World AIDS Day, December 1, 2017
CONNECTICUT GETTING TO ZERO INITIATIVE
Zero discrimination, Zero new cases and Zero deaths from AIDS in Connecticut
Connecticut launched the “Getting to Zero” initiative this summer with the aspirational goals of getting to zero discrimination, zero new cases, and zero deaths from AIDS. In recognition of World AIDS Day, the Yale School of Public Health asks some of its HIV/AIDS experts what’s one thing the state can do to meet these goals?
Yusuf
We should use research findings to guide investing in the social determinants e.g., housing, employment, neighborhood services that are potential antecedents to some of the behavioral and biomedical strategies that include HIV testing, PrEP access and linkage to HIV care.
Robert Heimer
The state needs to develop a more active surveillance system that can identify and squelch potential outbreaks in response to new case diagnoses in high-risk social group or geographic location. This will require modeling efforts to determine what constitutes high-risk social and geographic units and what number of sporadic diagnoses in a unit constitutes a threshold for immediate action.
Gregg
In order to get to zero, the state of Connecticut is going to have to invest financially in this goal, supporting HIV/AIDS programs, but also the kind of services that allow people to maintain their health, which includes substance-use treatment, needle exchange, housing and mental health care, for a start. Ending an epidemic doesn't come from slogans, it comes from spending what it takes to get the job done.
Paul
We need to target HIV screening programs more effectively for at-risk populations throughout the state and then immediately link all new cases to care providers to improve health outcomes and prevent further infections.
Elaine
Engaging local communities is key to achieving the goals of Getting to Zero. We need to reignite interest in HIV and focus where the epidemic is having the greatest impact. Gay men make up the largest number of people newly diagnosed with HIV in CT. Black and Latinx communities are disproportionately affected. And the epidemic is concentrated in our major cities. Retooling strategies with the active participation of communities and groups that are most impacted is what is needed to prevent new HIV infections, and reduce HIV-related illness and death in CT.
Daniel
We need to shift our thinking about HIV as an individual’s burden, resulting from “risky behavior,” and addressed through individual interventions (condom use, medication adherence, behavior change). Individual behaviors occur in context, such as existing high rates of HIV in minority communities (Black gay men, for example). It’s no coincidence that groups disproportionately impacted by HIV are socially and/or economically marginalized. To Get to Zero we need to address HIV prevention and care through systemic change, not just condoms and PrEP. This means access to quality health care and the means to pay for it, economic opportunity and education.
Sten
I'm afraid that the one thing that we can do is a trio, namely expanded HIV testing initiatives for vulnerable populations, better linkage to and retention in health care, and improved adherence to antiviral drug regimens. Doing just one of the three will not achieve the goal since they are all necessary to prevent the disease among persons living with HIV and reduce transmission of HIV among others.
Tamara
We should continue to engage in a multi-sector approach by collaborating with communities, policymakers, and researchers. This kind of approach is needed to address the interconnected structural, social, and behavioral determinants of HIV. We also need to prioritize reaching underserved populations, expanding biomedical and behavioral approaches to HIV prevention, and increasing efforts to improve retention and linkage to HIV care.