The Fast-Track Cities initiative hosted a skills-building workshop for 10 Portuguese cities on October 18, 2019, in Lisbon as part of a Gilead Sciences-funded series of European workshops organized around unique language families. The one-day workshop focused on exchanging best practices among the cities of Almada, Amadora, Cascais, Lisbon, Loures, Odivelas, Oeiras, Portimão, Porto, and Sintra, as they work to end the public health threat posed by HIV in their respective communities.

IAPAC President/CEO Dr. José M. Zuniga opened the workshop by welcoming representatives from the various cities and praising their innovative efforts to reach and surpass the UNAIDS 90-90-90 targets that are enumerated in the Paris Declaration on Fast-Track Cities. These targets seek to ensure that 90% of people living with HIV know their status, 90% of people living with HIV are receiving antiretroviral therapy (ART), and 90% of those on ART achieve and maintain viral suppression. Cities that have endorsed the Paris Declaration also pledge to eliminate the stigma and discrimination that often acts as a barrier to those seeking HIV testing, treatment, and prevention services.

Portugal’s capital city of Lisbon will also host the Fast-Track Cities 2020 conference next year. This year’s inaugural Fast-Track Cities 2019 conference in London welcomed more than 750 delegates from almost 200 Fast-Track Cities worldwide.

Lyon and Two French Overseas Territories Join Fast-Track Cities Network

(LYON, France – October 10, 2019) The city of Lyon and Métropole of Lyon, France, joined the Fast-Track Cities network coinciding with the October 9-10, 2019, replenishment meeting of the Global Fund to Fight AIDS, Tuberculosis & Malaria hosted by French President Emmanuel Macron.

The Paris Declaration on Fast-Track Cities was co-signed by the Métropole’s President David Kimelfeld; IAPAC’s Vice President for Strategic Partnerships Bertrand Audoin; Dr. Fodé Simaga, Fast-Track Department Coordinator at UNAIDS; and Dr. Jean-Michel Livrozet, President of COREVIH, at a signing ceremony on October 7, 2019. Lyon’s Mayor Gérard Collomb announced his signing of the Paris Declaration during opening remarks he delivered at the Global Fund replenishment meeting.

In signing the Paris Declaration, Mr. Kimelfeld said that “in the face of AIDS, we can never let our guard down. Following the commitments made by [Paris Mayor] Anne Hidalgo, we signed the Paris Declaration. Our goal is to be aggressive in our fight against the disease: awareness, information and screening are our priorities.”

A week earlier, the French overseas territories of Mayotte and Saint-Denis de la Réunion joined the Fast-Track Cities network during a signing ceremony on October 1, 2019, in Paris. Elected officials, clinicians, and community leaders from various French overseas territories participated in the event, which was jointly coordinated by IAPAC and Gilead Sciences, in partnership with the Overseas Territories Delegation to the French National Assembly.

Mayor Gilbert Annette of Saint-Denis de la Réunion signed the Paris Declaration and Mayotte County Council Vice President Issa Abdou signed the Paris Declaration, alongside IAPAC President Dr. José M. Zuniga. IAPAC and the City of Paris are original core partners of the Fast-Track Cities initiative, which has grown to reach over 300 communities around the world since it was launched in the French capital on World AIDS Day 2014.

“With 30 new cases detected each year, Mayotte is, in terms of its population, the territory with the highest HIV prevalence in France, outside the Paris region, ahead of Guyana. This signature [on the Paris Declaration] is therefore of particular importance,” said Issa Abdou.

Late diagnosis and insufficient data were cited by several event participants as challenges in accelerating HIV responses in overseas French departments. Located in the Indian Ocean, Mayotte and La Réunion also contend with the added challenges associated with poverty. IAPAC called for the development of regional cooperative networks for all French overseas territories. Participants at the event agreed that tackling stigma and discrimination should remain a high priority.

“Behind the word “AIDS,” there are men, women, and children. We must not fight against them, but fight HIV,” Jean-Luc Roméro reminded the event’s participants. In 2002, Roméro became the first elected official in France to publicly reveal that he is living with HIV.

Dallas County Expands Texas Fast-Track Network Against HIV

August 27, 2019 — Dallas County, Texas joined an expanding network of US counties that are part of the Fast-Track Cities initiative yesterday as Dallas County Judge Clay Jenkins signed the Paris Declaration on Fast-Track Cities. The ninth-largest county in the United States now joins two other counties in Texas — Bexar County (San Antonio) and Travis County (Austin) — in a push by the International Association of Providers of AIDS Care (IAPAC) to integrate counties into an international network of more than 300 cities and municipalities that are working to end urban HIV epidemics. The cities of Addison, Balch Springs, Dallas, DeSoto, and Grand Prairie accompanied Dallas County in signing the Paris Declaration during a community kick-off event in Dallas.

