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Press Briefing Transcript

CDC Telebriefing on Vital Signs Report: HIV Prevention Through Care and Treatment — United States

Tuesday, November 29, 2011 – 12:00pm ET

OPERATOR: Welcome and thank you for standing by. You're in a listen only mode. During the question and answer session, you may press star one to ask a question.  Today's conference is being recorded and you may begin, sir. 

TOM SKINNER: Thank you, Shirley, and thank you all for joining us today for this telebriefing on a Vital Signs report out of CDC on “HIV Prevention through Care and Treatment in the United States.” We're joined today with four speakers who will provide opening remarks and then we'll get to your Q&A.  We have the CDC director, Dr. Thomas Frieden. We have Drs. Kenneth Fenton and Jonathan Mermin, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention.  And we also have Mr. Kali Lindsey who is the director, Legislative and Public Affairs with the National Minority AIDS Council.  Dr. Frieden will begin with opening remarks and then we'll move to the other speakers and get to your Q&A. 

TOM FRIEDEN: Good afternoon, everyone.  Thank you very much for joining us.  The bottom line here is that we have the tools to stop HIV from spreading in an individual patient and we have the tools to greatly reduce its spread in communities. As we approach World AIDS Day two days from now, we reflect on some of the major advances in HIV prevention and treatment over the past year.  We know from our own CDC data release this year that new infections in the U.S. are stable overall.  And this was borne out globally with infections showing a plateau across the world. Perhaps the most encouraging new finding is the recent study showing that when people start HIV treatment early, when their immune systems are still relatively strong, they are 96 percent less likely to infect their partners. This is a very important finding because it shows that treatment for HIV can prevent the spread of HIV to others.  For too many years there has been sometimes friction between HIV treatment and HIV prevention.  And this study brings home that treatment is prevention, that treatment is essential to prevention.  However, the Vital Signs that we're releasing now shows that we have substantial work ahead to fully realize the potential benefit of treatment in the U.S. Nearly 1.2 million people in the U.S. are living with HIV and the data we're releasing today shows that only about a quarter of them, 28 percent, are taking medicine regularly and have their virus under control.  This means that for those 28 percent, the level of HIV is low enough for them to stay healthy and for them to drastically reduce the risk that they will spread HIV to others.  Unfortunately, it also means that about 850,000 Americans with HIV do not have the virus controlled. 

To increase the proportion of people with HIV who have their virus under control, there are several things that are essential. First is to increase the proportion of people who know their status.  Knowledge is power and Dr. Kevin Fenton will discuss this in a moment. And second, to make sure that people with HIV have every opportunity to remain in ongoing care after they're diagnosed. Only about half of those diagnosed with HIV are in regular care. And there are many missed opportunities even among those who are in care for prevention counseling.  For doctors, nurses, allied health workers to encourage people to reduce risky behaviors.  Ultimately increasing the proportion of Americans with HIV who have their virus under control requires all of us to be more accountable. Individuals can get an HIV test, learn their status and if they're positive, seek treatment, care and prevention counseling.  Health care professionals can offer HIV tests as a regular part of medical care, provide treatment, provide prevention counseling for those with HIV and work to keep people in HIV care and to ensure that their viral load is suppressed.  Health departments can fund programs and activities that support testing and linkage to care, educate people about the benefits of testing and regular care and treatment, and systemically track viral load in communities so that we can help work with communities to reduce the risk.  Not only for people in the health care systems, but even for people who are not well engaged in care. 

And government is doing many things.  Educating health care providers, funding more programs to support effective HIV prevention services, and Dr. Mermin will talk about these activities in a few moments.  But it will take all levels of government, federal, state and local to increase the number of people in care and treatment and to increase the number of people who are effectively treated to make a difference in this epidemic.  The bottom line is that we're in a time of new hope for stopping HIV and this week′s World AIDS Day is a time to acknowledge that.  The latest Vital Signs highlights the challenges we face in helping people with HIV learn their status, get into care and stay in care so that they are controlling the virus in their own bodies, in their own communities.  This is possible and that's why we think that it really is a message of hope that we do have tools, not only to stop the virus from spreading within a person's body, but to stop it from spreading within a community. And I'll now turn it over to Dr. Jonathan Mermin to talk about what CDC is doing to maximize prevention benefits of treatment and care. 

