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MIDWEST LGBTQ HEALTH SYMPOSIUM Symposium addresses HIV treatment, prevention and elimination
by Matt Simonette

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Delivering the kickoff speech at Howard Brown Health's 2017 Midwest LGBTQ Health Symposium on Oct. 7, Richard Elion, clinical professor of medicine at George Washington University School of Medicine, said, "There has never been a time when it's been more important to make progress as a society."

Elion—a prominent advocate for HIV/AIDS prevention and treatment in Washington, D.C.—was speaking about the decline in the overall number of new HIV infections there.

"We've now gotten to the point where new cases are just under 450 [new infections]," he said. That's a trend mirrored in a number of American cities, Chicago among them. Overall infection rates have been declining, but new infections remain on plateaus or on the rise within particular demographics.

Chicago recently launched a citywide program aimed at curtailing infections by the year 2027. But any city doing that needs to address how, what and to whom it communicates about HIV/AIDS, Elion said. He called such strategies "a good example of science influencing pubic policy," especially strategies stressing the important of Treatment as Prevention interventions, or TasP, and pre-exposure prophylaxis, or PrEP.

"Testing is not the way to get out of the epidemic," he added, noting that some individuals do infect others even when they know their HIV status. Rather, advocates need to also aggressively promote how individuals can have resources to protect themselves against infection, or begin prompt treatment should they be diagnosed with HIV.

In a different session, John Schneider, M.D., who now heads Howard Brown's new 55th Street location and has been active in HIV/AIDS healthcare delivery on the South Side for some time, spoke further about the possibility of total elimination of transmission events nationwide, which he said would be possible by the year 2041 "if we invest at current levels, provided there is no public health collapse."

Schneider added, "We have the tools we need; we just have to utilize them."

He gave smallpox and polio as examples of diseases that were effectively eliminated. "I'm not saying it will be 'zero' [new HIV cases]," he said. "There will be outbreaks of 50-100 people. ... But that's much better than this sledgehammer every year where we get these numbers of people."

Maya Green, MD, who heads Howard Brown's 63rd Street clinic, and Jim Pickett of AIDS Foundation of Chicago addressed how providers, advocates and officials can discuss PrEP to emphasize that the intervention can enhance sexual pleasure, not just be a clinical tool.

"We have to talk about it in a way, that asks, "How can you have yummy sex the rest of your life?" Green said, emphasizing that such rhetoric needs buy-in from all stakeholders in HIV treatment and prevention.

"We need to all have the same language," Green said. "It does no good if it turns a person off. There's no way they're going took want to come in and see me."

Green and Pickett emphasized that one useful adaptation might be a switch from referring to HIV "screening" rather than HIV "testing." Providers, they noted, usually refer to "screening" for other chronic conditions, such as heart disease or diabetes.

"We have to look at our own stigma," Green said.

Pickett spoke at length about the PrEP 4 Love advertising campaign that was launched in 2016, which attempted to deliver a sex-positive message about PrEP. Pickett said that the ads were intended to not invoke risk or judgement, or deliver a message about condoms.

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