Important note: Information in this article was accurate in 2009. The state of the art may have changed since the publication date.
New York Times (11.06.09) - Friday, November 20, 2009
Carol Pogash
"These hot spots are perpetuating themselves, increasing infection in marginalized communities," said Dr. Julio Montaner, president of the International AIDS Society. "As long as we don't deal with that problem, the reservoir of HIV will ensure that we're promoting the continued spread of HIV in perpetuity." In San Francisco, "you can identify hot spots where, in all likelihood, most transmission is occurring," he noted.
"If you're monitoring the epidemic by just following the number of cases there are, you haven't prevented new cases," said Dr. Moupali Das-Douglas, lead investigator on the project. "If you have a marker upstream that may predict new cases, you can know where to target your services to prevent transmission." "The more people I start on medication, the more people will be virologically suppressed and the less likely they will be to transmit HIV," he explained.
"If any place is able to reduce infections by treating people effectively, San Francisco should have the best chance. We're hoping it will be a model," said Dr. Grant Colfax, director of HIV prevention and research at the city's Department of Public Health.
All involved agree that acting on such mapping will be controversial. Officials still have to decide on responses, such as whether to shift services, conduct highly targeted campaigns, or directly contact patients with the highest viral loads. Approaching patients could be seen as acting like a "police state," scaring some away, Montaner said.
CDC applauds the city's "novel approach" and is considering expanding it nationwide, said Dr. Irene Hall, chief of HIV surveillance at the agency.
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