Getting to Zero is an ambitious campaign underway in San Francisco to eliminate new HIV infections by 2020. The plan includes increased use of PrEP along with identifying HIV- positive people early and getting them into treatment.
Launched in 2013, Getting to Zero by 2020 would be a bold outcome after four decades of HIV/AIDS - especially as we face severe reductions in funding. San Francisco's comprehensive plan is bold but with a realistic approach.
Along with increased use of PrEP, other objectives include health literacy, tracking of HIV-associated stigma, and continued condom use. So far - so good. With one of the highest HIV-positive populations in the country, San Francisco is seeing a drop in new cases.
It's important to stay the course, especially given that we're facing major health concerns. Along with HIV, we're now also fighting Sexually Transmitted Infections (STIs).
PrEP, without a condom, may prevent HIV. However, only condoms will protect people from STIs. Even the makers of PrEP, Gilead, encourage condom use with their drug. And for good reason.
California, like many states across the country, is witnessing a spike in STIs. In fact, California's STI rate is the highest it's been in 25 years. That's not all. Health officials are alarmed about drug-resistant gonorrhea, which is more prevalent among gay and bi men. Left untreated, STIs cause serious medical issues including cancer. Some can't even be treated at all.
A recent eblast from National Minority AIDS Council (NMAC) leader Paul Kawata left me grasping for answers. The eblast was distributed to promote registration for the Biomedical HIV Prevention Summit.
Kawata wrote, "Our movement’s work is shifting from condoms to HIV Care…” and “The HIV community needs to own the challenge that PrEP may decrease condom usage and potentially increase STDs.”
Wait! Our work in the movement has always included HIV care AND condoms, along with many other tools. We are dealing with people’s health. This is not a multiple-choice test with only one correct answer Mr. Kawata.
Young adults 18 - 24-years-old and communities of color remain the groups most highly impacted by HIV and they're also at great risk for STIs. PrEP is expensive. Insurance in these populations is questionable. A 7-cent condom could be the best resource available.
PrEP is another important tool in the toolbox, but doesn't replace what's been working all of these decades - condoms, education, and prevention. San Francisco is a shining example. We can't afford to gamble with trading one public health crisis for another. It's not fair to anyone, especially our young people - a key community highly impacted by HIV.
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