World AIDS Day 2018: Updates from the CDC Center for Global Health

Cross-posted from Centers for Disease Control and Prevention

Dear Colleagues,

World AIDS Day is December 1. This year, the U.S. Government's theme, Saving Lives through American Leadership and Partnerships, celebrates that the world has made substantial progress toward ending HIV as a global health threat, thanks to the generosity of the American people and to our critical partnerships.

Today, we find ourselves at an urgent moment in the history of the HIV response. Global efforts to stop HIV through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the U.S. Centers for Disease Control and Prevention (CDC) – a key implementer of PEPFAR – have saved millions of lives worldwide. We have an opportunity to ensure that, in addition to improving and saving lives, countries that have been most affected achieve sustainable control of their HIV epidemics. If we do not use every tool available and control HIV in the near term, there is risk of global gains being undone.

The good news is that results from the CDC-supported Population-based HIV Impact AssessmentsExit Disclaimer (PHIAs) are providing an increasingly complete body of knowledge regarding HIV epidemics in countries and globally. Data from the PHIAs show that seven high-burden countries in Africa have made significant progress toward controlling their HIV epidemics. The findings also show places where more work remains and reveal key gaps in HIV case finding, treatment, and prevention. These surveys underscore the need to find undiagnosed people living with HIV, particularly men, adolescent girls, and young women. We must also redouble our efforts to find children living with HIV, link them to treatment, and ensure that adolescents on treatment are achieving viral suppression.

Finding undiagnosed HIV-positive men is more important than it has ever been before. Across countries with a high HIV burden, a higher proportion of men do not know their positive status compared to women. This matters because testing is the entry point to clinical care. If a person doesn't know his or her status, he or she won't begin treatment and achieve viral suppression, and HIV transmission will continue. CDC is using data to identify effective approaches for finding and linking undiagnosed HIV-positive men to treatment and reaching more HIV-negative men with prevention services. CDC has improved and targeted case-finding activities to offer HIV testing in the places men frequent and during hours that work with their schedules. CDC is also working in facilities and communities to provide male friendly services.

CDC is leading the way to address historical gaps in provision of life-saving tuberculosis (TB) preventive treatment [PDF, 342KB] among people living with HIV. Last year, fewer than one million people were receiving TB preventive treatment globally, and our goal is to increase that number to five million by 2020 with support from PEPFAR. We have seen in South Africa and Kenya that it is possible to rapidly scale up providing TB preventive treatment to people living with HIV. Working with national HIV programs to accelerate the rollout of TB preventive treatment will help us to address TB risk among people living with HIV. CDC's team of global TB experts has developed a toolkit to assist the countries with their TB preventive treatment implementation and scale-up.

As a key implementer of PEPFAR, CDC has played a leading role in helping to accelerate global progress towards controlling and eventually ending the HIV epidemic. CDC supports more than one-third of all people on treatment worldwide, including more than half of those whose treatment is supported by PEPFAR. CDC also brings an unequaled capacity to strengthen surveillance and laboratory systems, which are necessary to depict and measure the problem and to support the foundation of the HIV response from diagnosis to measuring viral suppression.

Over the past 15 years, we have seen significant reductions in HIV incidence in many countries. This progress means that we are on the cusp of a historic opportunity to control HIV without a vaccine or a cure. There is only a short time for us to achieve epidemic control, or we could see the tide turn towards an increase in cases if we don't find those living with HIV who have not been diagnosed and started on treatment. Without eliminating HIV, we will always need to have access to both diagnosis and treatment. On this World AIDS Day, CDC encourages the global community to redouble efforts to find the remaining people living with HIV who are not yet aware of their status, get them on treatment, and help them to become virally suppressed and stop transmission. We know what works because we've seen where it's working. Our challenge now is to bring that hard-won knowledge to bear in the places and among the populations still lagging behind so that on a World AIDS Day in the near future, we can speak of not just controlling but ending this epidemic.

Sincerely,

/Rebecca Martin/
Rebecca Martin, PhD
Director, Center for Global Health
Centers for Disease Control and Prevention
www.cdc.gov/globalhealth

/Hank Tomlinson/
Hank Tomlinson, PhD
Director, Division of Global HIV & TB
Center for Global Health
Centers for Disease Control and Prevention
www.cdc.gov/globalhivtb