Anthony S. Fauci, MD, former director of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH), presented the keynote address for the George Washington University (GW) School of Medicine and Health Sciences (SMHS) 10th Annual Clinical Public Health (CPH) Summit on HIV, “How Clinicians Can Help End the HIV Epidemic: Prescriptions for State and City Action Plans.”
Joining Fauci for the opening of the three-day summit, were representatives from the Center for Aids Research Community Advisory Board, officials from the National Alliance of State and Territorial AIDS Directors, and Marissa Robinson, DrPH, initiative coordinator of the U.S. Department of Health and Human Services program Ending the HIV Epidemic.
The annual event is the first of four clinical public health summits GW MD program students participate as part of the MD program curriculum. The summits are designed as scientific conferences with problem-solving labs to develop a state- or city-level action plan to improve HIV/AIDS community health. Working in teams alongside HIV/AIDS officials from eight jurisdictions — Chicago, Indiana, Iowa, Louisiana, Maryland, New York City, New York State, and Washington, D.C. — students examine unique risk factors, existing health systems, and the local community considerations and translate that information into action plans for their assigned communities.
GW’s unique Clinical Public Health curriculum, “is one of our signature programs,” said Barbara L. Bass, MD, RESD ’86, Bloedorn Chair of Administrative Medicine, vice president for health affairs, dean GW SMHS, and CEO of the GW Medical Faculty Associates. “There are places that integrate community service and population health management into their curriculum, but our school does it in such an intentional, thoughtful structured way that is really extraordinary.”
She added, “I hope it’s one of the things that brought you to us, but I also hope one of the things that really enriches your education in a very special way. One that gives you an additional skill set.”
In her welcoming remarks, LaQuandra Nesbitt, MD, MPH, senior associate dean for population health and health equity, Bicentennial Endowed Professor of Medicine and Health Sciences, called the summits among the most exciting and unique learning opportunities students have during their medical school educations. “As future physicians here in the U.S., or if you choose to practice globally, you recognize that today’s physicians do more than practice medicine at the individual patient level,” she told the students. “You have to recognize that to really understand an individual’s full health, we must understand all of the different domains of health, including the social context of the patients live in. This summit does exactly that.”
A Personal Journey
As he has done since GW’s Clinical Public Health summits first began in 2014, Fauci, who now serves as Distinguished University Professor at Georgetown University, led first-year MD program students along his career evolution in his address titled, “HIV/AIDS: A Personal Journey Following the Science.”
Fauci recalled first hearing about the emergence of a new infectious disease through an article in the journal Morbidity Mortality Weekly, about five gay men from Los Angeles who had all contracted Pneumocystis, a serious fungal infection in the lungs.
A month later, when the journal ran a similar report, this time about 26 gay men from cities across the country suffering from the same rare cancer, Fauci knew the world was witnessing the emergence of a deadly new pathogen. Almost immediately, he left a successful career exploring cures for Wegener’s granulomatosis to tackle what would become known as HIV/AIDS.
“Those years before 1996, I have to say those were the dark years in the dark days of my special experience,” recalled Fauci. “I had developed relatively curative therapies for some of these inflammatory vasculitis disorders. My medical experience to that point was one of almost consistent success.”
Life expectancy after diagnosis in the era before early protease inhibitors was rarely longer than a year, he said, leaving physicians and researchers feeling like they were “putting Band-Aids on hemorrhages.”
Today, thanks to antiretroviral therapies, and pre- and post-exposure prophylaxis, life expectancy following diagnosis average 56 years.
That, according to Fauci, means “if you’re diagnosed with HIV in your early 20s, and you get on combination therapy that brings down the virus to below detectable, the chances are highly likely that you will live into your mid 70s, which is almost a normal lifespan. That’s one of the greatest accomplishments in the history of biomedical research.”
A Global Approach
From 1996 to 2002, Fauci recalls, combination therapy revolutionized HIV/AIDS treatment, but only in the developed world — United States, Europe, Australia, Canada. In places such as sub-Saharan Africa, access to effective antiviral therapy was still relatively nonexistent.
Fauci believed the United States had an obligation to share these novel treatments with the developing world. Fortunately, he wasn’t alone.
George W. Bush called Fauci to the White House for a meeting, where he told him “We as a rich nation have a moral obligation to help those who do not have access to HIV treatment care because they lack resources.”
From that meeting grew PEPFAR (President’s Emergency Plan for AIDS Relief), which distributes drugs to treat millions of people around the world living with HIV/AIDS. By the program’s 20-year anniversary earlier in 2023, the program had administered $110 billion leading to an estimated 64 million people tested, 25 million lives saved, 5.5 million babies born free to mothers with HIV.
“I consider that to be one of the most important developments I have been involved with,” Fauci said.
Addressing the Syndemic
Marissa Robinson, DrPH, Ending the HIV Epidemic initiative coordinator laid out national strategy for addressing HIV/AIDS through a syndemic lens, or considering the multiple social or health conditions within a population that exacerbate the burden of disease.
The goal, she explained is to reduce new HIV infections in the United States by 75% by 2025 and 90% by 2030. To reach those figures, initiative partners are looking to diagnose all individuals with HIV as early as possible, treat HIV rapidly and effectively to achieve sustained viral suppression, prevent new HIV transmissions, and respond quickly to potential HIV outbreaks.
According to the most recent estimates released by the Centers for Disease Control and Prevention in 2021, approximately 1.2 million people in the U.S. are living with HIV, of whom about 13% (1 in 8) are unaware they are infected. An estimated 36,136 Americans became newly infected with HIV in 2021 – a decrease of 7% from 2017 to 2021.
“There are multiple national strategies to combat syndemic,” Robinson told the students. “It’s really important that we think about things in on a grander scale of intersectionality. We don’t want to just look at HIV without looking at all these other factors and other co-morbidities or other things that are emerging.”
