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Hello. This is Dr. Ron Valdiserri reporting
from the International AIDS meeting here in Washington, DC
and it is my pleasure to be joined by my friend
and colleague Dr. Kevin Fenton who is
the Director of the National Center for ***, Viral Hepatitis,
STD and TB Prevention at CDC.
That’s quite a title and I know it’s quite a center.
Thank you so much, Kevin, for being here.
We wanted to have you share with our viewers
some of the important developments around
the so-called treatment cascade.
I wonder if you could begin by reminding our viewers:
What do you mean, what is meant by the treatment cascade?
Ron, great to be here. So, as you are aware,
there are more than 1.1 million Americans
who are currently living with ***.
The treatment cascade really describes the journey
that those *** positive persons take as they navigate
the health care system, in other words as they become
diagnosed with ***, as they become linked to effective care,
whether or not they are retained in care;
for those who are in care, whether or not they are offered
antiretroviral treatment, and then finally the proportion
of those who are in care and on treatment
and who are virally suppressed.
So it really is a journey as that patient goes through
the health care system to be maximally benefitting
from effective treatment.
And so to state the obvious, certainly obvious to you,
we would like to see each of those steps being very high
but in reality that’s not the case, is it?
That’s right. Now in an ideal world, everybody
who’s diagnosed would be linked to care,
maximally suppressed and maximally benefitting
from antiretroviral treatments.
But CDC and other researchers have shown that there is
a tremendous fall-off in the cascade.
And in fact the most recent data from the CDC suggests
that only one in four of all *** positive patients
are actually, get virally suppressed, in other words,
maximally benefitting from these effective antiretroviral treatments.
So this is a real concern for us as we are thinking about ***.
And, CDC has done a current analysis looking
at the cascade from several different angles,
including age and race and gender.
Can you share with our viewers what you found when you did that analysis?
Absolutely. So we have previously released data
for World AIDS Day 2011 suggesting that about 28%
of persons were virally suppressed.
In the most recent analyses, we’ve updated those estimates
to about 25% or 1 in 4 *** infected persons
being maximally suppressed.
In addition, we’ve now provided data on that cascade
by age group differences, by gender differences,
by the transmission categories, as well as by race
and ethnicity. There are some very interesting findings.
Younger people -- those aged for example under 29 or 30 years of age
-- are far less likely to be virally suppressed
than older adults in the United States.
We also see very significant differences across the racial
and ethnic groups in the U.S.,
with unfortunately African Americans who are hard hit
by this epidemic faring the worse with the treatment cascade.
Fewer African Americans are virally suppressed
compared to Hispanic and Latinos and whites.
Encouragingly we did not see any differences,
significant differences across genders.
Men and women were equally likely to be suppressed
and very few differences across the transmission categories.
So whether you are gay, whether you are heterosexual
or injecting drug user, most of those groups were equally suppressed.
So interesting differences and areas for us to focus our efforts.
I think just to make clear for our audience the reason
this information is so important is that it helps prevention
experts like Dr. Fenton and his colleagues and treatment experts
better understand where to intervene.
Because what’s happening at each step
is that we are losing people essentially.
That is correct.
So maybe someone gets diagnosed but as you said,
they don’t get referred to care.
Or maybe they get referred to care but have fallen out
of care for a number of reasons.
Maybe they are homeless; maybe
they have an ongoing substance abuse issue.
So this information really is extremely important
from a practical level. I do want to emphasize that.
It is absolutely important.
One of the things that we’ve certainly heard at the recently
completed International AIDS Conference
is this concept of moving towards an AIDS free generation.
And, a key strategy for getting there is ensuring that those
who are *** positive are diagnosed and maximally benefiting
from the effective treatments which are now available.
And, so if we know that young people,
if we know that certain minority groups or ethnic groups
in the U.S. are faring less well in the system,
that helps us to target and that helps us to do a much better job.
We are clearly talking about the medical benefits
of treatment and keeping the viral load suppressed
is good for a person living with ***.
But, Kevin, why don’t you reinforce the prevention benefit
of that as well? I mean, we want to make sure
folks understand that.
Thank you and you are so right.
The good thing is treatment is treatment so everybody
benefits as an individual by taking those drugs.
But what we also know that treatment also
has this amazing prevention benefit because
it reduces the risk of onward transmission of the virus
to unaffected partners by approximately 96%.
So that’s a very powerful tool that we now have
in our armamentarium, in our toolkit to help stop
the spread of ***. And that’s why all of us should have
a vested interest in knowing our status,
if we are *** positive getting into care
and getting treatment as quickly as possible
for our own benefits and for the health and wellbeing of our partners.
Great answer, and that’s of course why
we are hearing more about treatment as prevention.
That’s correct. That’s correct.
Really, really important. We do clearly have a ways
to go if less than 1in 4 individuals who are infected
with *** are really receiving optimal care.
But I want to give you an opportunity to maybe highlight
some of the, one or two examples of the many positive
examples of work that CDC has done to try to intervene
on that cascade.
Well, you know, CDC views the cascade
and improving on the cascade as a key prevention priority.
We have a vested interest in ensuring that all Americans
are aware of their *** status.
And over the past five to seven years,
we have really been investing new resources to support states
and local health departments and community based organizations
across the country to scale up *** testing.
The good news, Ron, is that we are seeing year on year
increases in the proportion of Americans who report
ever having an *** test but we need to do more.
In addition, CDC has been partnering with our state partners
and with CBOs to look at ways in which we can best link
people to care and support those persons who are *** positive
to remain in care and we do this in our partnership
with other agencies such as HRSA as well as CBOs
across the country.
So, CDC’s role is really around encouraging *** testing,
raising awareness, getting people into care, and keeping them there.
Let’s just close with one last question.
I want to give you an opportunity to talk about CDC’s
great new media campaign that is trying to address
the stigma which unfortunately still exists in this nation
– fear and stigma about learning about an *** diagnosis.
But you folks have a really great example of how to impact that.
Can you share with the audience?
Absolutely and thank you for the opportunity.
You know, more than 30 years into this epidemic,
the sad reality is that we are still dealing
with stigma in the United States.
Stigma has a pervasive impact on the ways
in which people access treatment and care,
the way they get the support that they need from family
and friends to deal with this disease and of course
the way people access *** testing.
So in our new campaign which is called
Let’s Stop *** Together, we have brought together people
who are infected and uninfected to talk about their
experiences about getting diagnosed.
These are real people, not actors
Real people, absolutely not actors.
To talk about their experiences of getting *** tested
and having the loving support of those around them
to combat this disease.
It is an empowering campaign, beautiful images,
strong messages, and really drives home the point
that if we are going to end this epidemic,
it will take all of us, *** negative and positive, to end this together.
Well, thank you so much for sharing those outstanding examples
of what CDC is doing to achieve the goals and vision
of the National ***/AIDS Strategy.
This is Dr. Ron Valdiserri reporting
from the 19th International AIDS Meeting.
It has been our pleasure to talk with my friend
and colleague Dr. Kevin Fenton from the CDC.
Thank you so much Kevin.