The following is a transcript of the conversation between Karl Schmid and Dr. José Zuniga.
KARL
HIV gone by 2030? Up next.
Hello there, and welcome to “+TALK” on +LIFE, where we’re all about turning positive into a plus. Today, my guest is joining me from Lisbon, Portugal. His name is Dr. Jose Zuniga. He’s the CEO of the International Association of Providers of Aids Care and the Fast-Track Cities Institute. Just what does all of that mean? Well, good thing he’s here to tell us all about it. Good to see you, doctor.
DR. ZUNIGA
Thank you very much for having me, Karl.
KARL
So this is a really important conversation that a lot of people, we talk about these conferences, AIDS Conference, and all these important things that happen around the world. But for a lot of us living with HIV in our cities, wherever they might be, it doesn’t really mean much to us. Obviously the results of what come out of these do, and they get trickled down to us. So I wanted to have you on today to really break down what Fast-Track Cities are and what you guys do and how they’re helping, how they’re making a difference to people like myself and others living with HIV. So, first of all, I hear Fast-Track Cities all the time. What is a Fast-Track City?
DR. ZUNIGA
Well, a Fast-Track City is a city that has committed to accelerating its local HIV response towards the goal of ending HIV as a public health threat by 2030, but it’s also a city that recognizes the importance of placing community at the center of the response. And so there are 350 Fast-Track Cities around the world that are doing so, major cities, smaller cities, all achieving a certain level of progress, even through the COVID-19 pandemic.
KARL
So what do they do? What do they actually do? And why is it so important?
DR. ZUNIGA
Well, the Fast-Track Cities initiative itself is pretty complicated in that there are multiple stakeholders who are engaged. The first I would mention are political leaders. Too often, political leaders have said the right thing around HIV, and sometimes the wrong thing, but beyond saying something or signing a document, they don’t do much else. And so the Fast-Track Cities initiative really creates a space for mayors, municipal governors, other elected leaders to consistently speak the message of ending HIV and ensuring the stigma and discrimination are eliminated within their cities. Of course, I already mentioned communities, and communities are very engaged. In every one of our Fast-Track Cities, we have steering committees that work towards creating a space for community, not just to be at the table, but to take active charge of planning, delivering services, and monitoring, and ultimately holding elected officials accountable for their actions or their lack thereof.
KARL
Well, sir, that’s great to know. So that it really does get, I guess, down to a grassroots community level. We do have a say, we do have an input, because I think so often, and those of us living with HIV just feel like, we’re in the system and elected leaders and scientists and politicians are pulling all the strings. But what you’re saying here is that community is a big part of this.
DR. ZUNIGA
We are trying to change that dynamic, where we have followed a top down approach and a very bureaucratic approach to the HIV response in the US and other countries for far too long. That’s business as usual. We’re flipping that on its head and really saying let’s level the playing field. Let’s ensure that elected officials, public health department officials, clinicians, service providers, all get that people living with HIV are equal and that they need to be an integral part of the decision-making team.
KARL
I love that. I mean, it’s funny, I’ve just finished reading Peter Staley’s memoir, and looking back at all the work he did with ACT UP. And really in the early days, that’s what they were fighting for. Give us a seat at the table, because we’re the ones going through this. How is the work that’s being done by them and being discussed at the conference that you’re all at in Lisbon at the moment relevant, though, to those of us living here. So what you guys are talking about on the ground, you’ve been doing it all week. How’s that affecting me?
DR. ZUNIGA
So the guys you’re speaking about here at the conference include the myriad stakeholders that are engaged in the global HIV response. And so we have robust community participation, participation from clinicians, service providers, health departments, and multiple mayors and elected officials. The work is relevant in that we’re sharing best practices with each other. That sense of solidarity to look at cross-cutting challenges and say to each other, “Hey, I’m having a problem in scaling up pre-exposure prophylaxis or prep,” for example. “What did you do in your city to increase the coverage by double, triple percentage points?” That’s the type of work we’re doing here. And that’s important. We have woven throughout the conference, the importance of eliminating stigma discrimination, but also the inequities, the inequalities, and the social marginalization that drive epidemics underground and create a sense that people living with HIV are not treated with the decency and dignity that they deserve. And sadly, that’s still the case this many years of the epidemic.
KARL
Yeah. And certainly among Black and brown communities here in the US. I mean, time and time again, and we just see it again now, even going through vaccinations for COVID, the disparities that exist. U=U, Undetectable Equals Untransmittable is an important message. It’s one that we champion every day here at +LIFE. I know people like Bruce Richman are there at the conference. It’s one that is struggling though. This message of U=U, simple as it is, take your pill, get undetectable. You can’t transmit the virus. It struggles here in the US. What more can be done and what are you guys at conferences like this, and when you talk about collaborating and sharing ideas, what are we learning that has worked, that we can implement here in the US that say, hasn’t worked.
DR. ZUNIGA
So first and foremost, the Paris Declaration on Fast-Track Cities, which governs the initiative, fully embraced U=U several years ago. And as such, we require a commitment from Fast-Track Cities to promote U=U, both because it’s a de-stigmatizing message and a life affirming message, but also because it can create demand for HIV testing and treatment, which we’ve seen in quite a number of cities where U=U has been successfully implemented, including for example, New York, Paris, et cetera, Amsterdam. What we’re learning here are different ways of communicating to a variety of stakeholders that naturally would not be inclined to support something they might believe is not evidence-based. Having said that, it is evidence-based. And so these are opportunities to present the evidence to those who may be skeptical, or who are introducing value judgements into their decision-making, particularly clinicians who may not necessarily understand the science, primary care commissions, to be specific, and educate them about how to communicate with a person living with HIV post-diagnosis, and even past that as they decide to take their HIV treatment.
KARL
Yeah, it still amazes me that there are doctors out there that say, oh, well, U=U, but it’s not my opinion.
DR. ZUNIGA
It’s stunning because for a very long time, treatment as prevention was accepted as science. For some reason, when the message was converted into a message with very powerful community, U=U, for some reason amongst the medical community, it was no longer acceptable. So we’re working to change that.
KARL
Fantastic. In the last few moments I’ve got you, through the work that Fast-Track Cities are doing, just how realistic, really. I know I’m putting you on the spot. How realistic is this timeline to end HIV?
DR. ZUNIGA
I’m an eternal optimist, but I recognize that we were off track already pre-COVID to meet the prior set of targets and goals for ending the epidemic. They’ve been adjusted since to reflect what has happened throughout the COVID-19 pandemic. I remain optimistic that we can regain momentum against HIV, but it will require a concerted effort by all key stakeholders, and that’s important, the resources and political commitment that HIV has enjoyed in prior years. My deep concern is losing that momentum permanently because we’re stuck in a place where COVID-19 or pandemic preparedness, as important as they are to address, usurp the possibility of ending the HIV epidemic, which we can certainly do with the tools we have at our disposal.
KARL
Yeah, well, and again, things like U=U, and even just talking about HIV amongst ourselves, amongst our peer groups, helps take the sting and destigmatize HIV. Dr. Jose Zuniga, thank you so much for your time from Lisbon. Really nice to talk to you, and thanks for this great information. I appreciate it.
DR. ZUNIGA
Thank you for all you’re doing.
KARL
Thank you. That’s gonna do it for this episode of +TALK. If you want more information about what we’ve talked about, you can go to the website, pluslifemedia.com, or check us out on social media. Like and follow. We are @pluslifemedia. Until next time, take care. Bye bye.