CDC in Houston Monday touting plan to end HIV
Todd Ackerman July 15, 2019 Updated: July 16, 2019 4:02 p.m.
1of12A view of some of the materials that have been handed out across the country dealing with PrEP, a medication for people who are at high risk for contracting HIV.Photo: Albany Times Union
2of12Truvada is an HIV treatment pill used to prevent infection in people at high risk of getting the AIDS virus.Photo: Jeff Chiu, STF / Associated Press
3of12Executive Director of Harris County Public Health, Dr. Umair Shah speaks to CDC Director Robert Redfield about the area's HIV problem during a meeting, Monday, July 15, 2019, at Texas Southern University. This is part of the federal government's ambitious initiative to end the epidemic. The meeting marks the launch of the initiative, first touted by President Trump in March, seeking to dramatically cut the rate of new infections by better deploying preventative drugs. The focus is on 48 hotspots - Harris County is one -- where half of new infections occur.Photo: Karen Warren, Houston Chronicle / Staff photographer
4of12CDC Director Robert Redfield speaks to local officials about the area's HIV problem during a meeting, Monday, July 15, 2019, at Texas Southern University. This is part of the federal government's ambitious initiative to end the epidemic. The meeting marks the launch of the initiative, first touted by President Trump in March, seeking to dramatically cut the rate of new infections by better deploying preventative drugs. The focus is on 48 hotspots - Harris County is one -- where half of new infections occur.Photo: Karen Warren, Houston Chronicle / Staff photographer
7of12CDC Director Robert Redfield along with Franaldo Curl, Harris County Public Health's HIV Prevention Coordinator, board Harris County Public Health's mobile HIV testing unit after a meeting with local officials, Monday, July 15, 2019, at Texas Southern University. This is part of the federal government's ambitious initiative to end the epidemic. The meeting marks the launch of the initiative, first touted by President Trump in March, seeking to dramatically cut the rate of new infections by better deploying preventative drugs. The focus is on 48 hotspots - Harris County is one -- where half of new infections occur.Photo: Karen Warren, Houston Chronicle / Staff photographer
8of12CDC Director Robert Redfield, left, chats with Dr. Umair Shah on board the Harris County Public Health's mobile HIV testing unit after a meeting with local officials, Monday, July 15, 2019, at Texas Southern University. This is part of the federal government's ambitious initiative to end the epidemic. The meeting marks the launch of the initiative, first touted by President Trump in March, seeking to dramatically cut the rate of new infections by better deploying preventative drugs. The focus is on 48 hotspots - Harris County is one -- where half of new infections occur.Photo: Karen Warren, Houston Chronicle / Staff photographer
9of12CDC Director Robert Redfield speaks to Franaldo Curl, Harris County Public Health's HIV Prevention Coordinator, at their mobile HIV testing unit after a meeting with local officials, Monday, July 15, 2019, at Texas Southern University. This is part of the federal government's ambitious initiative to end the epidemic. The meeting marks the launch of the initiative, first touted by President Trump in March, seeking to dramatically cut the rate of new infections by better deploying preventative drugs. The focus is on 48 hotspots - Harris County is one -- where half of new infections occur.Photo: Karen Warren, Houston Chronicle / Staff photographer
10of12CDC Director Robert Redfield speaks to Franaldo Curl, Harris County Public Health's HIV Prevention Coordinator, at their mobile HIV testing unit after a meeting with local officials, Monday, July 15, 2019, at Texas Southern University. This is part of the federal government's ambitious initiative to end the epidemic. The meeting marks the launch of the initiative, first touted by President Trump in March, seeking to dramatically cut the rate of new infections by better deploying preventative drugs. The focus is on 48 hotspots - Harris County is one -- where half of new infections occur.Photo: Karen Warren, Houston Chronicle / Staff photographer
12of12HIV, the virus that causes AIDS, is still out there spreading and now most affecting blacks and Hispanics.Photo: Houston Chronicle
Top federal health officials Monday brought the Trump Administration's ambitious initiative to end the HIV epidemic to Houston, home to one of the nation's highest rates of new diagnoses.
The initiative, announced in President Donald Trump's State of the Union address in February, seeks to dramatically cut the rate of new infections by better deploying drugs that stop the transmission of the virus that causes AIDS. The focus is on 50 "hot spots" — 48 counties, Washington, D.C., and San Juan — where half of new infections occur.
