Rutgers Public Health dean talks barriers and breakthroughs on World AIDS Day

BY Briana Vannozzi, Correspondent |

Each Dec. 1, we mark World AIDS Day as the first ever global health day. It began in 1988 as an opportunity for people worldwide to unite in the fight against HIV. Since then we’ve made great strides, but work remains. Joining Correspondent Briana Vannozzi is Perry Halkitis, dean of the Rutgers School of Public Health, to talk a little about this day.

Vannozzi: So, 1988 is when it started, so why is it important that we continue to commemorate this day?

Halkitis: Well, thank you for having me here. The battle against HIV and AIDS continues. In our country, we have some 40,000 new infections each year. And Dec. 1 is an important day to think about the progress we’ve made, but also to honor the losses — the over 600,000 people who have died in the United States since the beginning of the epidemic and the over 35 million people who have died worldwide. So, it’s an opportunity to come together and commemorate and honor, but at the same time to look forward and unite and fight this evil monster that continues to exist.

Vannozzi: How does New Jersey stack up? I’ve read that we are around ninth as far as the country goes. What does that mean numbers wise?

Halkitis: So, there are 37,000 people in New Jersey who are living with HIV. That’s a high prevalence. When you look at the United States, the majority of the infections of people living with HIV are on the East Coast — New York, New Jersey, Georgia. And, so in New Jersey we struggle. We struggle with populations that continue to be infected: gay men, women of color, cisgender women, transgender women and injection drug users.

Vannozzi: So, what are the barriers because we are known anyway for our medical systems here, the outreach that we have for declining our rates, so what are the barriers then to getting to these populations?

Halkitis: It’s a really complex disease and so if it was just about the transmission of a virus, the medications would solve our problems. But, I have said over and over again that HIV is a socially produced condition, as much as it is a virally produced condition.

Vannozzi: What do you mean by that?

Halkitis: By that I mean that people who have marginalized lives, people who are discriminated against because of their race, because of their sexual orientation, because of their economic status, who experience stressors in their lives because of who they are are more vulnerable to any disease, including HIV. And so you see HIV lodged in the populations that tend to be treated as fringe populations in our society.

Vannozzi: The social, political climate right now adding to that?

Halkitis: It probably is adding to it, the sociopolitical climate right now. One could argue that we’ve made huge advances of the rights of gay people in this country, but if you’re a young person who is still grappling with your sexuality and you see a governor, a president, a politician speaking badly about the LGBTQ population, that has an affect on you. It may not be obvious right away, but it becomes embedded and deep. And, this is what I talk about with marginalized populations. Marginalized populations experience minority stressors that place them at risk for cigarette smoking, for alcohol abuse, for drug use, for HIV, you name it.

Vannozzi: Sure, a whole number. There’s something I want to ask you about. The CDC released new guidelines, not without controversy, of course, indicating that people who maintain an undetectable viral load of HIV have effectively no risk in transmitting the virus to a partner. How has that changed the conversation and when exactly were these guidelines released?

Halkitis: So, we have had enormous breakthroughs in the last decade with biomedical advances. And it started as early as 1996 when the effective medications first came into place, but this last fall, the CDC released the U=U statement — undetectable equals untransmittable. And, what that means is that a person who is detected to be HIV positive, who is on medication, who has a suppressed virus is unable, has zero percent chance of transmitting the virus to a partner even without the use of a condom. Now, interestingly, the Swiss said this in 2008, so we are like 10 years behind. But the efforts of the Prevention Access Campaign, Bruce Rickman, whose lead that effort, has gotten the CDC to be on board with this which is absolutely remarkable if you think about it. So, all we had was a condom for a very long time, now we have treatments that are effective.

Vannozzi: Well, something that stems from that makes me think of some of the criminalization acts, cases that have been prosecuted for folks who have transmitted the virus. In fact, New Jersey is among one of the states with the HIV criminalization law. So, what exactly does that entail, what does that mean for someone?

Halkitis: So, I love that you asked me this question because HIV criminalization is something that I’ve been thinking about a lot the last several years. These laws were founded at the time of great fear in our country. And, here we are in 2017, the epidemic’s changed. So, what these laws still do is they prosecute somebody for potentially transmitting HIV. Here’s the problem with these laws, if you’re a person living with HIV and you do not know your status because you have not tested and you transmit the virus, you cannot be prosecuted. If you are HIV positive and know your status, and potentially transmit the virus, you can be prosecuted. So, these laws work counter to our efforts to target people, to test them and to treat them so they are completely outdated.

Vannozzi: Quickly in just about 20 seconds or so, in 2012, you wrote that legalizing gay marriage would help improve the health outcomes for the LGBTQ community, specifically for gay men. Has that happened, is that happening?

Halkitis: I think that we’ve seen advances in the health of the LGBTQ population of gay men. I think we are seeing less infections in certain segments of the population. But if you are a young, black man, or if you are a young, Hispanic gay man, you are at high risk for HIV. So, in some ways yes, but in many ways no.

Vannozzi: Much more to talk about. Dean Perry Halkitis, thank you so much for coming in.

Halkitis: Thank you for having me.