Judge Jenkins signed the Paris Declaration at the Communities Foundation of Texas alongside IAPAC President and CEO Dr. José M. Zuniga. He spoke about the experience of people living with and affected by the HIV epidemic in Dallas County and how the Fast-Track Cities objectives can make an impact in their lives.

“By ensuring that 90 percent of people living with HIV/AIDS know their status, 90 percent are receiving appropriate treatment, and 90 percent have viral loads that are undetectable and therefore cannot be transmitted; we can end the HIV epidemic by 2030. That is transformative for our community, especially the approximately 18,000 people in Dallas County living with HIV/AIDS and their families,” said Judge Jenkins.

Dallas County Health and Human Services Director Dr. Philip Huang spoke at the signing ceremony, which included local mayors, healthcare providers, and community organizations. Dr. Huang said that the county has set a goal of reducing the incidence of new HIV infections by 50%. Dallas County is also one of 50 jurisdictions that are being targeted by the Trump administration’s strategy to end the HIV epidemic in the United States.

“We welcome Dallas County’s commitment to fast-track its HIV response in solidarity with Bexar County and Travis County. Accelerating local HIV responses will contribute to our aim of ending the HIV epidemic in Texas and the United States,” said Dr. Zuniga. “We also thank the Mayors of various cities, including Dallas, who are joining Judge Clay Jenkins in signing the Paris Declaration on Fast-Track Cities. Your leadership is important to facilitate the active engagement of all stakeholders, especially affected communities, and to eliminate HIV-related stigma that can impede progress towards the goal of ending the global HIV epidemic by 2030.”

Dallas County’s efforts through the Fast-Track Cities initiative align well with the federal strategy to end the US HIV epidemic and support the “Achieving Together Texas” community to end the HIV epidemic in Texas. Community leaders from fellow and prospective Fast-Track Cities in Texas — Austin, Houston, and San Antonio — sent messages of support to the welcome Dallas County to the Fast-Track Cities network.

“We are here with you,” said Crystal Townsend, the coordinator of End HIV Houston. “We join you in this movement, and this is just the beginning.” IAPAC is in discussions with Harris County and Houston officials about recruiting both the county and city, since an estimated 50% of people living with HIV in Texas reside in Dallas and Harris Counties.

Select Countries and Cities Report 90-90-90 Progress in Mexico City

US Amb. Deborah L. Birx opened the 2019 90-90-90 Targets Update in Mexico City on July 21, 2019, with a discussion of efforts to link evidence-based policies and data with action in countries supported through the President’s Emergency Plan for AIDS Relief (PEPFAR). Dr. Birx stressed that political will, policies, data, and resources matter to achieve HIV epidemic control across all age bands, genders, and key populations.

The International Association of Providers of AIDS Care (IAPAC) hosted the satellite symposium ahead of the 10th IAS Conference on HIV Science (IAS 2019), in partnership with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Global Network of People living with HIV (GNP+), to report on global, national, and local progress towards attaining the UNAIDS 90-90-90 targets.

Representatives from China, France, Mexico, and South Africa presented country-level estimates about progress in closing HIV testing, treatment, and viral suppression gaps in the context of the 90-90-90 targets. These targets seek to ensure that 90% of people living with HIV know their status, 90% of people who know they are HIV-positive are receiving antiretroviral therapy (ART), and 90% of those on ART achieve and maintain viral suppression. Achieving zero stigma is an additional but no less important UNAIDS target.

“Our aim during this year’s 90-90-90 Targets Update is to highlight successes achieved and challenges faced globally, nationally, and locally as communities affected by HIV worldwide strive to attain and surpass the 90-90-90 targets. We do so with the clear understanding that 90-90-90 is a starting point on a trajectory towards getting to zero new HIV infections and zero AIDS-related deaths,” said IAPAC President/CEO José M. Zuniga.

“Our challenge in France is to reduce entry into the [treatment] cascade and improve the first 90 overall,” said François Dabis, Director of ANRS, the French National Agency for Research on AIDS, during his presentation. Dr. Dabis added that one of the major challenges in France is to reduce the amount of time – an average of 3.3 years – between when a person becomes infected with HIV and when they learn their positive status. French officials estimate that they have reached 86-88-97 nationally as of 2016, with approximately 5,800 new HIV infections per year.

