Dallas County and Agencies Are Ramping Up Efforts to End the HIV Epidemic by 2030. Will It Be Possible?

Dallas County and other local governments are doubling down on their commitment to battle AIDS after declines in HIV infections have slowed in recent years. Dallas County Judge Clay Jenkins and mayors from Addison, Balch Springs, DeSoto, Grand Prairie and representatives of other local communities on Monday are expected to sign a declaration that sets the ambitious goal of ending the HIV epidemic by 2030. "When you look at where the cases are most prevalent, it's major metropolitan areas like ours," Jenkins said. "We have an epidemic right here in Dallas County, so this is just another step in moving us closer to ending the epidemic, another step in being more effective in what we do." By joining Fast-Track Cities, a global partnership of cities and other organizations, the local governments will become part of an alliance that adopts the United Nations' HIV/AIDS's 90-90-90 progress targets. The aim to get 90% of people with HIV diagnosed and 90% of diagnosed people on antiretroviral therapy to suppress the infection in 90% of diagnosed people. For Dallas County, that will mean expanded outreach programs designed to educate and involve people in the campaign against AIDS, especially in underserved communities such as the black gay community. The new efforts will be but one of many seeking to drive down HIV infections in Dallas by increasing access to health care and reducing the stigma of AIDS. Medicine has come a long way since AIDS was first recognized in the 1980s. When the HIV infection that leads to AIDS first became treatable in the late 1980s, Doctor Deborah Morris-Harris remembers patients had to take several medicines, many with negative side effects. "People were taking multiple doses, two to four times a day, you know, literally carrying around clocks or watches or some other mechanism for figuring out when to take your medicine," said Morris-Harris, Chief Medical Officer of the healthcare nonprofit Prism North Texas. Today, people can take one pill a day to suppress or prevent HIV infection. But the number of new HIV infections has remained relatively constant instead of decreasing sharply in recent years, and blacks and Latinos are overrepresented in new infections. Why are there new efforts?After years of dramatic declines in HIV infection cases, progress has stalled in the U.S. since 2013, according to the Centers for Disease Control. "We have about 40,000 new cases per year, and we haven't been able to drive that down," said Laura Cheever, associate administrator for the federal Health Resources and Service Administration's HIV/AIDS bureau. This slowed progress has also been the general trend in Dallas-Fort Worth, according to data from Texas Health and Human Services. In Dallas County, HIV cases jumped from 874 to 894 in 2014 before decreasing to 811 in 2018. Tarrant County saw a spike of 306 cases in 2016 and a slight decline to 276 last year. Philip Huang, Dallas County's medical director, said that's why the county decided to join the Fast-Track Cities partnership. The Fast-Track designation doesn't come with dedicated federal funding, but Dallas County does hope to benefit from the Trump administration's "Ending the HIV Epidemic" plan in 2020. The administration is seeking to funnel an additional $291 million to 48 targeted regions and counties, including Dallas and Tarrant counties, to help local governments to improve diagnosis, treatment and prevention. But Congress has to approve that funding. "We're really hoping for that money because otherwise, the plan won't be very helpful," Jenkins said. Increased funding would help the county to expand outreach staff and screenings in places among at-risk populations such as the homeless and those behind bars. By joining Fast-Track, the county and the cities also hope to improve coordination of efforts to provide housing, transportation and other services for those with HIV/AIDS. "We're getting partners at the table," said Huang. What will it take to end the epidemic? Health officials like Huang and Cheever are counting on anti-HIV drugs to reach the 90-90-90 goals. "We should be able to significantly decrease the number of new infections," Cheever said. "With what we have in HIV medication today, it's easier than ever before." If taken everyday, PrE P, or Pre-exposure prophylaxis, can prevent people who may be at risk of infection from getting infected. For people who may have been exposed to HIV, PEP, or Post-exposure prophylaxis, can prevent infection if it is taken within 72 hours. But Jalenzski Brown, a prevention specialist at the Resource Center, which offers HIV/AIDS and many other services for the LBTQ community, warns that these drugs won't be enough to completely stop all infections."I think most of the hope to ending the epidemic is that, you know, we have biomedical tools available," he said. "But if you don't have community support, or community level interventions to support people getting these things, then they become worthless tools."   Continue reading...