JONATHAN MERMIN: Thank you Dr. Frieden.  Despite the very important progress we've made in the 30 year fight against AIDS, the HIV crisis in America is far from over. Every year in the U.S., approximately 50,000 people become infected with HIV and more than 16,000 people with AIDS die. Today's Vital Signs shows that closing the gaps in testing, care and treatment will all be essential to slowing or reversing the U.S. HIV epidemic. Now that we have strong scientific evidence that treating people with HIV is among the most effective prevention strategies we have, it is time to act even more aggressively and I want to discuss a few of the actions CDC is taking to maximize the prevention benefits of treatment. 

First, in the new round of funding that CDC will soon be providing to state and local health departments, we will be requiring for the first time that health departments have in place a comprehensive prevention with positives program, including activities that link and retain HIV positive people in care, support the use of and adherence to antiretroviral therapy and provide risk reduction counseling.  Second, CDC is expanding programs that help HIV positive individuals consistently take their medication as prescribed. Third, while clinical trials have shown that effective treatment can greatly reduce a person's risk of transmitting HIV to others, we need to know more about the effects of expanding treatment on a population level.  CDC is collaborating with NIH and local health departments on a study in Washington, D.C. and the Bronx to do just that. The study is looking at the feasibility of testing as many people as possible in a community and immediately linking those who test positive to HIV care and treatment and providing support so that they take their HIV medicine regularly.  And we expect to have results from that study in 2013.  Fourth, CDC is conducting modeling studies to explore the potential impact of different components of the continuum of care on prevention in the U.S. epidemic so that we can maximize the prevention effects of our activities. 

These are only a few of the actions we're taking at CDC and we're working across government with our federal partners, who also lead efforts in treatment care programs for people with HIV in the country, to ensure we are all working together to maximize every step in the continuum of care and prevention services for people with HIV.  I want to make one final point.  While these approaches could have a substantial impact on the epidemic both in terms of prolonging life and preventing new infections, alone they won't end AIDS in the U.S.  Even if we significantly expand testing and were able to retain everyone with HIV care, there would still be a substantial amount of transmission that would occur in the earliest and most infectious stage of the disease before the vast majority of people know they're infected.  For that reason, we will continue to need to ensure that we are not only maximizing strategies for people with HIV, but also providing the most effective combination of proven behavioral and biomedical approaches for those who aren't infected, but are at highest risk of acquiring HIV.  That includes HIV testing, condom distribution and behavior change programs.  Thank you.  I'll now turn things over to Dr. Fenton. 

KEVIN FENTON: Thank you, Dr. Mermin. There is an important part of the equation that we haven′t yet discussed in depth and that is HIV testing. The reality is we can only achieve a full benefit of treatment as prevention if those who are infected with HIV know their status as soon as possible after infection.  So of course people need to get tested for HIV. The reality is that HIV testing is the gateway to effective treatment, care and prevention.  But today one in five Americans with HIV do not know they're HIV infected.  That's about a quarter of a million individuals.  Now, reaching these individuals is critical because the majority of new infections in the United States occur when people do not know they're infected and unknowingly transmit the virus to others.  So HIV testing has been at the core of CDC′s HIV prevention strategy and as many of you are aware, CDC now recommends that every American gets tested for HIV as part of routine medical care at least once.  And that those at high risk such as men who have sex with men get tested at least annually.  In fact, recent CDC data suggests that gay and bisexual men might even benefit from testing as often as every three to six months. 

But there are many reasons why individuals may not get tested for HIV.  Some may not think they're at risk.  Others may want to avoid the stigma of HIV testing. And some may fear learning that they're HIV positive.  And that's why part of our HIV testing efforts include awareness and education campaigns.  So today CDC is launching a new campaign called “Testing Makes us Stronger”. This campaign is designed to increase HIV testing among black gay and bisexual men, one of the populations hardest hit by HIV in the United States.  It is the latest initiative of “Act Against AIDS” which is CDC's broader communications campaign to fight complacency about HIV nationwide.  The need for this new campaign could not be clearer.  Black men who have sex with men account for nearly a quarter or 22 percent of all new HIV infections in the United States.  And young black men who have sex with men are the only group in the United States who are currently experiencing an increase in new HIV infections.  In addition, a recent 21 city study of gay and bisexual men in the United States found that nearly two–thirds of black men who have sex with men who have HIV did not know they were infected. 

