HIV/AIDS Control Within Reach as World AIDS Day Observed in Loma Linda and Redlands

Redlands and Loma Linda are becoming centers for new thinking about how the
spread of HIV/AIDS can finally be brought under control and steadily reduced. On
November 17, the annual meeting of Beyond AIDS, a national organization
dedicated to preventing the spread of HIV, was held at the Weisser Education
Pavilion at Redlands Community Hospital. The organization's president, Dr.
Ronald Hattis, lives in Redlands, and Deanna Stover, who works at the hospital,
heads the organization's educational Beyond AIDS Foundation. Members from as far away as New York came to discuss a new strategy for control and prevention of HIV/AIDS. 

In observance of World AIDS Day (which was December 1), Hattis also gave a
presentation on November 30 about this new thinking, and also about the latest
guidelines and advances in HIV/AIDS treatment and prevention, at Loma Linda
University. The program was attended by physicians, medical residents, and
public health nurses and students.
 
Central to the new strategy is "treatment as prevention." This concept
was first developed at Loma Linda University in 1996 by Hattis and a preventive
medicine resident. The idea is that even though HIV/AIDS cannot be cured,
treatment with a combination of anti-viral drugs can suppress the virus enough
so that it is unlikely to spread from an infected person being treated to anyone
else. It took 15 years, but by 2011, studies in 9 countries had verified that
this can actually reduce new infections by 96%, and Science Magazine recognized
"treatment as prevention" as the "science breakthrough of the year" for 2011. 

However, treatment cannot have much of an impact on the spread of the
disease unless patients are diagnosed by testing, and brought into effective
treatment, so early that they have not already passed on the virus. Furthermore,
anyone who has already been exposed needs to be informed and tested, and
similarly brought into treatment if already infected. And the treatment must
fully suppress the virus, and must be continued lifelong. Putting all those
elements together constitutes the Beyond AIDS strategy.

Unfortunately, all this has not been implemented in many places. For one
thing, national guidelines until now have recommended delaying the start of
treatment for years, until the concentration of CD4 cells, a type of white blood
cell indicating the strength of the immune system, dropped to low levels. Only
in 2012 did those guidelines change to recommend offering treatment to all
people with HIV infections, and that change has not been widely promoted or
implemented. Only in a few places, like New York City, has the full new strategy
recommended by Beyond AIDS, including early treatment, been put into effect. At
the Redlands meeting, Dr. Monica Sweeney, who heads HIV/AIDS programs for New York City, reported on how early treatment along with wider testing and
availability of condoms, are working to reduce new infections.