After announcing that HIV infections in the United States dropped by 18% between 2008 and 2014, the CDC rolled out its new ‘HIP’ (High-impact Prevention) approach to HIV prevention, which includes HIV testing, treatment-as-prevention, needle exchange and PrEP, but fails to include or mention condom use.
CDC tries to tie decrease in HIV infections to use of PrEP—which was only available for less than two of the six years studied and which very few people were actually on during that time. In addition, those first targeted for PrEP use: gay and bisexual men, “…did not experience an overall decline in annual HIV infections from 2008 to 2014,” according to the CDC.
The CDC previously released a forecasting study in February 2016 of plans to prevent 185,000 new HIV infections by 2020, and also failed to mention or include condoms as a component of that effort.
LOS ANGELES (February 23, 2017) AIDS Healthcare Foundation (AHF) welcomed the news last week of an 18% decline in HIV infections in the United States between 2008 and 2014, but is questioning some of the conclusions drawn by Centers for Disease Control and Prevention (CDC) officials regarding the role of pre-exposure prophylaxis (PrEP), in particular, in the decline.
In addition, AHF chastised the CDC for overlooking the role that condoms may have played in the decline and blasted the organization for failing to even mention or include condom use in the roll out, and as part of its new ‘HIP’ (High-impact Prevention) approach to HIV prevention, which includes HIV testing, treatment-as-prevention, needle exchange and PrEP, but no mention of condoms.
In a CDC press release issued last week timed to coincide with the annual Conference on Retroviruses and Opportunistic Infections (CROI) held in Seattle, (“New HIV infections drop 18 percent in six years” February 14, 2017), CDC officials rightly tagged treatment-as-prevention as a likely contributor to the welcome decline in infections, noting:
“CDC researchers believe the declines in annual HIV infections are due, in large part, to efforts to increase the number of people living with HIV who know their HIV status and are virally suppressed — meaning their HIV infection is under control through effective treatment. This is a top public health priority. Studies have shown that, in addition to improving the health of people living with HIV, early treatment with antiretroviral medications dramatically reduces a person’s risk of transmitting the virus to others.”
However, AHF officials believe that the CDC was on far shakier ground when it claimed, “Increases in the use of pre-exposure prophylaxis, or PrEP, may also have played a role in preventing new infections in recent years.”
First, PrEP was only available for less than two of the six years studied (Gilead’s Truvada for use for a PrEP indication for HIV prevention was first approved by the FDA on July 16, 2012) and which very few people were actually on during that time period. In addition, the population initially targeted for PrEP use, gay and bisexual men, “…did not experience an overall decline in annual HIV infections from 2008 to 2014,” according to the CDC press release issued last week. Instead, the steepest declines in HIV infections were found in injection drug users (56%) and heterosexuals (36%), populations not targeted or prioritized for PrEP.
“We are glad that HIV infections are down 18% overall in the six year period studied; however, STDs are skyrocketing around the country today, particularly among young people and men who have sex with men,” said AHF President Michael Weinstein. “Unfortunately, individual and organizational complacency has set in at the CDC and elsewhere regarding condoms, which remain the best way to prevent most STDs, including HIV. So it was disappointing, but not surprising that the CDC failed to mention or include condoms as part of its new prevention effort: ‘HIP’ – its ‘High-impact Prevention’ approach focusing on ‘… cost-effective solutions.’ Inexplicably the new CDC effort again excludes condoms, which cost pennies and also prevent other STDs, while it includes PrEP, a prevention protocol which includes a $1,300 per month pill—and offers no protection against other STDs.”
In February 2016 (timed to last year’s CROI), the CDC released a forecasting study of plans to prevent 185,000 new HIV infections by 2020, and failed to mention condoms as a potential tool in that effort.
“We are encouraged by the overall reduction in new HIV infections across the U.S., but alarmed by clear regional disparities in access to treatment and prevention services that this report shows,” said Whitney Engeran-Cordova, Senior Director of Public Health for AHF. “We know that treatment-as-prevention works well to break the chain of new infections. These regional disparities are stark and speak to the lack of access to preventive services and medical care, and must be addressed by communities and public health officials on both a local and national policy level if we are to further reduce new infections in the future.”
AHF: CDC should prioritize condom use, place STDs at forefront of national public health agenda
Regarding the abandonment of the condom culture in the US: advocates from AHF note that in just a one month period between December 2013 and January 2014—and with little public review—the CDC changed its longstanding HIV and STD prevention wording regarding condom use from using the phrase “unprotected sex” to describe sex without a condom or some form of barrier protection to using the phrase, “condomless sex”—a move that may suggest to some that condomless sex is protected. A further indication of the erosion of the condom culture came in February 2016, when the CDC released a plan to prevent 185,000 new HIV infections—and also failed to even mention condoms as a potential tool in that effort.
All this played out at a time when sexually transmitted infections (STIs) or diseases (STDs) are increasing dramatically, particularly among young people, with potentially “…staggering human, economic costs.” In October 2016, the CDC released a report, “Reported STDs at Unprecedented High in the U.S.” At the time, AHF called out the CDC’s own policies—chief among them, the CDC’s sanctioning of the widespread abandonment of the condom culture for STD and HIV prevention—as a primary catalyst for skyrocketing STD rates, particularly among young people.
The CDC requested less overall funding for 2017 for HIV/AIDS, hepatitis, sexually transmitted infections (STIs) and tuberculosis (TB) than it did for 2016. For STIs, the CDC’s funding request has remained stagnant, while the HIV/AIDS Prevention and Research funding request is $10 million lower than the previous year. While the CDC did request more funding for 2017 than the agency actually received in 2016, enacted funding has consistently fallen short of requested funding.