Now, “Testing Makes us Stronger” encourages black gay and bisexual men to take a stand against HIV by getting tested regularly.  It communicates empowering messages that emphasize HIV testing as a source of strength and not a reason for fear. The campaign ads themselves draw on the diversity of the black gay community by featuring images of a wide range of black gay men.  You should already have received samples of the campaign, but if you haven't, our media office can send them to you after this briefing.  The new campaign will reach black gay and bisexual men in their everyday lives through national and online ads which are now running, through Facebook, Twitter and blogs, and coming in 2012, transit and billboard ads in six hard hit U.S. cities.  Also in the coming year, the campaign will be featured in black pride events in 15 cities across the country.  The campaign was designed by black gay men, for black gay men. About 400 people gave input to CDC as we designed this campaign through focus groups and surveys.  And an expert panel of black gay and bisexual men worked closely with CDC to develop the campaign messages and/or strategy.  Now, while this campaign is just one part of the solution, we're very excited about the role we hope it will play in communicating to black gay and bisexual men that HIV testing makes them safer, wiser and stronger.  I'm very pleased that Kali Lindsey of the National Minority AIDS Council and one of the expert panelists who advised CDC on this campaign is with us today and I'd like to turn the call over to him. 

KALI LINDSEY: Thank you, Dr. Fenton.  It is a pleasure to talk about my experience as a community member helping to develop the “Testing Makes us Stronger” campaign today.  It WAs my own decision to agree to be tested for HIV that has given me the chance to remain healthy after being diagnosed with HIV in 2003.  That decision alone has not only helped me to improve my health, but also prevent further transmitting the virus to those that I love.  Far too many black gay and bisexual men, particularly young black gay and bisexual men continue to contract HIV each year.  Too many more may have HIV and remain unaware that they have the infection.  This is the challenge that i along with many of my fellow colleagues faced when developing this campaign.  If we are to reduce HIV transmission and the growing burden of HIV among black gay and bisexual men, it is critical that we enhance our efforts to reach men who may be unaware of their status and encourage them to get tested for HIV. However, we cannot just stop at testing young black gay men for HIV. 

CDC′s focused effort to improve linkages to and retention in health care are important steps toward addressing the necessary systems and environmental changes that will ensure that appropriate health care and treatment are received after diagnosis.  Changes to systems and social marketing campaigns cannot do the job alone.  Research advancements have also provided us with an important opportunity to change the hearts and minds of society and their approach to HIV.  It will take all of us to speak with our friends, family members and loved ones and encourage them to be tested for HIV and get the care and support they need to maintain their health and suppress their viral load. Finally we hope that this campaign will also have an impact on gay and HIV related stigma.  Far too often individuals from both within and outside of the gay community make individuals who may have been at risk for HIV or who might be living with HIV or AIDS feel isolated from the communities that they will need to rely on for love and support.  It will result in a more compassionate approach both at the governmental level and at the community level to reach out to people who need to be tested for HIV and bringing them in the care –– bringing them into the care and support systems that we know will achieve the results that we desire.  Thank you for your time to speak on today's call. 

TOM SKINNER: I think we're ready for questions and I'll remind our speakers to identify themselves prior to answering questions so that our callers know who is speaking.  So, Shirley, we're ready for questions, please. 

OPERATOR: Thank you.  At this time we're ready to begin the question and answer session.  If you would like to ask a question, please press star one and record your name clearly.  Again, press star one to ask a question and one moment for our first question.  First question comes from Mike Stobbe with Associated Press.  You may ask your question. 

MIKE STOBBE: Hi, thanks for taking it. You can all hear me?  Okay.  Thank you.  This is a follow–up question to Dr. Mermin.  Could you just repeat, you started to talk about some new initiatives including a new round of funding to states for –– did you call it comprehensive prevention with positives program?  Could you go over that one more time and when that's expected to start and also the second thing, too? 

TOM FRIEDEN: Yes, this is Dr. Frieden.  Before Dr. Mermin answers, I would just like to say that the program Dr. Mermin will describe is an example of how we at CDC are trying to ensure that every dollar we have for HIV is going to the place most needed, to the population where it can benefit the most, and for the programs that work the best.  And an example of what we at CDC are trying to do to ensure that we continue to make progress and accelerate our progress in HIV prevention in this country. I'm going to have to step off the call in a moment, but before Dr. Mermin answered this question, I just wanted to reiterate first my thanks to for you joining the call.  My thanks to our partners for the work on this very important effort, and that there is new hope for stopping HIV.  If you're an individual living with HIV, knowledge is power.  Knowing your status can make you stronger.  Knowing your status can help you prevent a number of serious health complications and help you feel better for longer. In addition, knowing your status and getting on treatment can help us turn the tide on HIV in this country.  So thank you very much for joining and Dr. Mermin. 

