ACT UP Protests CDC to Curb Transmission of HIV

On Monday, June 9, members of ACT UP NY, along with Treatment Action Group (TAG) and Atlanta allies, met with the Centers for Disease Control & Prevention (CDC)'s HIV prevention personnel in Atlanta. Via the newly created "Atlanta Principles," ACT UP called upon the CDC Director Dr. Tom Frieden to meet the commitment of keeping all Americans healthy and to act upon the promise of TasP, PrEP and PEP, address social and structural barriers to lifesaving prevention options, and reduce the transmission of HIV in those groups where the incidence is rising.

"Let me say this: In the U.S. we've seen 50,000 new HIV infections each year now for the last 10 years," said ACT UP's Annette Gaudino. "We also know that only a fraction of people with HIV are receiving treatment, and many don't even know their status. The CDC website says they are about saving lives, protecting people. We think it's time CDC make the full use of all the tools now available to fight HIV -- TasP, PrEP and PEP -- to do just that. The end of this epidemic won't come simply through a pill, but the status quo just isn't cutting it."

Up until recently, preventing sexual transmission of HIV meant one thing: condoms. Today, there are three additional, proven means of HIV prevention. People can avail themselves of Treatment as Prevention (TasP). Sustaining an undetectable viral load if you have HIV means you are highly unlikely to transmit the disease.

Truvada, a pill originally developed for the treatment of HIV, can now be taken once daily as Pre-Exposure Prophylaxis, or PrEP, to pharmaceutically prevent HIV in negative people at risk.

In addition, there is Post-Exposure Prophylaxis (PEP): Taking anti-HIV medications as soon as possible after exposure to HIV can reduce the chance of becoming HIV positive. To be effective, PEP must begin within 72 hours of exposure.

"The great thing about where we are is that we have amazing tools that we have never had before," said ACT UP New York's Terri Wilder. "But we're concerned because a lot of people don't know about them."

Wilder said that TasP was now the treatment touchstone, that PEP had been around for a long time in occupational settings to treat needlesticks, and that the Food and Drug Administration approved Truvada for PrEP in July 2012, but many people still don't know about these prevention methods.

"Where is the awareness campaign?" said Wilder. "Why am I on subway platforms in the epicenter of the epidemic in the U.S., and not seeing subway ads for this. Where are the public service announcements and bus stop ads? Why are we not hearing about this on the radio, or via ads popping up on Facebook? Why are there no campaigns tied with Pride festivals and other large gatherings where people who could be at risk of HIV could benefit from this?"

Wilder said that ACT UP was angry that health officials seemed to celebrate that HIV infections have stayed steady, rather than worrying that they hit 50,000 new infections per year.

This is why they returned to the CDC headquarters on Clifton Road in Atlanta on June 11 to leave a "postcard" in the form of a critical banner for the CDC's head honcho Frieden, taking him to task for dragging his feet on spreading the word about this new way to address HIV prevention, and for failing to educate health care providers on how to provide this medication in a non-judgmental manner.

"We are calling out Frieden because even when he was the NYC Health Commissioner, he had a poor record on HIV," said Wilder. "He does not seem to want to make HIV a priority. You never hear him talk about ways to end the HIV epidemic in the U.S. We target Frieden because he's silent, and he's a disappointment."

ACT UP said that without real leadership and promotion from U.S. public health officials, these prevention methods would remain underutilized. Without a concerted effort to address the HIV prevention needs of marginalized communities affected by high levels of homelessness, job insecurity, and HIV-related stigma, it will not be feasible or safe for individuals to access the resources they need to protect themselves.

ACT UP Creates "Atlanta Principles"

In a June 10 press conference, ACT UP publicly released their new manifesto for HIV treatment, which they had delivered to the CDC the day before. In honor of the groundbreaking "Denver Principles" created in 1983 by people with AIDS from around the country to articulate PWA self-empowerment and a human rights-based approach to addressing the epidemic, ACT UP NY, TAG and Atlanta allies have created the "Atlanta Principles," a series of proposed actions the CDC can take now to radically change and improve the way it currently conducts HIV prevention in the United States.

Among them are: sexually frank HIV prevention messaging and education, better promotion and availability of TasP, PrEP and PEP, revised testing guidelines for key populations, more sensitive HIV epidemiology, reform of the National HIV Behavioral Surveillance (NHBS), and ongoing partnership with HIV-affected communities.

Researchers from the Emory School of Public Health recently released an estimate that 12 percent of young black gay men in Atlanta become infected with HIV each year. In the cohort studied, a man who becomes sexually active at age 18 has a 60 percent chance of seroconverting by the time he's 30. The most recent figures on the wider epidemic from the CDC are almost as alarming. Over a two-year period new infections rose by about 12 percent among all men who have sex with men (MSM, a category that includes transgender women), and by 22 percent for young MSM. A gay man was thirty times likelier to become HIV-positive than a straight man.

Last month a prominent NIH researcher summarized long-term HIV incidence data to an audience at Columbia University: "Among MSM," he said, "new HIV infections are out of control."

The Atlanta Principles notes that while in the past, HIV prevention meant using condoms, today, there are options including PreP, Pep and Treatment as Prevention.

Now that this research has shown just how crucial TasP, PEP, and PrEP could be for lowering the number of new infections, this knowledge must be translated quickly into policies and programs that could help relieve our communities of the massive burden of disease into the foreseeable future.

Toward that end, ACT UP NY and their community allies are asking the CDC to change the way it conducts HIV prevention by incorporating the following:

Sexually Frank HIV Prevention Messaging

Treatment as Prevention (TasP)

Pharmaceutical Prophylaxes: PrEP and PEP

Funding New Prevention for High-Risk Populations

HIV Testing and Identifying Acute HIV Infection (Seroconversion Illness)

More Sensitive HIV Epidemiology

Reforming National HIV Behavioral Surveillance (NHBS)

Teaching Basic Sex Education

Allow the Lives of People with HIV to Inform Clinical Practice

Continue an Ongoing Partnership with HIV-Affected Communities

"We will only see a drop in the number of new HIV infections after we see significant gains in the numbers of people practicing all methods of HIV prevention. CDC must act now to curb and reduce the rising incidence of HIV transmission in highly impacted communities and ensure that other vulnerable subpopulations such as women and people who inject drugs do not see a rise in transmission," they wrote. "AIDS is not history until we make it history. ACT UP, FIGHT BACK, FIGHT AIDS!"