Essay: Don't let up in fight to end the HIV epidemic by 2020

December 1 is World AIDS Day. Since 1989, this United Nations observance remembers people who have died of AIDS. More recently, we have begun to look ahead to a world without AIDS.

New York State leads the way with our initiative to End the HIV Epidemic by 2020 (EtE2020). EtE2020 is designed to increase HIV testing, link HIV-positive people to health care, and retain them in care so that virus levels remain below the level for sexual transmission to others.

Modern era treatment follows the science with the end game of getting to zero. HIV care today advances the science to get ahead of the epidemic and stop HIV transmission. Another game changer is a one pill a day regimen to prevent infection in HIV-negative people at risk (pre-exposure prevention; PrEP).

Identification of HIV infection earlier, and treatment as soon as possible after diagnosis is a new treatment strategy aligned with EtE2020. Unheard of two years ago, this is becoming the standard of care worldwide.

With Rapid Start Treatment, patients have a more stable course of HIV infection, do not progress to AIDS, and do not transmit HIV sexually; a win for both public health and the patient. Up next with Rapid Start is to identify and treat people before the HIV test becomes positive, perhaps preventing infection altogether; one patient at a time.

With 35 years of sound public health policy, and investments of time, human capital and money, we have made monumental strides in treatment and prevention. Streamlined care with earlier diagnosis, rapid HIV testing with results in 20 minutes, and better, more effective drugs have begun to show results.

From 2000-2016, new HIV infections in New York State decreased 80 percent and deaths decreased 50 percent; the most significant decrease in new infections since the beginning of the epidemic.

Still, the road to 2020 and after has roadblocks. Unexpectedly, the White House Office of AIDS Policy closed in January 2017. This void in national leadership, uncertain funding, lack of information and uneven access to care fuel the epidemic in all populations, especially in hard-to-reach young people ages 13-26.

Still, HIV care remains a high energy, high stakes game. The EtE 2020 call to action has put HIV back into the public consciousness. It has galvanized health care and service providers, patients, advocates, communities and public health authorities. If we don’t reach the 2020 target of fewer than 750 new infections statewide, we will come very close.

Regardless of the outcome, EtE2020 will be the most important public health initiative of the 21st century. At Trillium Health, we are proud to continue our leadership role in the effort.

End the Epidemic? Its time has come.

William Valenti, MD is co-founder and staff physician, Trillium Health, Rochester and serves on Governor Cuomo’s EtE 2020 Task Force. Recently, he published his memoir, AIDS: A Matter of Urgency.