JONATHAN MERMIN: Thank you.  Thank you, Mike and colleagues for your question.  What I was referring to is the CDC's funding opportunity announcement for state and local health departments, which will start in January of 2012.  Over half of the resources that the Division of HIV/AIDS Prevention at CDC receives are given to state and local health departments for HIV prevention activities.  And this is the main way we do it through this funding announcement, which –– and this funding announcement is different from prior ones in that it requires that 75 percent of the funds are used for four specific activities.  And they include testing, comprehension prevention with positives as we discussed, policy, implementation and development, and condom distribution.  And then the 25 percent can be used for other proven effective prevention programs and activities.  We also have a component for innovative demonstration projects.  And for HIV testing.  So that's what we were referring to in the initial opening remarks was that we really are highlighting the importance of a comprehensive approach to care and prevention for people living with HIV and their partners. 

MIKE STOBBE: Can you just repeat– so there was no rule before that 75 percent had to be spent on those four specific activities, it was just more general in the past? 

JONATHAN MERMIN: Yes.  And we also –– that is correct.  And also we've highlighted that there's a focus on certain specific programs and interventions that have been proven to be effective. 

TOM SKINNER: Next question, Shirley. 

JONATHAN MERMIN: I'm sorry, one other thing, Mike.  We also are distributing the resources to be aligned with the epidemic themselves just as Dr. Frieden had mentioned so that the funding goes to the places to be aligned with the epidemic to the populations most affected by HIV and to affected programs. 

OPERATOR: Thank you.  Our next question comes from David Brown with "Washington Post."  You may ask your question. 

DAVID BROWN:  Yeah, hi, thanks a lot.  Two unrelated questions.  One actually goes to what Dr. Mermin was just talking about.  Can you tell us how much this round of funding is, how many millions, and also how much the new –– the “Testing Makes us Stronger” program cost to develop or what the price tag of that is?  And my other unrelated question is in the MMWR article, it mentioned that 89 percent of people in care were being prescribed antiretroviral therapy which strikes me as a very high percentage.  And I′m just wondering if it struck you as high, also, or if there′s any comments you want to make on that. 

JONATHAN MERMIN:  Sure, I can answer the first one and then also I think put some perspective on the second. Our health department funding announcement is at the current time $359 million annually. It's a five year announcement. It's obviously dependent on congressional appropriation of funds to CDC.  And then the “Testing Makes us Stronger” campaign, for that we've invested $2.4 million for creating ads, for the website and social media components and then we'll have additional resources for activities at black pride events next summer. In terms of the second question, you know, it's interesting the epidemic of HIV in the United States has been here for at least three decades. And because of that, well, in addition, the number of people living with HIV is growing every year.  So we estimate that there are about 1.2 million people living with HIV in the country and that's a 60 percent increase from 15 years ago. And the reason that's increasing is that the drugs work well and so people, who access medication at the current time when their CD4 counts are relatively high, above 350, are estimated to have a life expectancy of about 75 years.  So that the reduction in life expectancy from having HIV infection is only about 7 to 10 years depending on when you started your therapy and whether you're able to access the medication. So that reduction is similar to other chronic diseases and risk factors like tobacco smoking.  However –– so among people who are currently in care, a lot of them that started ART many years ago and so they are maintaining themselves on medication and that's why they are living and are receiving ongoing services.  For people who are not eligible for ART yet based on CD4 counts, those folks would have had to be infected relatively recently in the past few years and so because their CD4 counts are higher because we estimate there are only about 50,000 new infections every year, obviously considerably more than we would hope to have, but much less than the 1.2 million people who are currently alive, the vast majority of whom are taking antiretroviral therapy, so to have 89 percent of people in care taking ART is probably what one would expect. 

