New Drug Focuses Attention On HIV Prevention

Following the FDA approval of Truvada — the once-a-day pill that can drastically lower a person's risk of contracting HIV — Audie Cornish talks with Dr. Wafaa El-Sadr of Columbia University's Mailman School of Public Health. They examine the status of HIV prevention efforts in the U.S. today — what progress has been made and the challenges that still ahead. El-Sadr has worked on HIV/AIDS prevention and treatment since 1981.

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AUDIE CORNISH, HOST:

As we mentioned, Truvada was approved in the U.S. yesterday, so it's too early to know for sure what it's impact will be on HIV prevention. For more on the state of prevention efforts in the U.S., we turn to Dr. Wafaa El-Sadr. She's at the Mailman School of Public Health at Columbia University where she heads up a program on HIV/AIDS prevention, care and treatment. Dr. El-Sadr, welcome to the program.

DR. WAFAA EL-SADR: Thank you.

CORNISH: Now, the rate of transmissions and the rate of new infections in the U.S. is way down from what it was in the 1980s, but it hasn't changed much in the last two decades. And can you give us some sense of why not?

EL-SADR: Unfortunately, we haven't been able to make a dent in the numbers of yearly infections and in particular this has been very disappointing because we do know that some things work for prevention and we do have some effective treatments for people living with HIV.

CORNISH: And just to give people some sense of scale, that number of new infections, I think it's hovering around 55,000 a year. Is that correct?

EL-SADR: It's about 55,000 a year. And looking forward, it would be important to be able to turn this around to set goals for ourselves as a country, to say that we're going to try very hard to aim for 50,000 next year and 40,000 the year after and 30,000 the year thereafter. So we need to pool all of our resources together and focus on getting there, turning this around.

CORNISH: What have been the biggest obstacles to reducing the rate of new infections, at this point?

EL-SADR: There are a couple of reasons. One is that, unfortunately, HIV is targeted and affected largely disenfranchised populations - men who have sex with men, minority populations in the United States. They're often poor, often have limited access to services and programs. The epidemic in the U.S. is complex because it's not a generalized epidemic. It's concentrated in specific populations and populations at very high risk.

And one of the challenges has been to take the biomedical advances that have been made over the past decades and try to incorporate them into appropriate programs.

CORNISH: So you're saying getting medications to a particular group, maybe, or access.

EL-SADR: And how they use it and to know that it's available even, and then to engage people for the long term.

CORNISH: Can you describe a particularly effective prevention program?

EL-SADR: There are examples from around the world where promotion of male condom use has turned the epidemic around. We do know that using clean needles and syringe exchange has also been quite effective. We also know from a very important ground-breaking study last year, that even treatment of people who, themselves, are HIV infected can prevent transmission to others. So this opens a whole new world of potential for really stemming the spread of HIV around the world, including in the United States.

CORNISH: As you said, you've worked in this field for a good 20 years now and I was wondering if there's a patient or a particular group of people you've worked with in the past that helped you understand the challenges when it comes to prevention.

EL-SADR: I think my work at Harlem Hospital for the past 25 years and in the Harlem community has really been very instructive and has helped me to gain a much deeper understanding of the complexity of HIV and where it fits in people's lives and families' lives and the community as a whole. And it's made me appreciate that tackling this epidemic is not about one single pill or one single method. It's about really understanding the lives of people, the lives of families, the lives of disenfranchised poor communities, so that we can actually make a dent in addressing the spread of HIV in our communities.

CORNISH: Dr. Wafaa El-Sadr is at the Mailman School of Public Health at Columbia University. Thank you so much for talking with us.

EL-SADR: Thank you. My pleasure.

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