Moving from disease to pleasure

Dr. Demetre Daskalakis, Acting Deputy Commissioner of Disease Control for the New York City Department of Health and Mental Hygiene, delivered the morning plenary on the last day of CROI 2017 in Seattle, Washington, and as they say, they saved the best for last. Daskalakis is one of the architects of the Ending the HIV Epidemic (EtE) in New York State, along with TAG’s Mark Harrington, Housing Work’s Charles King, and others.

Daskalakis pointed out in his excellent presentation that they realized they have the technology to end the epidemic through treatment as prevention (TasP), the use of condoms, and PrEP, and that there are three pillars to their plan to end the epidemic in New York:

  • Test everyone;
  • Linkage, retention, and viral load suppression; and
  • Make PrEP a public health intervention.

In 2014 New York Governor Mario Cuomo formed a task force with input from community activists, community-based organizations, the Health Department and other key stakeholders, and the state plan was released in 2015. New York City Mayor Bill DeBlasio approved $23 million to implement the citywide plan on World AIDS Day 2015.

In New York City they began to treat HIV as an emergency and an outbreak, says Daskalakis, and by combining the political will, biological interventions, and harm reduction “you can get to zero” new infections. He also spoke of the importance of acknowledging pleasure in the plan, and using “a population-wide strategy” to end disparities.

Daskalakis outlined six points in the implementation strategy:

  1. Transform STD clinics into destination clinics for sexual health services.
  2. Make sexual health clinics a gateway for HIV treatment and prevention by launching same-day starts for PrEP (pre-exposure prophylaxis) and antiretroviral therapy (ART), and 28 days of PEP (post-exposure prophylaxis), no questions asked.
  3. Support NYC community providers of HIV prevention in the launch of PrEP, while repairing the nPEP (non-occupational post-exposure prophylaxis) delivery system. (PEP supports condom use, says Dr. D, but currently the system is a mess; they are creating PEP centers of excellence, using an urgent care model, with immediate starts of PEP regardless of insurance, and linkage to PrEP.)
  4. Support priority populations using novel strategies.
  5. Take NYC viral suppression from good to excellent.
  6. Make NYC a “status neutral” (stigma-free) jurisdiction.

Throughout the process he noted that HIV activists turned into rabid activists for sexual health, so that a visit to the STD clinic becomes the point where people get right onto treatment or PrEP, using delivery systems for different types of health care that are community appropriate.

Using EtE funding to expand services and hours to make sexual health clinics destination clinics, he stated that as of last week (early February), “STD clinics are dead. No more disease, only health.”

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