KEVIN FENTON: David, its Kevin Fenton, here and I just wanted to add, that as we're thinking about really changing the tide with HIV in the U.S., we're going to have to look at all aspects of this treatment and prevention and care cascade.  So, yes, it is encouraging that we have the type of portion of individuals who are on antiretroviral treatment, but the data suggests that again that the central proportion are not verily suppressed and there are many reasons to explain that.  So clearly we need to be looking at people that are in care, on treatment and showing that they're consistently accessing services, that they're engaged and supported to be adherent to their antiretroviral treatment and of course monitored, as well, to ensure they are virally suppressed. We also have to look at the other end of the cascade, doing a better job of squalling up HIV testing, linking people to care, and when they're in care and showing that providers are aware of the recommendations for earlier treatment and support for patients, and ensuring that more patients are able to access effective treatments, either through insurance, government supported programs or other mechanisms.  So we really need to look across the spectrum to address this issue of treatment as prevention in the United States. 

TOM SKINNER: Next question, Shirley. 

OPERATOR:  Thank you. Our next question comes from Anita Manning, with USA Today.  You may ask your question. 

ANITA MANNING:  Hi, thanks very much. I just had a couple of quick questions.  Dr. Fenton, you say again, you mentioned what percentage of black gay men are not aware of their status. I wonder if you can go over that, what percentage of black gay men are thought to be infected and what percentage are unaware of that status.  Thank you. 

KEVIN FENTON: Ok, well, thank you so much.  We are very concerned about the very troubling statistics of HIV among gay men in the United States.  And as you're aware, gay men have always borne the brunt of a U.S. HIV epidemic.  And over time, we're seeing an increasing concentration of HIV especially among men who have sex with men of color and specifically black gay men and Hispanic gay men. Now, black gay men account for about a quarter or 22 percent of all new infections that are current in the United States.  And in a study that we did in 21 cities across the U.S., nearly a third of black gay and bisexual men who were surveyed were HIV infected and that was more than twice the proportion of the level of HIV infections among white men who have sex with men.  So we see this very disproportionate burden of HIV among black gay and bisexual men. Now, the majority of black gay and bisexual men in the surveys did not know that they were HIV infected. The estimates from the survey suggest that nearly 60 percent of black gay men who were living with HIV did not yet know that they were HIV infected.  So, again, this really underscores the importance of a campaign such as “Testing Makes us Stronger” to ensure that we're getting the right messages out to gay men, especially black gay men, about the importance of testing, the importance of knowing their status, and availing themselves as new and effective treatments are available for HIV. 

TOM SKINNER: Anita, did you have a follow–up? 

OPERATOR: One moment, please.  Your line is open if you have a follow–up. 

ANITA MANNING: No, I don't have a follow–up. Thank you so much. 

TOM SKINNER: Okay. Thank you.  Next question, Shirley. 

OPERATOR:  Next question comes from Jon Cohen with “Science magazine”. You may ask your question. 

JON COHEN:  Hi, thanks for taking my question and for doing the conference. I'm curious whether CDC is considering doing things that are done in other countries to increase testing. And specifically I mean things like opt out which is done in countries with pregnant women, such as Botswana. Looking at testing days where there are massive campaigns to do testing on single days and also looking at ways to do acute infection testing, either using new third generation assays or pooled samples in a grand sort of scale up way especially in communities like black men who have sex with men where acute infection may actually as you suggest undermine any treatment as prevention campaign. 

KEVIN FENTON: Thank you. Again, let me just reiterate that HIV testing and opportunities to scale up HIV testing has been a main focus of our activities here at CDC.  I want to draw your attention to the fact that we have a national HIV testing day which really focuses the nation on the importance of HIV testing.  And really the focus for CDC to work with federal partners and the community to raise awareness of testing and as well as supporting local events throughout the country to mobilize communities around HIV testing.  Over the past five years, CDC has also been investing new resources to ensure that states and local health departments have additional resources to invest in novel as well as HIV testing approaches. This gives an added boost to our prevention efforts at the local level and ensures that state and local health departments, community organizations are able to do a lot their scaling of assays. Dr. Mermin will speak about some of our latest developments and initiatives related to continuing our efforts to scale up HIV testing in the U.S. 

