World AIDS Day is a Reminder that Despite Great Progress, HIV Continues to Spread

This year’s World AIDS Days, Dec. 1, fell on two significant anniversaries. Forty years ago, in 1981, a New York City LGBTQ newspaper, The New York Native, ran an article entitled “Disease Rumors Largely Unfounded.” It was the first reported appearance of a rare disease that seemingly was affecting gay men. Soon thereafter, the Centers for Disease Control and Prevention (CDC) confirmed cases of pneumocystis carinii pneumonia in gay men. It would later be given the designation AIDS for “acquired immunodeficiency syndrome.” In 1984, HIV, human immune deficiency virus, was discovered to be the cause of AIDS.

In Wisconsin, the first case of the disease was reported in 1982. That individual was from out of state. The first Wisconsin resident would be diagnosed in 1983. Cases rose exponentially, locally and worldwide. Infection with HIV inevitably was a death sentence.

Fifteen years after that first report, infection numbers began to stabilize and, in fact, decline. An experimental therapy, the medication, azidothymidine or AZT, successfully treated those infected and despite serious side effects, managed to improve their health. In the following years, new anti-retroviral therapies evolved to the point of suppressing HIV viral loads to an undetectable level. Those infected but with undetectable virus levels were determined to be incapable of transmitting the disease to others. The crisis seemed to be contained with those treated living normal lives. HIV had become a chronic but manageable infection. Today, the positive news is that of the nearly 7000 Wisconsinites currently living with HIV, 71% are virally suppressed.

Prevention through Education

Beyond treatment of those already infected, efforts in prevention through education have, since 2014, been buttressed by pre-exposure prophylaxis (PrEP),  a drug program that can reduce HIV transmission by 99%. The drugs Truvada and Descovy have been approved as PrEP therapy. Payment is largely covered by insurance, BadgerCarePlus, and Federal programs.

Forty years after its first recorded cases, it would seem like the HIV/AIDS pandemic is largely under control. However, the most recent statistics released by the Wisconsin Department of Health Services, while indicating a new infection rate trending lower, is not quite as optimistic as one might expect. While PrEP data reveal a 55% average annual increase in persons using PrEP across the United States, studies indicate that PrEP uptake in Wisconsin remains slow.

In 2018 I spoke with Dr. Jeffrey Kelly of the Medical College of Wisconsin, who, in a partnership with a study in Cleveland, OH, had received a $3.4 million National Institute of Health grant to study PrEP (Pre-exposure Prophylaxis) awareness among men having sex with men (MSM). The five-year research project with 500 participants between Milwaukee and Cleveland, focuses on men of color because that particular demographic had traditionally shown higher rates of infection. In a recent follow-up conversation with Kelly, he indicated that, while the study is continuing, the COVID-19 pandemic had slowed its progress.

Among people of color, along with a history of health care disparities, distrust of the health system, inherent cultural and religious issues vis-a-vis the LGBTQ community, a specific gay community phenomenon has presented itself as an obstacle to PrEP uptake, namely PrEP shaming. In this scenario, those taking PrEP are stigmatized for being promiscuous. The result is a significantly lower percentage of PrEP uptake within the demographic with the highest infection rate.

Meanwhile, the Wisconsin Department of Health Services (DHS) data report for 2020 reveals a slow decline in new cases over the past 10 years. It also confirms the continuing trend of new infections in a certain demographic, namely people of color, and cites 61% of 208 newly diagnosed cases concentrated in this group. The majority of those are in Milwaukee County. The DHS report did not include any new PrEP data.

Milwaukee’s Vivent Health, today a national leader in comprehensive HIV care and prevention, along with Diverse & Resilient, 16th Street Clinic and other agencies continue the struggle for a world without HIV/AIDS.,

Yet, despite this incredible infrastructure, access to care, and particularly to PrEP, has been disproportionate. While this has been exacerbated by the COVID-19 pandemic, it is primarily due to pervading social disparities. 

Perhaps once COVID-19 is truly on the wane, a concerted effort will be made to refocus on revitalizing strategies to make care accessible for all, remove stigma and achieve zero HIV transmission.

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