By Mary Velan
Last week, communities worldwide recognized Worlds AIDS Day and put the fight against HIV and AIDS front and center. Cities are experimenting with a variety of strategies to not only help individuals with AIDS or HIV, but also end the worldwide epidemic by 2030.
Many cities across the country and worldwide has implemented clean needle exchange programs to help reduce the transmission of diseases, specifically HIV and AIDS. Though opponents argue needle exchange programs do not address the drug use problem, proponents provide research proving a reduction in transmission rates when clean needles are readily available. In fact many cities that originally stood against needle exchange programs are now showing support as a means to control public health epidemics.
The Worcester City Council in Massachusetts, for example, recently endorsed a needle exchange program in the community after hours of debate. The city’s Department of Public Health plans to include the needle exchange program in a larger effort to combat the opioid problem, heroine overdoses and HIV, AIDS and Hepatitis C transmissions. Worcester will join five other cities in the state operating clean needle exchange programs working toward the same goal. From 2001 to 2014, Worcester saw 300 new cases of Hepatitis C annually, and the cost of treating HIV and Hepatitis grow significantly. The needle exchange program would not only reduce transmissions but save money as well, Mass Live reported.
Similarly, a superior court judge recently rules that a clean needle distribution program in Hyannis has proven to save lives and is perfectly legal. The decision resulted in ensuring the program cannot be shut down by the Town of Barnstable, where public employees were found interfering with the AIDS Support Group of Cape Cod’s needle distribution program.
Barnstable issued a cease-and-desist order against the needle distribution program alleging the practice was illegal and creating public health risks such as leaving dirty needles in public. The superior court judge, however, found the needle distribution had proven to be successful in helping individuals addicted to drugs and reducing disease transmission in the community, Boston Globe reported.
San Francisco recently announced it will dedicate $1.7 million to support the city’s Getting to Zero program – which is designed to make the city the first in the country to be free of AIDS and HIV infections. After receiving a $500,000 grant from the MAC AIDS Fund, San Francisco decided to contribute an additional $1.2 million to help target at-risk individuals that have limited access to public health resources.
The goals of the Getting to Zero program include:
- Cutting HIV transmissions and HIV-related deaths by 90 percent by 2020
- Expanding access to the HIV-prevention drug known as PrEP
- Enrolling more people into the city’s treatment program
- Preventing new infections
- Avoiding preventable deaths
- Eliminating the stigma surrounding the disease
The $1.2 million commitment from the city follows a $54 million HIV/AIDS allocation for the prevention and care for San Francisco residents this year. The additional funding will support staff members reaching out to people who have contracted the virus or who are at high risk of doing so and may not be currently treated by medical and mental health professionals. Over the past two decades San Francisco has reported a significant drop in new infections. Last year, the city reported a record low number of HIV diagnoses at 302 new cases, compared to 2,332 recorded at the peak of the epidemic in 1992, SF Gate reported.
One way cities are taking a stand against HIV and AIDS while implementing solutions to reduce the incidence rate is by signing the HIV Fast-Track Cities Declaration. Though launched in 2014, many cities such as Washington, D.C., are signing onto the declaration now and looking to deploy best practices in their communities.
Last year, mayors from around the world met in Paris to sign a declaration to end AIDS in their cities. By signing the declaration, mayors commit to putting cities on the Fast-Track to ending the AIDS epidemic through a set of commitments such as achieving the UNAIDS 90-90-90 targets, which will result in:
- 90% of people living with HIV knowing their HIV status
- 90% of people who know their HIV-positive status on antiretroviral treatment
- 90% of people on treatment with suppressed viral loads, keeping them healthy and reducing the risk of HIV transmission
“Ending the AIDS epidemic is achievable if the world’s major cities act immediately and decisively to fast-track their AIDS responses by 2020,” said Michel Sidibé, Executive Director of UNAIDS. “A Fast-Track AIDS response in cities will also encourage new, cutting-edge service delivery programs that can pave the way for cities to address other public health challenges, including tuberculosis, sexual and reproductive health, maternal and child health, gender-based violence and noncommunicable diseases.”
The meeting is taking place 20 years after the Paris AIDS Summit, at which world leaders and communities agreed to a set of principles for the greater involvement of people living with HIV. Known as the GIPA principles, the historic commitment continues to guide the global AIDS response today.
During the event, UNAIDS released a report on HIV in cities, which outlines the important role that urban areas will play in ending the AIDS epidemic by 2030. The OUTLOOK: cities report shows how cities and urban areas are particularly affected by HIV, with the 200 cities most affected by the epidemic estimated to account for more than a quarter of the 35 million people living with HIV around the world. In many countries, cities are home to more than half of all people living with HIV across the country. In sub-Saharan Africa, 45% of people living with HIV reside in cities.
According to the report, more than half the world’s population lives in cities, with the proportion set to expand to 60% by 2050. The vast majority of megacities, defined as having populations of more than 10 million people, will be in low- and middle-income countries. Fast-tracking HIV responses in cities—without neglecting efforts in rural and other areas—will therefore be crucial to ending the AIDS epidemic.
“Cities provide ready, flexible and creative platforms that can contribute to ending the AIDS epidemic in a pragmatic, balanced and efficient way,” said Joan Clos, Executive Director of UN-Habitat. “Cities can act as the fora where the linkages, trust, respect and inclusiveness that are part of any sustainable solution can be built.”
The Cities report shares the city photography of renowned photographer Richard Silver. It also features testimonies from community activists, health workers and public officials who have been at the forefront of the AIDS response in the world’s cities. Their stories show how the same urban centres that have been most affected by HIV from the beginning of the epidemic are now uniquely positioned to end the AIDS epidemic. It also highlights the importance of ensuring that people who are marginalized and often stigmatized—including sex workers, people who inject drugs and men who have sex with men—have access to HIV prevention and treatment services.
Tackling poverty and inequality will also be essential. Globally, an estimated 1 billion people live in poverty, with access to only a few services. Poverty and inequality are further tested by multiple health challenges, including HIV and related diseases, such as tuberculosis, the leading cause of death among people living with HIV.
Ending the AIDS epidemic in the world’s cities will require leaders who can inspire and harness the compassion and generosity of ordinary urban citizens in order to bring about lasting change. It will depend upon energized communities accelerating and sharpening the focus of local AIDS responses and sharing best practices across urban centres.
In addition to the 90–90–90 targets, UNAIDS also calls for reducing the annual number of new adult HIV infections by more than 75%, to 500 000 in 2020, and achieving zero discrimination. UNAIDS estimates that reaching the 90–90–90 Fast-Track Targets will prevent almost 28 million new HIV infections and 21 million deaths by 2030.
Another way communities are showing support for the fight against HIV and AIDS is by holding ceremonies and services to honor those who have passed from the disease. Austin, Indiana, held a vigil this year to raise awareness for the disease and encourage more action to combat its spread. The event, which featured a vigil and march, was organized by the AIDS Healthcare Foundation (AHF) and Foundations Family Medicine.
See video footage of the event here.