"This is a once in a generation opportunity to use tools science has spent decades developing," said Dr. Robert Redfield, director of the Centers for Disease Control and Prevention. "We've had these tools to end the epidemic in our back pocket for a decade. Now it's time to put them into action."
Redfield met at Texas Southern University Monday with local health officials and groups that serve populations living with HIV or at high risk of acquiring the infection. The meeting was one of many the CDC has been holding in the hot spots — Harris County is one — touting the plan and listening to ideas on the best strategies for the community.
Redfield told meeting participants that the initiative can cut the rate of new infections by about 90 percent in 10 years — from about 40,000 a year nationally to about 4,000. Trump has called for $290 million for the program's first year in the 2020 budget.
The initiative entails a two-pronged attack: get all Americans living with HIV on the triple-medication drug cocktail that lowers the viral load to a level where it is not transmitted during sex; and all those at high risk of infection on an expensive daily pill, known as PrEP, that makes it impossible to get HIV.
HIV experts consider the plan medically sound, but add that it represents a big challenge because it requires getting people into care currently not being reached, either because they don't know they have the virus, lack access or don't seek it, typically because of the stigma associated with the disease.
In the 1980s and '90s, the infection was diagnosed most often in whites, but it is now seen most often in minorities. In 2018 in Harris County, for instance, 48 percent of new diagnoses were in blacks and 35 percent were in Hispanics.
Currently, more than 26,000 people in Harris County have HIV. The county's 1,200 new cases annually are the most in Texas and Houston has the nation's eighth highest rate of new infections.
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Stephen Williams, director of the Houston health department, said he felt challenged by statistics mentioned at the meeting showing previously launched efforts in Baltimore and Washington have reduced the number of new diagnoses in those cities annually by 75 percent and 50 percent, respectively.
"Those cities have a lot of problems," said Williams. "We need to look at what happened there and determine how we can replicate their improvement."
AIDS peaked in the United States in the mid-1990s, when it was annually diagnosed in more than 75,000 people and claimed more than 50,000 lives. In the ensuing years, drug cocktails made it a chronic disease.
But the infection continues to be transmitted and the South has become the new epicenter. The region accounts for more than half of new infections and nearly half of deaths. All of the 10 metropolitan areas with the highest rates of new HIV diagnoses are in southern states.
Not many people at high risk of acquiring HIV are on PrEP.
"We're getting PrEP into about 10 percent of people who need it," said Dr. Charlene Flash, a Baylor College of Medicine professor of infectious disease and associate chief medical officer at Legacy Community Health.
Trump's plan to stop the epidemic has been welcomed by groups that work with HIV, though many have complained that other proposed actions by the administration — such as cuts to Medicaid and the Housing Opportunities for People with AIDS program — could undermine the effort.
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Others have questioned whether there will be enough money going forward to fund a program that experts estimate could add as much as $25 million more a year to the amount the federal government already spends on HIV prevention and treatment.
But Redfield and Dr. Brett Giroir, assistant secretary for Health and Health Human Services, said they are "100 percent confident we will have the resources to do this."
They said funding for the initiative will go up in subsequent years as more people are diagnosed and on drug regimens. They also noted the initiative will benefit from the deal by which Gilead Sciences has agreed to donate enough of PrEP to supply 200,000 patients annually for up to 11 years. The pill, which goes by the brand name of Truvada, has a list price of $20,000 per patient each year.
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Redfield and Giroir noted that Trump's request for $290 million for the initiative was made before the government struck the deal with Gilead. They stressed that the funding now can be used for other aspects of the program.
"I want to end by saying this is not just an aspirational goal, it is a pragmatic goal," Redfield said at the meeting's close. "We have every intention of bringing it home."
Besides Harris County, other counties in Texas being targeted under the initiative are Bexar, Dallas, Tarrant and Travis.
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Todd Ackerman
Todd Ackerman is a veteran reporter who has covered medicine for the Houston Chronicle since 2001. A graduate of the University of California at Los Angeles, he previously worked for the Raleigh News & Observer, the National Catholic Register, the Los Angeles Downtown News and the San Clemente Sun-Post.
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