JONATHAN MERMIN: So John, thank you very much for highlighting what we think is one of the most important tools we have for both prevention and treatment. Which is HIV testing. So first off, it's a major priority for CDC and in 2006, we issued guidelines for HIV screening in health care settings that recommend offering HIV testing to all people between the ages of 13 and 64. And also try to reduce some of the burdens that had delayed or not allowed the provision of HIV testing to patients in that setting. And we've had quite a lot of success with the campaign that we began alongside those guidelines, the expanded testing initiative.  In the first three years of the expanded testing initiative, 2.8 million Americans were tested for HIV and we helped 18,000 people learn that they had HIV who had not known that.  When we looked at the return on investment, that program helped over $1.2 billion in direct medical costs in the United States, and for every dollar that we at CDC invested, there was a return of a dollar and 95 cents to the nation and that includes the cost of treatment.  So testing not only works, but as you've highlighted, making it easier to access testing works very well for public health and for saving money.  In the United States, we do have an HIV Testing Day, it's June 27th, but we do encourage testing at all times throughout the year. We are working on a new algorithm for diagnosing HIV which will be more accurate and potentially easier to implement.  It does involve fourth generation HIV tests. We also are looking and expanding the use of rapid HIV tests.  And we have several studies that are ongoing looking at different ways that we can bring testing to people who don't normally access testing and then help those people who would benefit from more frequent testing get testing as often as they need it. 

KEVIN FENTON:  I think just one final perspective to share on this issue of testing. And also it's a clear priority to areas in CDC.  As we move forward, other federal agencies have been taking an expanded role in expanding HIV testing in the United States. So really looking at agencies such as SAMHSA, HRSA, CMS, other agencies who are investing more to ensure that patients who are in contact with their services are also getting tested, as well. We've been working with a range of partners including professional organizations, including communities across the country to ensure that we are raising the profile of HIV testing as an important intervention and showing that resources are used to do even more testing.  So although it's a clear area of focus for CDC, we can't do it alone and we really need to get a wider cross section of the nation, at the federal level, state and local levels, the private sector and the community to be engaged and to do more HIV testing. 

JON COHEN:  A quick follow–up.  I really would like you to address, if you could the opt–out idea for the population at large. Have you considered that, that rather than simply recommending that people do it, that it become an opt–out situation? 

JONATHAN MERMIN: I'm sorry, Jon, I didn't make it clear.  In 2006 in our guidelines, we specifically recommend opt–out testing. Other countries have actually followed our example and not only do we offer opt out testing for all pregnant women, but now for all patients between the ages of 13 and 64 in communities where HIV prevalence –– well, where the prevalence of undiagnosed infection in the patient population is 0.1 percent or greater. And, I should say that, all but two states Maine and Nebraska –– I′m sorry, Massachusetts and Nebraska do allow opt out HIV testing. And there's been quite a lot of success with this in that if you look at the continuum of care figure in the Vital Signs today, we do see that 80 percent of people in the United States with HIV do know that they are infected.  We still want to help the other 20 percent learn that they have HIV infections, but part of the reason, a high proportion of people with people in the U.S. do know they have HIV  because of both routine testing in opt out situations as well as targeting people at highest risk of infection.  And just to give some information about the change in policy, in 2006 when our guidelines first came out, only 24 states –– I′m sorry; only 36 states actually allowed opt out testing.  And now it's all but two. 

TOM SKINNER: Next question, Shirley. 

OPERATOR: Thank you. Our next question comes from Emma Hitt with Med scape. 

EMMA HITT: Thank you. Is there anything in particular that health care providers can do it to assist in spreading the word about the “Testing Makes us Stronger” program?  And also what would you have them communicate to patients about testing in general? 

KEVIN FENTON: Absolutely.  We're very excited about “Testing Makes us Stronger” because this is the first time that the federal government has had such a voice on both having a national campaign which focuses on promoting HIV testing and awareness among gay and bisexual men. And the first time we're specifically focusing these messages to black gay and bisexual men so we're very excited about this campaign. Clearly we'll be focusing on areas hardest across the United States and we'll begin in six jurisdictions and then over time to scale it nationally.  Within those jurisdictions and across the country, we're asking health care providers to ensure that they are offering patients an HIV test as a regular part of medical care.  And if they are managing gay and bisexual patients to ensure that they're encouraging those gay men to get tested as least once a year.  So that's just a key message for health care providers. In addition, because we know that STI′s can facilitate both the transmission of HIV as well as the acquisition of HIV, we're also encouraging health care providers to ensure that patients who may be at risk should be offering STD testing and treatment services. 

