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An Era of New Possibilities: HIV Prevention for Gay and Bisexual Men

CDC McCray_Eugene_2007_301_hiresWe have achieved some hard-won victories against HIV in recent years. New infections among women and injection drug users are declining, people with HIV are living longer, and more people than ever know their HIV status.  But one population — gay and bisexual men –is seeing infections rise, driven by increases among young gay men.

As I wrote last year, reducing new infections among gay and bisexual men, who bear the brunt of the new infections, is CDC’s top HIV prevention priority.  If we are to bring down new HIV infections from 50,000 per year, we must focus on the tools with the greatest potential to slow the spread of the HIV – including powerful new prevention approaches that weren’t on our radar just a few years ago.

To help meet this challenge, the Centers for Disease Control and Prevention (CDC) has announced new prevention initiatives up to $125 million to expand use of two potent but underutilized tools to slow the spread of HIV among gay and bisexual men, particularly men of color.  One is pre-exposure prophylaxis, or PrEP.  The other, called Data to Care, is a new way of using surveillance data to help people living with HIV stay in care, protect their health, and reduce the risk of transmission to others.  These two approaches reflect how CDC is reshaping its HIV prevention strategies in an era of new possibilities.

PrEP: A Powerful Prevention Tool

At its heart, CDC’s mission is prevention – helping people stay healthy and avoid illness.  For HIV, that means making sure that everyone at risk has access to the tools they need to protect themselves from infection.  PrEP – taking an antiretroviral pill daily – is one of those tools, and a powerful one. Studies have shown that daily PrEP can reduce the risk of HIV transmission by more than 90 percent when it is used as directed.

That’s why CDC is making an unprecedented investment in the implementation of PrEP.   CDC will fund up to 24 health departments in areas where gay and bisexual men are most affected, ensuring that health providers are informed about PrEP and know when and how to offer it. It is equally important that these funds be used to increase the number of gay and bisexual men and transgender people at high risk for HIV infection, particularly persons of color, who know about PrEP and its potential benefits.

Our goal is to make sure that everyone who is eligible for PrEP is offered it, and that everyone who needs it can find a knowledgeable PrEP provider in their community.

Tapping into Data to Transform Care

Data have always been at the center of CDC’s HIV prevention efforts.  Analysis of HIV surveillance data shows us who is most affected, where the most urgent needs are, what the impact is, and how to accomplish more.  And now, through Data to Care, we are using data to improve HIV outcomes on the individual level.

A recent CDC analysis showed that three out of every five new HIV infections can be attributed to people who have been diagnosed but are not in care.  Reaching these individuals represents a huge untapped opportunity to improve their health while reducing new infections.

Data to Care is designed to close this gap in the HIV care continuum by using surveillance data to identify and follow up with people living with HIV who are not receiving medical care.  This approach is already being used successfully in several health departments. For example, in Louisiana, an early pioneer of the approach, seven out of every ten people contacted were successfully linked to care. With CDC’s new funding commitment, Data to Care will be implemented in up to 12 state and local health departments enabling us to reach far more people in need of HIV care.

Data to Care is the perfect example of how innovative use of data can strengthen prevention efforts across the country.  At CDC, we’ll continue to challenge ourselves to think differently about data, to test new ideas, and to put our resources behind new approaches that reshape the trajectory of HIV in the United States.

Looking Ahead

I’m excited by the potential of these initiatives, and even more so by the type of thinking they represent – innovative and focused on maximum impact.  To drive down new HIV infections among gay and bisexual men, we must expand use of the most effective strategies and invest heavily where the potential impact is greatest. I believe strongly that if CDC and its partners continue to push ourselves in this direction, we can help end the HIV epidemic in the United States.

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