Oregon launches effort to end HIV infections

Oregon launched an initiative Thursday aimed at ending new HIV infections in the state, building on decades of foundational work to introduce a new five-year plan focused on testing, prevention and treatment.

The initiative, called End HIV Oregon, envisions a state in which all new HIV infections are eliminated and where all people living with HIV have access to high-quality care, free from stigma and discrimination. The Oregon Health Authority leads the effort, with partners that include local health departments and HIV prevention advocacy organizations.

“Today, we look forward to a new reality in Oregon — the elimination of HIV transmission as we know it,” said Lillian Shirley, director of the OHA Public Health Division, whose HIV Program coordinates the initiative. “This is not a lofty, pie-in-the-sky goal. We know what it takes, and we have what it takes, to get there.”

The initiative was unveiled today during a media event at the OHA Public Health Division offices in northeast Portland. The event coincided with a day-long celebration of World AIDS Day that included a remembrance, a grand rounds talk, documentary screenings and displays of AIDS memorial quilts.

World AIDS Day is held each year on Dec. 1 as an opportunity for people worldwide to unite in the fight against HIV, show support for people living with HIV, and remember those who died. Oregon Governor Kate Brown and President Barack Obama both have issued proclamations recognizing World AIDS Day.

The End HIV Oregon strategy is centered around three facts:

— Testing is easy. Every Oregonian has an HIV status, but too few get tested for HIV. Confidential testing IS simple, convenient and fast. It is available throughout Oregon as part of a routine medical visit and is covered by most health insurance plans. Only 35 percent of adult Oregonians report having ever been tested for HIV. An estimated 1,100 people in Oregon are infected with HIV but don’t know it. If most or all of these people were tested for HIV and entered into HIV medical care, Oregon could prevent 150 new infections over the next three years alone.

— Prevention works. Core prevention programs such as syringe exchange, prevention education, and condom distribution must be maintained and expanded, and use of new tools, such as pre-exposure prophylaxis (PrEP), a daily pill that prevents infection, must be accelerated. When taken consistently, pre-exposure prophylaxis has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92 percent. OHA estimates that if 1,000 Oregonians at the highest risk of HIV infection started taking PrEP, the state could prevent eight new infections a year.

— Treatment saves lives. With early testing and treatment, people infected with HIV are leading long, healthy lives. Effective treatment, called viral suppression, among HIV-positive people has the potential to prevent the largest proportion of new HIV infections. Only 68 percent of people with HIV in Oregon are taking a daily viral suppression pill that prevents infection. But effective HIV viral suppression treatment can reduce transmission by up to 96 percent. If 100 percent of Oregonians who know they are HIV infected were virally suppressed, more than two-thirds of new HIV infections could be prevented, health officials say.

“We want to focus attention on the fact that we already have the tools to permit us to effectively eliminate HIV in Oregon and to challenge ourselves collectively to do it,” said Sean Schafer, MD, medical director for HIV programs, OHA Public Health Division.

Public health officials say data support a focus on testing, prevention and treatment, which could be the key to finally pushing the number of new HIV infections downward.

The End HIV Oregon initiative’s first year will be crucial to the effort. Oregon will increase the proportion of Oregonians who test for HIV by implementing statewide early intervention services, or EIS, which link newly diagnosed people to HIV medical care and quickly get their partners tested for HIV. There also will be a focus on increasing collaborations among local public health departments, coordinated care organizations, private health systems and partners such as AIDS Education and Training Center to increase testing in health care settings. And grants will be used to support strategies that promote culturally competent testing to underserved and other priority communities.

Also during year one, OHA will maintain foundational prevention programs and initiate new activities specific to PrEP, including improving channels through which the drug is provided to those most in need, and increasing health care providers’ assessment capacity to prescribe PrEP. In addition, the agency will partner with community-based agencies to educate individuals who could most benefit from PrEP and help them navigate services.

Finally, Oregon will support treatment as a prevention method by continuing to deliver programs that support access to and retention in HIV medical care. Activities include developing enhanced case management and patient navigation services statewide; increasing housing subsidies and support for people living with HIV who are homeless; and developing peer support programs to support long-term medication adherence.

OHA and its partners will issue a progress report each year on World AIDS Day. Oregon’s Integrated Planning Group (IPG) for HIV, viral hepatitis and sexually transmitted diseases will review progress on activities and recommend corrective action as needed. The IPG is composed of people living with HIV and at risk of HIV infection, as well as as people representing alcohol and drug abuse prevention and treatment, community-based agencies, corrections, health care, higher education, and hospice.

“There is a light at the end of the tunnel,” Schafer said. “We can end new HIV transmission in Oregon by going full-steam on these new efforts, and doubling down on what has been proven to work so far.”