With new medications and better support, the epidemic could be nearing its end
Twenty-nine-year-old Terence Steward II oozes potential and possibility.
By day, he is a receptionist at the Chicago branch of a posh social club. He dreams of international travel and a life untethered, one where he can meet as many interesting people as possible. When his shift ends, Steward is out the door and into Chicago’s artistic scene. A model, dancer and creative event organizer, he’s the definition of limitless. He’s a young man who has made his own way through a world that has thrown him curveballs at every turn.
Steward is male, queer and utterly full of life — a far cry from where he was nearly nine years ago when he received an HIV-positive diagnosis.
“I felt like I was dying. I literally felt I was going to die,” Steward says. Collapsed on the floor of a clinic room in Wisconsin, he wondered how this could be his life. Six months prior, he’d come out to his family and unburdened himself of the weight a closeted gay life carries. Yet in a moment, he’d gone from weightless to grounded as he joined the 1.1 million Americans who live with HIV. He’d just slid from the 14% who aren’t aware they carry the virus to the 86% who are most fully aware.
But living with HIV has changed from the early days, when secrets and scare surrounded the virus. Now advancements and modern medicine have transformed an HIV-positive diagnosis from a death sentence into a chronic illness that can be managed.
Those living with HIV are, like Steward, able to live their best lives. And they’re excited about the end of the HIV epidemic.
They’re also confident they’ll see that end in their lifetime.
Bringing an end to the epidemic
The federal government has announced a plan to reduce new HIV infections in the United States by 75% in five years and by 90% by 2030. To do this, public health initiatives have honed in on transmission prevention in communities with the highest rates of HIV.
HIV antiretroviral medicine can reduce the amount of HIV in the blood, making the viral load so low that a test can’t detect it. In 2017, the CDC validated that those living with HIV who have an undetectable viral load, which can happen within six months of starting treatment, cannot transmit the disease — a massive shift for those living with HIV and those who love them.
This brought about the Undetectable = Untransmittable (U=U) initiative, which is designed to disseminate the “revolutionary but largely unknown fact that people living with HIV on effective treatment do not sexually transmit HIV,” according to Prevention Access Campaign.
Advancements and modern medicine have transformed an HIV-positive diagnosis from a death sentence into a chronic illness that can be managed.
Bridget Magner, HIV/Hep C program manager with Erie Family Health Centers, is excited about getting patients to undetectable viral loads. “There are better medications than ever before with fewer side effects,” she says. “Often, patients can even start same-day treatment, and many patients only have to take a single pill a day.” That’s a massive shift from previous HIV drug cocktails, when patients were burdened with an array of pills taken several times a day that caused a range of serious side effects.
One innovative treatment is transforming the lives of at-risk communities in remarkable ways: a single pill that, when taken daily, reduces the risk of HIV infection by 92%.
PrEP (short for pre-exposure prophylaxis), currently on the market as Truvada, is a powerful prevention tool. Members of communities that are at a greater risk of contracting HIV can take PrEP every day to prevent HIV from establishing an infection inside the body. And getting this groundbreaking medication into the communities that most need it — at low to no cost — has been a significant push for community health organizations.
Ending the HIV epidemic is not just about medication. Successful treatment has as much to do with the drugs a patient takes as the support they receive, says Kathleen Jacobs-McLoyd, RN, director of nursing at Howard Brown Health.
Multifaceted support systems for those in communities at risk for HIV can help reduce the spread of the virus.
“When people have homes, that’s part of HIV prevention,” she says. “When they have a case manager and nurses who follow up, make sure they’re taking their meds and help identify challenges with keeping clinic appointments like transportation and childcare — all of these things support a patient’s journey toward an undetectable viral load.”
The most disappointing thing, however, is hearing from those on the front line of the HIV epidemic that many live in fear of something as simple as their medications being found. The stigma surrounding HIV still lingers, and if this epidemic is to be eradicated, the stigma must be eradicated as well.
“A positive diagnosis instantly labels people as an escort, a sex addict, a drug user. You’re dirty. I mean, it’s not said, but it’s definitely implied,” Steward says.
But Steward is committed to talking about the virus — openly and honestly — with anyone who wants to understand. That understanding is critical to ending the HIV epidemic and involves education, access to information and, most importantly, a willingness to learn.
Steward vows to continue living his best life — answering questions and being a steward, like his last name, for the HIV-positive community.