“It is very, very difficult to gauge the number of people living with HIV. That is still a global challenge,” said Zunyou Wu of the Chinese Center for Disease Control and Prevention. Dr. Wu’s presentation estimated that there were 148,589 new HIV infections in China in 2018. There was significant variation among various cities and regions within China, particularly with regards to HIV testing. Nationwide, an estimated 69% of people living with HIV know their status, but Beijing has reached 80%, whereas Shanghai remains below 50%. Dr. Wu said that getting people diagnosed is the biggest challenge for Chinese public health officials, who estimate that the country reached 69-83-94 on the UNAIDS targets in 2018.

“In terms of diagnosis we have managed to do well,” said Gloria Maimela, Director of Health Programs at South Africa’s Wits Reproductive Health and HIV Institute, but retaining people on antiretroviral treatment remains a key challenge. Dr. Maimela said during her presentation that is often difficult to locate people living with HIV and that better health data is badly needed. South Africa’s Department of Health has been working with PEPFAR and the U.S. Agency for International Development (USAID) to get 6.1 million people on ART by 2020. South African officials estimate that the country reached 84-74-55 on the UNAIDS 90-90-90 targets as of April 2019.

“It is clear that we need to keep fighting the HIV epidemic in Mexico,” said Alethse De la Torre Rosas of Mexico’s National Institute of HIV Prevention and Control (CENSIDA) during her presentation. Stronger prevention, early diagnosis, and the standardization of ART delivery are the main priorities for health officials in Mexico. These officials estimate that Mexico reached 79-72-55 in 2018, and that there are approximately 230,000 people living with HIV in Mexico.

City-level speakers at the 2019 90-90-90 Targets Update also reported data from Bangkok, London, Mexico City, and New York City. Florentino Badial Hernández, Director of the Clínica Condesa Iztapalapa in Mexico City, reported that although 14% of people tested positive for HIV in their facilities, that number rose to 37% for both transgender women and male sex workers in Mexico’s capital city. He also noted that antiretroviral drug resistance is a significant challenge for health workers.

Demetre Daskalakis, Deputy Commissioner for Disease Control at New York City’s Department of Health and Mental Hygiene, discussed his city’s “status neutral” approach to HIV treatment and prevention. The goal of the program is to ensure that people who are HIV-negative have access to preventative PrEP medicine, and that people living with HIV adhere to antiretroviral treatment so that they cannot transmit the virus to others. New York City reached 93-86-93 on the 90-90-90 targets in 2017.

Chulalongkorn University Professor Praphan Phanuphak reported that Bangkok reached 91-70-76 on the UNAIDS targets in 2017, compared to 98-70-83 nationwide for the Kingdom of Thailand. Dr. Phanuphak added that although same-day PrEP and same-day ART strategies have led to increasing the numbers of people on biomedical prevention and treatment, more work remains to identify people living with HIV who remain undiagnosed and link them to care, treatment, and support.

Tristan Barber, an HIV Specialist at the Royal Free Hospital, reported that London remains the most heavily HIV-affected city in the United Kingdom despite the city’s successes before and since joining the Fast-Track Cities initiative. He said that London’s public health leaders are continuing efforts to improve access to HIV services for key populations, including men who have sex with men, transgender individuals, and migrants, with a special emphasis on racial minorities. He further indicated that fighting stigma will also continue to be a priority. London, which reached 95-98-97 in 2017, is the host of the Fast-Track Cities 2019 conference taking place September 8-11, 2019.

In offering a series of what she termed “headlines,” Shannon Hader, UNAIDS Deputy Executive Director for Program, laid out the challenges still to be confronted to achieve universal progress towards the 90-90-90 targets on the eve of the 2020 milestone. Dr. Hader’s headlines included “unequal and uneven progress in stopping new HIV infections and AIDS-related deaths, large disparities between young women and young men in reducing new HIV infections, and the fact that more than 50% of new HIV infections are occurring among key populations and their sexual partners.”

Charleston Joins Fast-Track Cities Network to End HIV

Mayor of South Carolina’s Largest City Signs Paris Declaration on National HIV Testing Day

June 27, 2019 — Charleston, SC, Mayor John Tecklenburg signed the Paris Declaration on Fast-Track Cities today, adding South Carolina’s largest city to a growing network of more than 300 municipalities worldwide that are committed to ending their local HIV epidemics, including the City of Columbia, SC, which signed on earlier this year. The ceremony coincided with the 2019 National HIV Testing Day.

