Dispatches from the fight against homelessness and AIDS
Posted by Tim Murphy , September 26, 2013
Harrington: “We can break the chain of HIV transmission.”
[Editors note: Please email Tim Murphy, the current editor of the Housing Works update, with feedback or leads on stories.]
Two weeks ago, we reported that a coalition of HIV/AIDS activists and service providers, including Housing Works, were collecting organizational sign-ons to a letter to NY Governor Cuomo urging him to include launching a plan to end AIDS in New York State in his January 2014 State of the State address. A working paper, written primarily by Housing Works and Treatment Action Group, is also circulating among Cuomo staffers. It breaks into components a plan to end AIDS as an epidemic in New York State. In the following weeks, we will look at each of those components more closely. This week, we focus on improving detection and tracking of new HIV infections:
Recently, the CDC issued a lengthy report on the fourth-generation antibody test to detect HIV. The test, administered with a needle prick to the finger, can detect HIV as early as two weeks after exposure, when viral load is high and patients are highly infectious, as opposed to four to six weeks after exposure, the detection point of the widely-used oral swab rapid test. The End of AIDS in New York coalition urges the state and city health departments to facilitate the roll-out of this faster way of detecting new HIV infections.
“What’s alarming is that when this new test was being piloted in emergency rooms in Arizona,” explains Mark Harrington, executive director of Treatment Action Group, “they found that about a third of all ER visitors who were HIV-positive were in the acute, highly infection stage of HIV that would not be picked up on the traditional test.” Essentially, this means that someone who is highly infectious can test HIV-negative on the traditional rapid test and be sent away told that everything is fine.
“Being able to measure early infection provides an opportunity to intervene early with those found to be HIV-positive,” says Harrington. “You can find out who their sexual partners and family members are,” he says, and possibly get them onto PEP (post-exposure prophylaxis, a month’s course of HIV meds to prevent HIV infection in someone who’s been possibly exposed) or PrEP (pre-exposure prophylaxis, an ongoing course of one HIV medication, Truvada, to keep someone from getting HIV). “That way, you can break the chain of transmission.”
According to Harrington, discussions with staffers in NYC’s health department indicate that it wants to roll out the fourth-generation test, but hospitals are dragging their heels on it because of the extreme high price (around $1 million) of machines needed to sequence virus for the follow-up confirmatory test. However, Harrington points out that care centers could implement the fourth-generation needle-prick test, which provides a response in 20 minutes, and continue to confirm HIV infection when necessary with a Western Blot, the traditional confirmatory test.
Yet Harrington points out that there is another component to improved detection and tracking of HIV in order to stop its movement: The need to urge high-risk people, such as men who have sex with men and transgender women, to test for HIV more frequently, from once a year to every three to six months. This, too, will help detect more people infected recently who may be highly infectious. According to Harrington, San Francisco, in the past six years, has reduced HIV infections 40 percent by broadly getting gay men to test more frequently. He says that 93 percent of all HIV-positive gay men in that city now know their status. That can play a huge role in HIV-positive individuals not further transmitting the virus.
Then there is yet another component. “We haven’t done a very good job of preventive services for high-risk people,” he says. “Typically if you test negative, you get a pat on the back and are told to come back in a year. Preventive interventions such as PEP and PrEP, as well as primary care and stable housing, have to be considered essential health services under Obamacare and Medicaid expansion.”
And there is one final piece. “We need to understand in more detail where, and in whom, new infections are taking place. We need to use geomapping and social-network analysis.” Harrington acknowledged that tapping into social media to track HIV chains of transmission is “fraught with ethical pitfalls.” The answer? “Getting communities to be willing to participate in HIV surveillance in a more proactive way.”
Next week, we will take a closer look at prevention methods including routine and voluntary universal testing; effective and early treatment for HIV-positive people to reduce viral load and hence the risk of transmission; PEP and PrEP; high-quality sex-ed; screening and treatment for substance use, mental health issues, trauma and violence; and wrap-around services like housing and needle exchange. Stay tuned!blog comments powered by Disqus
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