( PrEP ) and post-exposure prophylaxis ( PEP );
c. Referral to treatment, retention, adherence, and viral suppression in all those infected.
4. CDC should develop a combination HIV prevention continuum of care and ensure that the Department of Health and Human Services ( DHHS ) mandates the inclusion of this prevention care continuum as an essential health benefit under Affordable Care Act ( ACA ) and Medicaid expansion; in addition, CDC should work with the Ryan White CARE Act programs at HRSA and in the states to ensure that undocumented individuals and those without health care are able to access comprehensive prevention services without regard to their immigration or insurance status ( whenever possible, however, programs should seek to provide primary care to all individuals ).
5. CDC, in partnership with key states such as New York, should design and implement an opt-out Chemoprophylaxis Registry ( CPR ) for all individuals prescribed PEP or PrEP to determine the safety, effectiveness, side effects, adherence levels, and real-world effectiveness of these interventions among people who choose to take PEP or PrEP.
These are just a few of the steps which are needed to set the stage for ending the HIV pandemic in the United States.
Science has developed the tools, and the United States has the resources, to dramatically reduce new HIV infections in the next five years.
It's time for us to force the federal and state governments to invest in an AIDS-free generation here at home.