The Year in HIV: Top 5 Resolutions to Make for 2019

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2018 was arguably the year of PrEP. More than any other clinical development, HIV pre-exposure prophylaxis (PrEP) brought into the spotlight how far we can come in not only treating the disease but providing people the tool to protect themselves from infection.

Not that it was the only story that captured headlines in 2018. We saw ourselves edging closer to replacing traditional three-drug therapies with two. We're likely of on the verge of having long-acting HIV drugs that require no more than a shot every one to three months.

On the downside, evidence suggests that resistance to the drug, tenofovir, is building and that contributions to global HIV organizations are shrinking as the United States and other G12 partners embrace nationalism over cooperation.

And every day we see the Affordable Care Act being undermined and chipped away by the Trump administration, placing the health of those living with chronic diseases, such as HIV, under the shadow of uncertainty.

To ensure 2019 is a year of continued good health, there are five resolutions everyone should make:

1. Get Tested Today

Currently, in the United States, it is recommended that everyone between the ages of 15 and 65 be tested for HIV as part of a routine doctor's visit. With an estimated 200,000-plus Americans still undiagnosed for the disease, the call for universal screening has never been stronger.

The options for testing include next-generation combination HIV tests endorsed by the Department of Health and Human Services. This simple, finger-prick assay can effectively cut the window period from an average of four weeks to as little as 12 days.

Over-the-counter, rapid in-home tests are also available for those who might otherwise avoid public testing facilities. While less accurate than standard, point-of-care tests, they can provide a person a greater sense of autonomy and confidentiality as well as hotline support should a positive test be returned.

2. Start HIV Therapy Today

2018 was the year when many global health authorities renewed the call for universal test and treatment. No longer should treatment be delayed based on the CD4 count. Today, treatment on diagnosis not only ensures a healthier, longer life but greatly reduces the risk of transmission to an uninfected partner.

Moreover, the early initiation of therapy translates to greater longevity in people with HIV, with life expectancy now equaling that of the general population.

3. Get and Stay Undetectable

The benefits of early treatment even extend to those not infected with HIV. By sustaining an undetectable viral load, a person living with HIV is up to 96 percent less likely to transmit the virus to an uninfected partner.

Start by committing yourself to uninterrupted drug adherence. This includes ensuring regular doctor visits and lab tests as well as finding support if you are finding it difficult to cope.

Today, as few as 65 percent of Americans on HIV therapy are able to achieve undetectable viral loads. The consequence of failure can be enormous, leading to the reduction in life expectancy by as much as 11 years.

4. Take PrEP

PrEP is a preventive strategy wherein a daily dose of Truvada can reduce a person's risk of getting HIV by as much as 92 percent. PrEP is currently recommended for people at high risk of infection, including men who have sex with men, injecting drug users, and mixed-status couples with HIV.

While the uptake of PrEP had been slow since the recommendations were first issued in 2014, consumer acceptance has been on the upswing. By 2018, a study released by the Centers for Disease Control and Prevention (CDC) reported that only 77,000 American were on PrEP, half of what was previously estimated and only 10 percent of the 1.2 million people who the CDC believe would benefit from treatment.

Despite the slow uptake, the rate of new infections in the United States dropped by 5.4 percent between 2012 to 2016, while the uptake of PrEP increased by over 78 percent during the same period.

Co-pay assistance programs are available to those who qualify, making access to PrEP far easier for those denied treatment by their insurance.

5. Get Linked to Medical Care

HIV is a chronic, lifelong condition, one that can be effectively treated but demands consistent medical oversight. Treatment failure is largely a by-product of inconsistent care, wherein persons who fall in and out of the system tend to fare poorer than those who remain consistently in care.

A recent study showed that 68 percent of individuals retained in care were able to achieve and sustain an undetectable viral load versus only 43 percent of those who voluntarily dropped out of the system.

The barriers to HIV care are often complex, particularly for those unable to afford the high cost of HIV treatment. But there are solutions, not only for lower-income individuals but for any persons struggling to pay for their drugs or insurance.

Start by learning what assistance programs you may be qualified for and explore new strategies for finding low-cost insurance coverage whatever your income bracket.

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