HIV & AIDS in the United States Update: Dear Colleague Letter

September 26, 2018

Dear Colleague,

Tomorrow is National Gay Men’s HIV/AIDS Awareness Day. This year’s theme, The Conversation About HIV Is Changing: Talk Undetectable, reflects advances in science that have given us real hope for dramatically reducing new HIV infections and helping people with HIV live longer, healthier lives. Gay and bisexual men remain the population most affected by HIV in the United States, and tomorrow’s awareness day is an opportunity to talk about how these advances can support gay and bisexual men.

Last year on National Gay Men’s HIV/AIDS Awareness Day, the Centers for Disease Control and Prevention (CDC) highlighted strong evidence that people with HIV who take antiretroviral therapy (ART) as prescribed and achieve and maintain viral suppression or have an undetectable viral load can stay healthy and have effectively no risk of sexually transmitting HIV to a partner. One year later, we are more confident than ever in the preventive benefits of maintaining viral suppression, sometimes referred to as “treatment as prevention.” New data released this year show no HIV transmissions via sex among HIV-discordant gay male couples when the HIV-positive partner had an undetectable viral load. These findings, combined with earlier studies involving gay men showing similar results, include more than 1,100 couples and more than 89,000 sex acts without a condom or pre-exposure prophylaxis (PrEP). These results are indeed a conversation changer for people with HIV, their partners, and all stakeholders in HIV prevention and treatment.

Treatment as prevention is one of the most powerful tools we have for preventing new HIV infections. However, it is effective only if an HIV-positive person achieves and maintains viral suppression or an undetectable viral load. Some people with HIV experience challenges with staying on treatment and achieving and maintaining viral suppression. More than 600,000 gay and bisexual men in the United States have HIV, and about half (52%) have achieved viral suppression, meaning they had a suppressed load at their last test. In the U.S., up to one-third of all people in HIV care do not maintain viral suppression over a 12-month period.

To harness the full power of treatment as prevention, health care providers, public health officials, and other partners must collaborate to ensure that all people with HIV receive a diagnosis and have the information, care, and services they need after diagnosis to maintain viral suppression, stay healthy, and protect their partners. CDC is committed to working with you to communicate the importance of viral suppression, increase the proportion of people with HIV who are in care, and remove barriers to treatment adherence.

We must also continue facilitating access to other tools that can empower people to protect their health and prevent transmission of HIV and other sexually transmitted diseases (STDs). For people who are HIV-negative but at very high risk for getting HIV, PrEP is highly effective for preventing HIV if taken as prescribed. A recent CDC analysis suggests that more than 800,000 gay and bisexual men could potentially benefit from PrEP. Condoms also remain an important and effective option for preventing HIV as well as other STDs.

Some of CDC’s activities to reduce new HIV infections, increase testing, and increase viral suppression among gay and bisexual men include:

• Funding state and local health departments to support HIV surveillance and prevention programs across the United States, as well as interventions that reach the populations most affected by HIV.
• Supporting projects to identify promising prevention and treatment strategies for gay and bisexual men of color, such as Project PrIDE (PrEP, Implementation, Data to Care, and Evaluation), which is helping health departments implement PrEP for HIV prevention and Data to Care demonstration projects to expand retention and reengagement in HIV care.
• Communicating the benefits and challenges of HIV treatment as prevention, working with federal and other partners to ensure that messages accurately convey the science, and conducting message testing to find the most effective ways to communicate about treatment as prevention with a variety of audiences.
• Providing gay and bisexual men with HIV prevention and treatment messages through Act Against AIDS. For example, Doing It, which encourages all adults to get tested for HIV, includes many resources for gay and bisexual men; Start Talking. Stop HIV. helps gay and bisexual men communicate about HIV prevention; and HIV Treatment Works provides resources to help people live well with HIV.

This awareness day is an opportunity to thank you for your many contributions to HIV testing, treatment, prevention, and support efforts for gay and bisexual men. Every day your work is helping change the conversation about HIV and making it possible to envision a future free of new HIV infections. We look forward to working with you to maximize the potential of treatment as prevention for gay and bisexual men, help all gay and bisexual men with HIV stay healthy, and expand other prevention options that give gay and bisexual men the tools to take control of their health.

Sincerely,

/Eugene McCray/ 

Eugene McCray, MD
Director
Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
www.cdc.gov/hiv

/Jonathan Mermin/

Jonathan H. Mermin, MD, MPH
Rear Admiral and Assistant Surgeon General, USPHS
Director
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
www.cdc.gov/nchhstp