Shift in strategy to treatment as prevention for HIV/AIDS

Jerome Smith said he never got tested for HIV until it was almost too late. By the time he was checked five years ago, his immune system was so weakened that he had developed AIDS. The doctor told Smith, a D.C. government worker, that he had probably been infected for at least a decade.

Smith, now 39, says he doesn’t understand how his disease had been missed. In the two years before the diagnosis, he had been treated in local hospital emergency rooms for pneumonia, for unexplained fever and for a deadly bacterial infection. Each time, he underwent countless tests as doctors tried to figure out why he was sick. Not once, he said, did anyone test for HIV.

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“They kept taking my blood and telling me they were going to see what’s wrong,” Smith said. “I thought they were automatically testing me for everything.”

As the International AIDS Conference gets underway in Washington this week, organizers are calling for big increases in HIV testing and treatment. Testing-and-treating is now the central AIDS prevention strategy in the United States, providing a critical tool beyond condoms, behavior change, clean hypodermic needles and a safe blood supply. Experts say treatment-as-prevention has the potential to dramatically alter the landscape of the epidemic. Not only does treatment improve a person’s health, but people treated with antiretroviral therapy can prevent the virus from being transmitted to others. The drugs prevent the virus from replicating, reducing the level of active virus in blood and other bodily fluids that are the usual vehicles for infection.

“While we undoubtedly still need a cure and a vaccine, we can save millions of lives with the knowledge we have today if we fully implement the proven strategies we now have to treat those living with HIV and prevent new infections,” said Diane Havlir, the U.S. co-chair of the conference.

Yet about half of Americans, 51 percent, don’t know that treatment helps prevent the spread of the disease, according to a new poll by the Washington Post and The Kaiser Family Foundation.

Following new national recommendations on HIV treatment, the District announced last month that health-care providers will start treatment immediately for all those newly diagnosed instead of waiting for evidence that someone’s immune system has been severely damaged.

The District has some of the most aggressive and innovative testing programs in the country — including free HIV testing at a Department of Motor Vehicles branch, at an Anacostia social services center and more than 20 other sites around the city. But still, cases such as Smith’s point to the many practical, institutional and cultural reasons that keep many from being tested.

Nearly 20 percent of Americans with HIV don’t know they are infected according to the U.S. Centers for Disease Control and Prevention.

In the nation’s capital, which has a higher HIV infection rate than any state and among the highest for cities, there are 14,465 adolescents and adults, or about 2.7 percent of the population, diagnosed as living with HIV. That is well above the 1 percent considered by the World Health Organization to be a general epidemic.