“I am proud to join this movement as the 24th Fast-Track City in the United States and to work alongside our remarkable team of community partners to address this public health crisis,” said Mayor Tecklenburg, who signed the Paris Declaration in the Council Chamber at Charleston City Hall. “We know that the tools to end HIV transmission exist, and with a unified effort by communities and public health organizations around the world, we can succeed in ending the HIV epidemic by the year 2030.”

IAPAC President/CEO José M. Zuniga co-signed the Paris Declaration and also spoke at the signing ceremony, which welcomed representatives from a number of local community organizations and healthcare providers, as well as municipal and state health agencies.

“We applaud Charleston for committing to the Fast-Track Cities goal of getting to zero new HIV infections, zero AIDS-related deaths, and zero HIV-related stigma,” said Dr. Zuniga. “Charleston can accomplish its mission with the political leadership of Mayor John Tecklenburg and the City Council, the expertise of public health officials, clinicians, and service providers, and the passion of local champions among HIV-affected communities. These factors are key elements of the ‘calculus for success’ that more than 300 Fast-Track Cities are implementing worldwide to end the HIV epidemic. Through the Fast-Track Cities network, Charleston’s progress in addressing HIV will have a direct impact in communities across South Carolina and beyond its shores.”

Charleston is the 24th U.S. jurisdiction to sign the Paris Declaration since the Fast-Track Cities initiative’s inception on World AIDS Day in December 2014. South Carolina’s capital city of Columbia joined the network earlier this year.

HIV testing and treatment services are vitally important in the southern United States, which is more heavily affected by HIV than any other region in the country. According to the U.S. Centers for Disease Control and Prevention (CDC), 46% of all Americans living with HIV reside in southern states. This region also has the lowest number of people living with HIV who are aware of their status. As a result, fewer people living with HIV in the southern United States are able to access the treatment they need to reduce their viral loads, avoid disease progression, and prevent transmission to others.

South Carolina is one of seven states and 50 jurisdictions that are being targeted by the Trump administration’s plan to end the HIV epidemic in the United States by 2030. Officials from the CDC and other federal agencies are working with state and local stakeholders to expand access to HIV-related healthcare services in these high-priority areas. Aligning efforts between the new federal HIV strategy and Fast-Track Cities is the topic of ongoing discussions between IAPAC and three federal agencies — CDC, the Human Resources and Services Administration (HRSA), and the National Institutes of Health (NIH).

The SYNChronicity 2019 Conference convened April 14-16, 2019, in Washington, DC, for three days of networking by and presentations from clinicians, policymakers, community advocates, and service providers about HIV, HCV, STDs, as well as health priorities among LGBT communities.

IAPAC Vice President for Programs Dr. Chris Duncombe briefed SYNC 2019 delegates about recent progress in the Fast-Track Cities initiative, and discussed its alignment with the new locally-focused federal plan to end the HIV epidemic in the United States by 2030. Since 2014, 23 US municipalities have joined the global Fast-Track Cities network of more than 270 municipalities working to achieve common targets related to HIV prevention, testing, treatment, and viral suppression. Fast-Track Cities are also working to eliminate HIV-related stigma, notably in health settings, and promoting the “U=U” message, which states that people living with HIV who take their antiretroviral therapy as prescribed and achieve an “undetectable” viral load cannot sexually transmit HIV to serodiscordant partners.

SYNC 2019, of which IAPAC was one of several supporting partners, also provided an opportunity for discussions about women’s health, opioid addiction, and aging with HIV. Another session dedicated to policy reform offered an update on the latest efforts to address HIV criminalization in the United States. Activists noted that laws criminalizing the transmission of HIV often fail to consider the presence of a deliberate intent to cause harm. Most state laws are also not scientifically accurate, failing to reflect the reality of HIV treatment in the 21st century. Furthermore, these laws can have a negative impact on public health. The repeal of criminal penalties for HIV transmission – as called for in the IAPAC Guidelines for Optimizing the HIV Care Continuum – can also reduce stigma and encourage people to get tested for HIV.

IAPAC President/CEO Dr. José M. Zuniga joined Amsterdam Mayor Femke Halsema and a public health delegation from the Dutch capital city during a visit to New York City this week for a bidirectional Fast-Track Cities exchange.

The visit provided an opportunity for mutual engagement about progress in New York City’s HIV response and the sharing of best practices. Dr. Demetre Daskalakis, who serves as the Deputy Commissioner of Disease Control at the New York City Department of Health and Mental Hygiene and Charles King from Housing Works briefed the Amsterdam delegation and discussed lessons learned and challenges still to be addressed to end New York City’s HIV epidemic.