As you've heard from the discussion today, clearly treatment is prevention. So we believe that health care providers as a part of “Testing Makes us Stronger” will be –– have to take a much greater role in ensuring patients are educated about the benefits of A.R.T. and of course where possible to prescribe A.R.T. for patients with HIV to ensure that their patients are virally suppressed. And this is particularly important for black gay and bisexual men given the increasing incidence that we see in this population and of course the high background prevalence of HIV within the black community. So it is especially important for black gay men as well as for all gay men and everyone living with HIV that they're prescribed A.R.T.′s and maintained in care. So there are a range of things that providers can do. I think the final thing just to say is again HIV is a chronic life–long condition. It's not just about diagnosing the disease and linking people to care, but ensuring that those who are engaged in care receive the support throughout their lifetimes to maintain protective behaviors, to be educated about their disease and to ensure that the relationship between the provider and patient allows for the ongoing support. So we are also asking providers to ensure that they're able to provide prevention counseling to patients, referral to other prevention services as needed as well as ongoing education.  So there are a range of things that providers can do. 

EMMA HITT: Thank you very much. 

TOM SKINNER: Shirley, a few more questions. Our next question comes from Matthew Bajko with the Bay Area Reporter. 

MATTHEW BAJKO: I have two questions.  Do you feel that local health departments currently are paying enough attention to the viral loads in their own community and the second question I had is if you could maybe list a couple of programs you′d like to see health departments start that would be part of the comprehensive prevention for positives––

JONATHAN MERMIN: Could you repeat the first question, do health departments appreciate the importance of ––

MATTHEW BAJKO: Are they paying enough attention to the current viral loads in their community? 

JONATHAN MERMIN: I think for HIV clinicians, there's an excellent understanding of the importance of suppressing HIV viral load in their patients. They know that having a fully suppressed viral load is the way to give their patients the chance to live the longest, healthiest life possible. I think there may be up until a few months ago less of an appreciation for the profound prevention effects of suppressing virus because up until that one randomized trial, it had been only co–work studies that indicated that taking antiretroviral therapy reduced your transmission risk.  Now we can be confident that it reduces the chance of spreading HIV during sex by over 95 percent, I think it raises for clinicians the importance of ensuring that all of their patients who are taking A.R.T. have suppressed virus both for their own health and for the health of their loved ones and sexual partners.  What is an important issue for local health departments is that providers only know about the patients that are currently under their care. But there are many people with HIV who are linked to care after their diagnosis, but then drop out for a variety of reasons. And it's important for us to be able to set structures and programs that would encourage both health departments and providers to re–engage people with HIV and to care and that can involve access to a lot of other services such as substance abuse services, mental health services, housing, and other kind of social support services that can maximize the potential for these patients to actually access A.R.T. and to be taking it effectively. 

TOM SKINNER: Shirley, we'll take one more question, please. 

OPERATOR: Thank you.  Next question comes from Michael Lavers with Edge Media Network.  You may ask your question.

MICHAEL LAVERS: Thank you for having this call. Just a quick question about the Vital Signs statistics in general.  Have those been broken down further along racial lines, and if so, what are the findings and as a follow–up to that question, what do they indicate about any potential barriers to post–infection treatment among those groups that might be disproportionately affected? 

JONATHAN MERMIN: Thank you for the question. If you have a chance, in the table of Vital Signs on page four, we do have a breakdown for at least three different categories by age, race and ethnicity and sex. And so you'll be able to look at the proportion of people among those categories who were prescribed A.R.T. whose most recent viral load indicated a suppression. And then of those who received prevention counseling by their health care provider. So there is some information that indicates that there's a variance, for example, in terms of suppressed virus among those prescribed A.R.T., for black or African–American people with HIV, only 70 percent had suppressed virus. But 84 percent of white Americans with HIV and 79 percent of Hispanics or Latinos. So there are differences. The cause of those differences is not completely known. We do know that there are a lot of challenges even among those prescribed A.R.T. to actually be able to access ongoing services, including issues like access to health care insurance, transportation to the clinic, migration and other factors that can really influence whether people can access this life saving medication. But we are looking more in–depth into the data to see if we can you ever you can factors that can be changed so we can increase for all people, regardless of race and ethnicity, the proportion of people who are both accessing A.R.T. and have achieved viral suppression. 

TOM SKINNER: Thank you all for joining us today. If you have any follow–up questions on HIV or particular questions about this Vital Signs on HIV, please call our public affairs office in the HIV/AIDS center at 404–639–8895.  This concludes our call and thanks once again for joining us. 

OPERATOR: Thank you and this does include today's conference.  We thank you for your participation.  At this time you may disconnect your lines. 

###
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