End to AIDS feasible in US by 2025, but making drug use a crime makes HIV prevention and treatment more difficult

Two separate studies found a feasible path to ending the AIDS epidemic in the US but the criminalization of drug use negatively affects the prevention and treatment of people with HIV.

By using prevention surveillance data to model rates of HIV incidence, prevalence, and mortality, a path toward ending to the AIDS epidemic in the US is feasible, a new study revealed.

This set of surveillance data enables the setting of targets—specifically a decrease in new infections—which would mark a transition toward ending the HIV/AIDS epidemic, according to the study conducted by investigators at the Brigham and Women’s Hospital and Johns Hopkins Bloomberg School of Public Health.

Their findings are published in The American Journal of Preventive Medicine.

The study used 2010 to 2013 surveillance data coming from the Centers for Disease Control and Prevention, which the investigation team modeled many key indicators including incidence and prevalence rates, transmission rates, death rates, and more through 2025.

Considering the goals set by the US National HIV/AIDS Strategy (NHAS) for 2020, the investigators estimated the potential trajectory of the epidemic if those benchmarks in care were met.

The NHAS goals for 2020 included that 90 percent of people living with HIV would know their status; 90 percent would receive quality care; and 90 percent of people on antiretroviral therapy would achieve viral suppression (the “90/90/90” goals).

The investigators found that by extending beyond 2020, these goals could be achieved at 95 percent levels by 2025 (the “95/95/95” goals).

The authors evaluated whether reducing new HIV infections would be achievable. Using mathematical modeling, they found that the US could achieve—provided a 90/90/90 HIV program framework by 2020 and 95/95/95 framework by 2025 is implemented—a 46 percent reduction in HIV incidence by 2020 and a nearly 70 percent reduction in HIV incidence by 2025.

Lead author of the study Robert Bonacci, MD, MPH, of the BWH Department of Medicine, said that “achieving these targets will require a sustained and intensified national commitment to ending the epidemic.”

“But if the U.S. does achieve a reduction to 12,000 new HIV infections by 2025, it could mark an important turning point in the U.S. HIV epidemic: a decline in the total number of people living with HIV in the U.S., and the beginning of the end of the U.S. AIDS epidemic,” Bonacci said.

Achieving these goals across the US is of utmost importance, the authors noted, especially in communities that have been disproportionately affected by HIV. David Holtgrave, PhD, of the Johns Hopkins Bloomberg School of Public Health, said that “providing HIV services to our most disproportionately affected communities is fundamental to future success.”

As this study provides hope to ending the epidemic, making drug use a crime has negative effect on efforts to prevent and treat people with HIV, suggested a review of published research conducted by the by the Johns Hopkins Bloomberg School of Public Health.

The researchers systematically reviewed 106 peer-reviewed studies published between January 2006 and December 2014 on criminalization and HIV prevention or treatment among people who use injection drugs.

This systematic review, the results of which appeared on May 14 in The Lancet IV, found overwhelming evidence that supports the so called “War on Drugs,” which called for stiff penalties for possession of illegal drugs, has been unsuccessful in reducing drug use and has put thousands of people in jail who might be better served through drug treatment.

HIV rates are being driven up by the unmet HIV prevention and treatment needs among people who inject drugs, according to the study.

“More than 80 percent of the studies evaluating the criminalization of drug use demonstrated worse health outcomes among those targeted by these laws and their communities at large,” said Stefan Baral, MD, MPH, an associate professor of epidemiology at the Bloomberg School. “The evidence that criminalization helps is weak at best and the vast majority of studies show that criminalization hurts when it comes to health, economics and society-at-large.”