“Bidirectional exchanges between Fast-Track Cities are a critical part of our best practice sharing strategy because a high tide lifts all boats,” Zuniga said. “IAPAC aims to work with Amsterdam, London, New York City, and other cities to facilitate such exchanges in 2019-2020.”

As part of a statewide “Ending the Epidemic” initiative, New York City has increased the number of people living with HIV (PLHIV) who have achieved viral suppression on antiretroviral therapy (ART) from 90% to 93% between 2015 and 2017. Yet more work remains to link a higher percentage of PLHIV to ART. In relation to the UNAIDS 90-90-90 targets, New York City reached 93-86-93 in 2017.

The Chelsea Health Center reopened in March 2018 after a multiyear renovation to transition from a sexually transmitted disease (STD) clinic into a sexual health center. The center is one of four located throughout New York City that offer a variety of sexual health services, including low-cost and free testing HIV testing, with linkage to preventative and therapeutic care.
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IAPAC President/CEO Dr. José M. Zuniga traveled to South Carolina last week to officially welcome the City of Columbia as the newest US member of the global Fast-Track Cities network. Dr. Zuniga also congratulated Mayor Steve Benjamin for his leadership in signing the Paris Declaration on Fast-Track Cities last month.

South Carolina is one of seven priority states that are being targeted alongside 48 counties, the District of Columbia, and San Juan, Puerto Rico, as part of the new national strategy to end the HIV epidemic in the United States by 2030. Federal officials are collaborating with state and local stakeholders to expand access to HIV testing, treatment, and prevention services in these areas.

“We believe that Fast-Track Cities is well-aligned with and can support the new Ending the HIV Epidemic Plan because our US efforts are focused in cities and counties – for example, Birmingham and Jefferson County, San Antonio and Bexar County, and Atlanta and Fulton County,” said Dr. Zuniga earlier this month in remarks before a meeting of the Presidential Advisory Council on HIV/AIDS (PACHA). Dr. Zuniga also discussed how Fast-Track Cities are making an impact on national-level epidemics in an op-ed for the Washington Examiner.

The meeting with Mayor Benjamin was attended by representatives from the South Carolina Department of Health and Environmental Control and ViiV Healthcare. Participants discussed strategies for accelerating local action on HIV, and extending the Fast-Track Cities network to more municipalities in South Carolina and the southern United States. Mayor Benjamin currently serves as the President of the United States Conference of Mayors.

“We can save lives by working together,” said Mayor Benjamin about the meeting. He also emphasized the importance of taking a data-driven approach in local efforts to end HIV transmission.

Officials from Odessa, Ukraine, met on February 28, 2019, to report on local efforts to attain the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets. The meeting marked two years since Odessa Mayor Gennady Trukhanov signed the Paris Declaration on Fast-Track Cities.

Sindhu Ravishankar, who serves as IAPAC’s Senior Director of Fast-Track City Programs, spoke during the roundtable discussion about Odessa’s work towards achieving the 90-90-90 targets. In less than two years, Odessa increased the percentage of people living with HIV who know their HIV status and are on antiretroviral therapy (ART) from 37% to 56%.

Ukraine has the highest occurrence of HIV outside of the African continent. The country also recently saw one of the largest increases in HIV infections in Europe, second only to Russia. Intravenous drug use and population displacement caused by armed conflict pose significant challenges to the AIDS response.

Despite these difficulties, health officials in Odessa have made considerable progress by implementing new strategies, such as expanding access to and scaling up the availability of rapid HIV tests in all city health facilities, as well as making ART immediately available upon an HIV diagnosis. Municipal officials have also focused on issues such as preventing mother-to-newborn HIV transmission, and combatting social stigma that often deters people from seeking and utilizing HIV testing, prevention, care, and treatment services.

The meeting, which was organized by the Odessa City Council, also sought to identify areas for improvement with regards to tuberculosis, hepatitis, and substance use. Odessa’s Deputy Mayor, Svetlana Bedrega, emphasized the importance of implementing internationally recognized best practices in the city’s efforts to combat these challenges. She indicated that nearly USD $2.5 million (66 million hryvnia) has been allocated by the city for work on these issues for the fiscal years 2018 through 2020.

Other meeting attendees included representatives from UNAIDS, the Ukrainian Ministry of Health, the World Health Organization (WHO), the US President’s Emergency Plan for AIDS Relief (PEPFAR), and the Public Health Alliance.