New York City’s strategy to end the HIV epidemic is firmly rooted in science, was developed in conjunction with community activists, and has support from top-level political leaders, Demetre Daskalakis told CROI 2017.
“When you combine political will, biological interventions and harm reduction, you can get to zero,” he said.
Dr Daskalakis is an unusual public health figure: an infectious disease physician who has delivered testing and vaccination in sex clubs and describes himself as a “queer health warrior”. He is now the deputy commissioner for disease control in the New York City Department of Health and is the architect of the city’s “ending the epidemic” initiative.
New York’s strategy places particular emphasis on identifying people with undiagnosed HIV and linking them to healthcare; retaining people in care to maximise virus suppression; and facilitating access to pre-exposure prophylaxis (PrEP). Mayor Bill de Blasio and Governor Andrew Cuomo have given political and budgetary support to the initiative, facilitating implementation by a range of government agencies.
The city’s sexually transmitted disease clinics are being transformed into ‘destination clinics’ that will provide efficient gateways that will link people to post-exposure prophylaxis (PEP), PrEP and HIV treatment. Same-day initiation for all these services is now offered, with social workers and benefits navigators dealing with insurance problems and underlying social issues. Contraception, HPV (human papillomavirus) vaccination, cervical and anal screening are all also offered.
The city has adopted what it calls an ‘HIV status neutral’ prevention and treatment cycle that places HIV testing at the beginning. People living with HIV need to be prescribed antiretroviral therapy and retained in high-quality care, which is understood to be an ongoing process.
The other half of the cycle pictures engagement with prevention for those who test HIV negative and are at risk of HIV. The individual remains engaged with high-quality sexual health services in an ongoing manner, which is understood to facilitate awareness and use of PrEP.
A ‘status neutral’ approach treats people taking HIV treatment and people taking PrEP in the same way, in the same services, thus reducing stigma, Daskalakis said.