Desert AIDS Project Looks Toward the Future: Innovation and Commitment

By Jack Bunting


In our work to address the health needs of the most vulnerable in our community, including our core focus on those affected by the HIV epidemic, we had believed for some time that the need for services was greater than the statistics illustrated. In November, Riverside County health officials released new data indicating that a staggering 51 percent more people are living with HIV/AIDS in the county than had been previously reported.


The increase was due to a change in the way state health officials collect data on those living with HIV/AIDS, and does not mean there has been a spike in the frequency of the illness, a five-page report states.


The largest increase is within the eastern portion of the county, which includes Palm Springs and the Coachella Valley. Previously, there were 3,252 cases reported for 2016 (the latest figure available) compared to 5,522 in the new calculations for the same period.


The numbers changed because public health officials previously could only track the number of people with HIV where they received a diagnosis. The new data analysis includes the movement of people with HIV in and out of Riverside County.


The state and county are taking a more thorough approach to measure the number of individuals living with HIV/AIDS here, which is necessary to thwart the spread of the epidemic. While we still do not have a cure or a vaccine, we do have testing and treatment.


A Goal to End HIV


This is why we have adopted the same set of goals that UNAIDS announced in 2017.

  • By 2020, 90 percent of all people living with HIV will know their HIV status.
  • By 2020, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
  • By 2020, 90 percent of all people receiving antiretroviral therapy will have viral suppression.


A key piece of the 90-90-90 strategy is ensuring that people with HIV/AIDS have access to care and they remain in treatment and stay healthy, so that the virus is suppressed to levels so low that the virus cannot be passed on to others. Better measurement of how many people need services locally means we can deliver more effectively on this promise we made to the community.

While condoms and HIV testing continue to be critical to our goal of ending new HIV infections, we now have additional evidence-based strategies that will play equally crucial roles. These include:


  • Pre Exposure Prophylaxis (PrEP): this one pill a day medication, when taken by an HIV-negative person, will prevent her / him from becoming infected with HIV. Our STD clinic, The Dock is prescribing PrEP and all persons we test for HIV who have any risk are educated about PrEP and linked with our counselors. We launched a targeted media campaign to increase awareness of PrEP among the populations at higher risk for HIV. We are moving to implement same day PrEP so we can prevent new infections quickly.


  • Post Exposure Prophylaxis (PEP): When taken for 30 days after a risky encounter, PEP can prevent HIV infection, but treatment must start within 72 hours. D.A.P.’s walk-in clinic, The Dock, now provides access to PEP.


  • Undetectable Equals Untransmittable (U=U): Recently released research proves that HIV-positive individuals who are on HIV treatment and have so little virus in their blood that current tests cannot detect it (called undetectable), are not able to transit HIV. This means our work to link newly diagnosed individuals quickly to HIV care is a critical strategy to end the HIV epidemic.



Addressing a Threat to our Goal


While we continue to focus on preventing and treating HIV, the hard work we are doing is endangered by additional heath threats facing the same population; namely, Hepatitis C (HCV).

As death rates from HIV are going down nationally, death rates from HCV are rising according to the Centers for Disease Control and Prevention (CDC). This is especially frustrating given it is preventable and treatable. And since it is passed the same way HIV is, through blood and other bodily fluid exchanges, it targets our clients just like HIV does.

It is estimated that as many as 4,000 Coachella Valley residents currently live with chronic HCV. Approximately 3.5 million people in the U.S. have HCV—with somewhere in the range of 40 percent to 85 percent unaware that they are infected.

HCV attacks the liver and often has no symptoms. Due to a lack of awareness and testing, many of its victims find out they have it far too late, long after the window for early intervention has closed. The heartbreak is that we have a cure for HCV, and those who have it can still lead happy, healthy lives. But we have to diagnose it early enough to do something about it.


Sound familiar?


In June of 2017, we reported back to the community on the results of the three-year, valley-wide Get Tested Coachella Valley campaign (GTCV). Together with more than 100 community partners, we tested more than 80,000 valley residents for HIV and got the nearly 500 people found to be HIV positive into care.


Our Get Tested Coachella Valley program gave us methodologies for getting people’s attention, and increasing awareness of HIV. If they are negative, we help them avoid contracting HIV. For others, we help them prevent their HIV positive status from ruining their quality of life and from spreading the virus to others.


So what if we applied the same tactics we regularly use to fight HIV, to prevent deaths and morbidity from HCV?

New Options for Curing Hepatitis C


We plan to use these same tools to prevent as many deaths and injuries from HCV as possible as we do to combat HIV. We can do this because of advancements in pharmacology, technology, and with a group of medical professionals that have a passion for battling infectious diseases.


  • New medications: Previous to 2011, HCV treatment required weekly interferon injections for about 12 months. The side effects could be pretty severe and often failed to clear the virus. Now direct-acting antiviral agents (DAAs) selectively target and cure HCV. For most patients with HCV the treatment is as easy as taking vitamins for just six-to-12 weeks with little to no side effects.


  • New testing equipment: Until recently, the only way to accurately measure how much the HCV had advanced was to perform a biopsy on the patient’s liver, requiring an incision in the abdomen. Now D.A.P. uses an enhanced version of ultrasound technology, called FibroScan®, painlessly telling our doctors what they need to know without even making a scratch.


  • Experts in infectious disease: Since becoming a licensed medical clinic in 1992, D.A.P. has grown with the goal of improving the overall health of our entire community, especially the disenfranchised. Our clinic now provides comprehensive, culturally competent, quality medical care including HIV and hepatitis specialty care, along with a range of supportive care services as well as labs and pharmacy under one roof. Our six on-staff physicians, three nurse practitioners, and pharmacy staff who specialize in hepatitis care make all the difference.


While we may be challenged throughout this coming year by legislative decisions made in Washington, D.C., D.A.P. will continue to press forward with the same passion we have had for ending this epidemic. It has fueled our insistence on innovation these past 33 years. We will continue pushing ourselves to look for ways to bolster the health of everyone in our community. D.A.P. does not have time to rest.