The last significant dent we’ve made in Massachusetts in fighting the spread of HIV came as a result of two common sense policy moves: legalizing needle exchange programs in 1999 (the state now has four) and, since 2006, allowing injection drug users to purchase sterile needles at a pharmacy without a prescription.
The numbers tell the story: In 1999, nearly one-third (29%) of new diagnoses of HIV were attributable to injection drug use. By 2012, the last year for which statistics are available, only six percent of those diagnosed with HIV (43 cases), had acquired HIV through injection drug use.
In 2015, as AIDS Action prepares to hold its 30th annual AIDS Walk, we have to ask: Is there a way to lower new infections of HIV among other groups vulnerable to HIV infection as we have with injection drug users? As was the case when the epidemic first began, those who are more likely to become HIV positive than the general population are those who are dealing with other societal ills such as racism and homophobia. Blacks make up only six percent of the state’s population, but they comprise 30 percent of those living with HIV/AIDS. Hispanics make up only 10 percent of the state’s population, but they comprise 24 percent of those living with HIV/AIDS. And the only group with rising rates of HIV diagnoses in Massachusetts are gay and bisexual men: They accounted for 33 percent of new diagnoses in 2003 and 46 percent in 2012.
Slowing—or, ideally, stopping—the spread of HIV among these groups is a complicated endeavor. Racism, homophobia, and other systemic problems impacting health are not going away anytime soon. Meanwhile, the sexual behavior that leads directly to HIV infection is tied to identity, self-esteem, and relationship status. In other words, it’s not at all easy to change.
Given these challenges, reasonable people might ask if we have achieved all that we can by lowering new diagnoses of HIV to 700 per year, and whether it is even realistic to claim that getting to zero new infections is possible.
To those questions, I would say—quite emphatically—that it is possible.
Since the beginning of the AIDS epidemic, Massachusetts has wisely invested resources (hundreds of millions of dollars in prevention and education strategies) and embraced controversial measures (such as needle exchange programs) to fight the spread of HIV. As a result, the state is a national leader in reducing new diagnoses of HIV and improving the health of those living with the disease. This success is one of the few victories in public health in Massachusetts that has not only improved lives, but also saved the state hundreds of millions of dollars in HIV-related health care costs that are over and above what the state has spent on prevention.
At the same time, we aren’t doing nearly enough in Massachusetts to stop the spread of HIV.
Just two years ago, the FDA approved a new tool, Pre-Exposure Prophylaxis (PrEP), which could dramatically reduce the spread of HIV. By taking just one pill per day, those who are uniquely vulnerable to HIV infection can significantly reduce their risk. Despite its effectiveness as a prevention tool, few of those who could benefit from it even know about it.
How many HIV infections that will show up as new diagnoses in the next surveillance report from the Department of Public Health could have been prevented with widespread adoption of PrEP? Are we talking about 50 people? 100? 500? By broadly educating the public about PrEP, which is already covered by health insurers, Massachusetts once again has a unique opportunity to lead the nation in HIV treatment, education, and prevention.
Twenty years ago, AIDS Action partnered with the city of Boston and the state to advocate for needle exchange programs. We did the same in the 2000s, when we pushed for passage of the Pharmacy Access Bill. Today, we are embracing the campaign to educate policymakers, healthcare providers, and the public about the potential PrEP holds as an HIV prevention strategy.
If we do this right, we can get to zero new HIV infections. And what an amazing achievement that will be.
Carl Sciortino is the Executive Director of AIDS Action Committee of Massachusetts. This year’s AIDS Walk Boston & 5K Run takes place Sunday, June 7. It is New England’s largest HIV awareness event and AIDS Action Committee’s largest fundraiser. Learn more at AIDSWalkBoston.org.