Combatting the HIV epidemic: A conversation with the U.S. Centers for Disease Control and Prevention

A team all put their fists together in a group huddle.

Since the first reported AIDS diagnosis forty years ago, HIV — the virus that leads to AIDS — is still an epidemic in America.

Although there’s no current cure, HIV can be managed with appropriate treatment and care. Advances in testing, prevention, and treatment can curb the spread, yet stigma, lack of awareness, and systemic inequities present barriers to access. Further, HIV has a disproportionate impact on certain minority populations and geographic communities in the U.S.

On World AIDS Day, December 1, 2021, the Biden-Harris administration announced a new National HIV/AIDS strategy to advance efforts toward ending the epidemic in the U.S. by 2030.

Joel Helle, VP of Physician Services for CVS Health sat down with Dr. Demetre Daskalakis, Director, Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention (CDC), to get his perspective on the HIV epidemic in America and how to stop it.

Joel: Thank you for chatting with me today, Dr. Daskalakis, on this critical issue in our country. The first AIDS diagnosis in the U.S. was 40 years ago. How have things gotten better in the past 40 years in terms of how we prevent HIV from developing into AIDS?

Dr. Daskalakis: When I think about the early days of the AIDS epidemic, I get emotional because it’s astounding to see how different the story is today.

At the peak of the HIV epidemic in the mid-1980s, there were over 130,000 new HIV infections each year. Since then, investments in HIV prevention and treatment have resulted in a dramatic reduction in new infections. By 2019, there were less than 35,000 new infections annually.

We now have the tools to prevent HIV and to keep people living with HIV healthy. We know that HIV testing is the bridge to HIV treatment and prevention. In the last four decades, we’ve seen advancements in prevention, including medication that can prevent HIV – known as pre-exposure prophylaxis or PrEP. Additionally, new treatments help people with HIV get to an undetectable viral load, which allows them to live longer, healthier lives and to be confident that they have effectively no risk of sexually transmitting HIV. There are more treatment options on the horizon, which is exciting as the more options we have, the more likely people will be to find an option that works in their lives.

Joel: Thank you — great to have your perspective on that. HHS launched Ending the HIV Epidemic in America, and CDC has developed a Let’s Stop HIV Together campaign. Could you talk more about the goals of each of these initiatives?

Dr. Daskalakis: The Ending the HIV Epidemic in the U.S. (EHE) initiative aims to reduce new HIV infections in the U.S. by 90% by 2030. This is a great road map for addressing HIV. CDC’s Let’s Stop HIV Together campaign encourages people to seek HIV testing, prevention, and treatment, and helps end the stigma of the virus. The campaign focuses on reaching Black/African American people, Hispanic/Latinx people, and other groups disproportionately affected by HIV with culturally appropriate and bilingual messages about HIV. It has a component to educate healthcare providers and give them resources to use with patients, and provides resources to help reduce stigma, including videos, language guides, stigma scenarios, and what to do when you see HIV stigma.

Joel: So how do we do it, from your perspective. How do we bring diagnoses down 90% by 2030?

Dr. Daskalakis: We’re at a crossroads of strategy and implementation. The path forward involves four key HIV prevention and treatment strategies.

  1. We must diagnose all people with HIV as early as possible. CDC recommends all people ages 13 to 64 be tested for HIV at least once as part of their routine health care.

  2. We need to treat people with HIV rapidly and effectively to reach sustained viral suppression, including starting treatment as soon as possible after diagnosis. Local community plans have been developed to lay the foundation for extending HIV treatment and care services to all people with HIV.

  3. We need to prevent new HIV transmissions by using proven interventions, including PrEP and Syringe Service Programs (SSPs).

  4. We must respond quickly to potential HIV outbreaks to get vital prevention and treatment services to people who need them.

    It’s also important that we address different communities in the ways that meet their needs. The way that testing and care delivery changed in COVID-19 could help us overcome longstanding barriers and might include telemedicine and telehealth, rapid HIV self-tests, mail-in self-tests, and other locally tailored, creative solutions. It is also important to consider the lab and vaccine infrastructure built for COVID-19 and how it can be leveraged for HIV.

HIV continues to disproportionately affect certain groups, including gay and bisexual men, Black/African American people, Hispanic/Latinx people, and transgender women. To end the HIV epidemic, we will need to address the systemic factors that turn health differences into public health injustice. These factors include discrimination, healthcare access and use, education, income, housing, and transportation which disproportionately affect some racial and ethnic groups.

Dr. Daskalakis: If I may ask you, Joel, how do you define CVS Health’s a role in Ending the Epidemic?

Joel: That’s a great question. CVS Health has committed to helping end the HIV epidemic in alignment with the Ending the HIV Epidemic initiative, and we aim to expand on what we’re doing today. To help people start on preventive medication, we’ve donated prescription dispensing services through the Ready, Set, PrEP program, which provides free PrEP regardless of insurance status. People can fill their valid PrEP prescriptions and pick up their medication at our retail locations. We’ve also launched our initiative to break down barriers to care through our pharmacy benefit manager, which serves 1 in 3 Americans. We’re focused on conditions that disproportionately impact patients of color, including HIV, to expand access to testing and optimize therapy.

Most recently, we announced how we’re advancing primary care delivery, virtual care, and home health capabilities. This will allow us to reach more consumers with preventive care options and help people with complex conditions like HIV manage care and mitigate the risk of transmission.

Dr. Daskalakis: Joel, how do you see various sectors working together – public, private, and non-profit, to end the epidemic?

Dr. Daskalakis: Partnerships between sectors are critical to stopping HIV. CDC is committed to meaningful, ongoing community engagement as part of the EHE initiative. For decades, local community planning—in coordination with state and local health departments, national and regional private organizations, and community-based organizations—has been critical to HIV prevention. This work continues in EHE as the 57 priority jurisdictions in the initiative have developed their own locally tailored, community-driven plans to lay the foundation for scaling up the initiative’s key strategies in ways that meet local needs, reduce health disparities, and achieve health equity in communities.

Dr. Daskalakis: I’d love to pivot the question back to you, Joel — how can CVS Health collaborate with the public and non-profit sector?

Joel: I’m so glad you asked this. I’m excited about the Biden-Harris administration’s new National HIV/AIDS Strategy. There’s a specific call-out for cross-industry collaboration, including engagement with the private sector.

We’re continuing our conversation with the U.S. Department of Health and Human Services (HHS) to build on our participation in Ready, Set, PrEP. During our World AIDS Day 2021 panel discussion, Lt. Nelly Gazarian, Deputy Director of HHS expressed that there’s a clear role pharmacists can play in ending the epidemic. We have 40,000 pharmacists across our company — along with thousands of other clinicians on the front lines. We’re eager to use our talent and assets to help end the epidemic.

CVS Health has a history of engaging with non-profit organizations at the national and local level. These organizations know their communities well, and in combination with our offerings, we’re eager to work with HIV-focused organizations to help expand access to testing, prevention, and treatment to stop the spread of HIV and support those who are living with it.

It was a pleasure speaking with you today. Thank you for sharing your knowledge and perspective. We have an ambitious goal ahead of us, but I believe with collaborative efforts, we can get there.

Dr. Daskalakis: Likewise, and thank you for having me!

Learn how you can know your status and help stop the spread of HIV at CVSHealth.com/EndHIV.

01.10.22