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Point of View: Ending the HIV epidemic in Oklahoma

Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, visited Oklahoma City on Tuesday, March 26, 2019.  Photo by Jim Beckel, The Oklahoman.
Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, visited Oklahoma City on Tuesday, March 26, 2019. Photo by Jim Beckel, The Oklahoman.

An unprecedented opportunity lies before us — one that brings a once impossible goal within reach — to end the HIV epidemic in Oklahoma and across the United States.

Last month, President Trump announced an ambitious and historic plan to end the HIV epidemic and prevent new cases of HIV in America. The president’s FY 2020 budget request to Congress proposed $291 million in new funding to begin this multi-year initiative. This goal is now possible due to critical scientific advances in HIV prevention, diagnosis, treatment and care. The path to success runs through Oklahoma.

The proposed initiative to end the HIV epidemic, which has drawn bipartisan support from lawmakers including Rep. Tom Cole of Oklahoma, calls for infusing the nation’s hardest-hit communities with the additional expertise, technology and resources needed to address the HIV epidemic in their communities. Oklahoma is one of the seven states that would receive support to address a disproportionately heavy HIV burden in rural areas, with an additional focus on tribal communities impacted by the epidemic.

HIV has cost our nation too much for too long, including 700,000 American lives lost since 1981. We are at risk of another 400,000 Americans acquiring HIV over the next decade if we don’t act now. In Oklahoma, 7,000 people are living with HIV — and about 1 in 7 are not aware of their infection. In addition, about 1,450 lives in Oklahoma have been lost to HIV since the late 1990s. We have the tools that we need to end this epidemic and we must apply them.

As we met with public health leaders and stakeholders in Oklahoma this week, we were optimistic that, working together, we will be successful. Efforts would focus on four key strategies to meet Oklahoma’s needs, as well as the needs of other states and in communities where the most HIV diagnoses occur:

• Diagnose HIV as early as possible after infection. Early detection is critical and can lead to quicker treatment results while preventing transmission to others.

• Treat those with HIV rapidly and effectively to achieve sustained viral suppression.

• Protect people at risk for HIV using proven, comprehensive prevention approaches and treatments like pre-exposure prophylaxis (PrEP), a daily pill to prevent HIV.

• Respond rapidly to growing HIV clusters to stop new infections. New laboratory and statistical methods allow us to identify and respond to new clusters of HIV in their earliest stages, helping to stop HIV from spreading.

To accomplish this, CDC would accelerate work with state, tribal and local health departments, and most importantly the community. Funding for the initiative would be used to establish specialized teams, putting “boots-on-the-ground" to support expansion of local HIV prevention and treatment efforts. This effort would involve listening to Oklahomans and tribal citizens living with HIV and learn from their experiences so that we reach those in greatest need and ensure local progress. And CDC will continue work to combat the stigma that is still associated with HIV — because stigma is the enemy of public health.

The Indian Health Service is a crucial part of this proposed initiative. Efforts in Indian Country would build upon the success of pioneering programs such as the Cherokee Nations’ efforts to eliminate Hepatitis C, and the Phoenix Indian Medical Center HIV Center of Excellence, which has been recognized two years in a row by the Ryan White HIV/AIDS Program Quality Award for treating more than 90 percent of patients so successfully that their viral load is so low it can’t be detected or transmitted to others.

Ending new HIV infections will require commitment and focus. CDC’s latest data confirm that national progress reducing the number of new HIV infections has stalled in recent years. There are prevention and treatment gaps, particularly in rural areas and among disproportionately affected populations like African Americans, Latinos, and American Indians and Alaska Natives. In addition, the ongoing opioid crisis continues to threaten progress; nearly one in 10 new HIV infections occur among people who inject drugs.

As public health officials, we are honored to witness this moment in history, when science has provided the tools to advance treatment and prevention of HIV and we have a president bold and caring enough to commit the resources and the momentum to this initiative. We have always believed in seeing the possible, and we believe it is possible to end the HIV epidemic for the next generation, both in Oklahoma and across the U.S.

Embracing the possible, we will end the HIV epidemic together.

Redfield is director of the Centers for Disease Control and Prevention. Weahkee is principal deputy director of Indian Health Service.