What's Stopping Us from Ending the AIDS Epidemic in the U.S.?

The late Dr. Maya Angelou said, "Do the best you can until you know better. Then, when you know better, do better!"

There have been a number of remarkable biomedical breakthroughs in the treatment and prevention of HIV/AIDS in the last few years. We have better surveillance tools, better diagnostic tools, better treatment tools and better prevention tools. We have the tools we need to end the epidemic in America. The scientific evidence is now clear. Or is it?

Last week, to commemorate National Black HIV/AIDS Awareness Day, the Black AIDS Institute released a report on the state of HIV/AIDS science and treatment knowledge among non-medical personnel working in HIV/AIDS in the United States.

The results of the study are shocking. The more than 3,600 respondents from 48 states, D.C., and U.S. territories who participated in the study answered on average only 63 percent of the questions correctly. If this were an academic exam, they would have earned a "D". Said another way, our nation's case managers, social workers, prevention educators, testers and counselors, public health workers and advocates, policy makers, contractors, volunteers and others working to end the AIDS epidemic are woefully unprepared to implement the new bio-medical tools touted as the key to ending the AIDS epidemic in America. It's gets even worse, the average score on treatment and clinical knowledge was only 56% and 46% respectively.

So why is this important? Treatment and bio-medical interventions offer our best chance of ending the epidemic in the US. Helping people living with HIV reach viral suppression can reduce transmission of HIV by 96%, and pre-exposure prophylaxis can reduce the chances of getting infected with HIV by over 90%. Both are game changers with the combined possibility when used properly of breaking the back of the AIDS epidemic.

All the bio-medical and scientific breakthroughs in the world aren't worth a damn if people working in the HIV field don't understand them, believe in them and know how to use them. We are leaving our most valuable resource behind. We have a large infrastructure of passionate, committed and capable people working in AIDS service organizations, community based organizations, clinical settings and health departments. They are ready to get the job done. But they can't do it unless they have the familiarity, knowledge and skills needed to use these new tools.

I have been living with HIV for over 35 years. Every night I take three pills that keep me healthy and keep me alive. And you know what? I look at those pills every night and there's one thing that I notice: Not one of them has a way to get into my body without my assistance. What the pills do is biomedical. What I do is behavioral. Ending the AIDS epidemic is going to require integrating the behavioral and the biomedical. Biomedical interventions alone will not get the job done.

The Institute is calling for there to be a national movement to:

• increase the HIV science and treatment knowledge of both the HIV AIDS workforce and those communities most at risk of HIV infection;
• establish a concise list of core competencies for people working with HIV;
• establish a certification process for HIV/AIDS workers, requiring continuing education for people working in HIV;
• dramatically increase the number of people living with HIV/AIDS in the HIV/AIDS workforce.

We need an educated AIDS workforce to help people like me understand why HIV/AIDS treatment is important and to help us stay on treatment when the going gets rough. Doctors can't really do that in the 15 minutes they have with a patient. And to exacerbate the problem, increasingly, people with HIV/AIDS are going to receive their HIV care from doctors who aren't HIV specialists. People in the communities most affected are needed to deliver that kind of message.

Dr. Angelou said, "When we know better, we do better." This report looks at what the HIV/AIDS workforce needs to knows to do better and makes bold recommendations on how to address the problem.

For more details the US HIV/AIDS workforce study, why science literacy matters and why the HIV workforce is vital to helping us reach an AIDS-free generation please go to www.BlackAIDS.org.

By Phill Wilson, President and CEO of the Black AIDS Institute.