This ETE Dashboard Blog post comes from guest blogger, Demetre C. Daskalakis, MD, MPH, the Deputy Commissioner of the Division of Disease Control at the New York City Department of Health and Mental Hygiene.
In the summer of 2016, I signed on to Prevention Access Campaign (PAC)’s “Undetectable = Untransmittable,” or “U = U” Consensus Statement, making New York City the first jurisdiction in the United States to join the “U = U” campaign. At the time, the statement – that people with HIV who are on antiretroviral treatment and have an undetectable viral load do not transmit HIV sexually – was not the party line for public health leaders in the United States. With the support of our forward-thinking leadership, including NYC Health Commissioner Dr. Mary T. Bassett and Mayor Bill de Blasio, we began the process of reframing New York City’s response to the local epidemic to reflect the finding that viral suppression effectively eliminates transmission.
In 2016, we developed the NYC HIV Status Neutral Prevention and Treatment Cycle to highlight several key messages not included in the traditional HIV care continuum. This new paradigm outlines the steps that can lead to an undetectable viral load and the steps for effective HIV prevention, such as taking PrEP and using condoms. HIV care does not end with the first undetectable viral load. High quality, culturally affirming care empowers New Yorkers with HIV to get treatment and stay engaged in care. Similarly, high quality prevention and harm reduction services for people at risk of HIV exposure help keep them HIV negative. Underlying all of our HIV prevention, care, and treatment programming and services is the evidence-based understanding that people at risk of HIV exposure taking daily PrEP and people with HIV with sustained viral load suppression do not acquire or transmit HIV. Ending the duality of status reflects the cutting edge where science and public health intersect. We serve people, not their HIV status.
It did not take long for other public health authorities to follow our lead. In September 2017, the Centers for Disease Control and Prevention (CDC) announced that there is effectively no risk of an HIV-positive person with an undetectable viral load sexually transmitting the virus to an HIV-negative partner, and the New York State Department of Health issued a statement endorsing “U = U.” New York City and New York State join more than 600 research, community-based, and activist organizations from 75 countries that have signed on to share the “U = U” message.
NYC Health Department’s Bureau of HIV/AIDS Prevention and Control has initiated a comprehensive review of its efforts – including staff training, provider communications, program planning, policy advocacy, social marketing, and HIV surveillance and field services – to ensure alignment with “U = U.” To coincide with World AIDS Day 2017, we released a Dear Colleague Letter and additional online resources for providers and for the public to get the word out that people with HIV who maintain an undetectable viral load do not transmit HIV to their sexual partners. It is critical that national, state, and local guidelines be reviewed to reflect the data showing that “U = U.”
And we’re seeing results. Data from the ETE Dashboard and our HIV Surveillance Annual Report for 2016 show that more and more New Yorkers with HIV are being linked to care, staying healthy, and becoming virally suppressed. In 2016, 84% of HIV-positive people receiving HIV medical care in New York City were virally suppressed, up from 70% in 2011 when we began tracking these data. Promoting “U = U” as an evidence-based public health intervention is key to dismantling stigma and connecting New Yorkers to the prevention and care services to which they are entitled.
New York City is proud to be the first jurisdiction in the United States to have joined the “U = U” movement, and even prouder that health departments across the country are following suit. We will continue to promote “U = U” as an important tool in the sexual health toolkit, alongside condoms, PrEP, and PEP because the science is clear: “Undetectable = Untransmittable.”
Demetre C. Daskalakis, MD, MPH
Division of Disease Control