In this exclusive MedPage Today video, Paul Volberding, MD, director of the AIDS Research Institute at the University of California, San Francisco, describes the barriers involved in getting people to come forward for treatment, as well as recent efforts intended to make progress.
The following is a transcript of his remarks:
I think one of the big challenges that we have in trying to end the HIV epidemic — whether it’s in San Francisco or New York or in the entire country — is that a lot of the people that haven’t been tested or who have been tested and haven’t decided to come into care feel stigmatized, feel isolated, and finding them, inviting them, and making sure there are no barriers — that’s going to be a real challenge. A lot of them are young African-American gay men or Latino gay men, and I think they’re feeling multiple stigmas of their situation, and dealing with that, finding ways to work within their communities to help encourage them to be tested and come into care is going to be a challenge.
San Francisco has had a really nicely coordinated approach to this involving academics, the health department, political leaders, community leaders, and all of them working together and especially with people from the communities that we’re trying to specifically reach. I think that’s been quite successful. Our numbers are kind of a milestone for the rest of the country, but it takes a lot of effort to do that, and it’s going to be much harder to do that in areas like the southeast, where a lot of the people that are infected are in rural settings and much harder to reach than in San Francisco. A lot of the gay men that are in those settings don’t want to come out as being gay, which is less often the case in San Francisco, so I think the same strategies will be used and will be useful, but I think it’s going to take a lot more effort over a longer period of time.
I think some of the shorter-term gains are going to be seen in really an aggressive marketing campaign for PrEP, pre-exposure prophylaxis, bringing the price down. I think there’s a growing sense that has to happen, that price should not be a barrier to prevention of HIV infection. I think marketing PrEP, getting people who can benefit from it on it, is going to be probably one of the short-term ways that we can start making some progress.