Kneeshe Parkinson was only 17 years old when she tested positive for HIV. Now, more than two decades later, Parkinson says that despite having a disease for which there is no cure, “I’m not just surviving, I’m thriving.”
The daily medicine that the University City native takes is keeping the levels of the human immunodeficiency virus in her body at undetectable levels, she explains—a goal of HIV treatment that doctors say can help those with HIV protect their immune systems, bear children, breastfeed without transmitting the virus, and live longer life spans. Left untreated, HIV, a virus that attacks the body’s immune system, can develop into AIDS, or acquired immunodeficiency syndrome.
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The sooner one knows their status—whether they are positive or negative for HIV—the better their chances of receiving treatment and lowering their viral loads, so they can lead healthy, enjoyable lives, says Parkinson, who is active in HIV awareness efforts and works for Washington University School of Medicine as a health navigator. She’s also among the founding members of a local steering committee for Fast-Track Cities St. Louis. Fast-Track Cities is an international partnership of more than 300 cities and organizations committed to bringing the number of new cases of HIV to zero by 2030.
On December 1, 2019, World AIDS Day, St. Louis city and county officials gathered to sign a Fast-Track Cities document declaring a commitment to the initiative’s goals. Then-acting city health director Dr. Fredrick L. Echols said at the time, “St. Louis becoming a Fast-Track city demonstrates a commitment of government leaders to leverage regional resources and critical scientific advances in HIV prevention and the continuum of care; coordinate efforts across the local public health system; reduce stigma associated with sexual health screening and prevention of sexually transmitted infections; and implement evidence-informed, culturally sensitive activities necessary to end the HIV epidemic.”
To help reach that goal, Fast-Track Cities members commit to what they call 90-90-90 targets: 90 percent of people with HIV will know that they are infected with the virus; 90 percent of people living with HIV will receive sustained antiretroviral treatment; and 90 percent of all people who are living with HIV and are on antiretroviral treatment will have durable viral suppression.
Two years after that initial Fast-Track Cities signing, Parkinson says, “We can reach that goal of zero new cases, but it is going to take a lot of work and commitment.”
Fast-Track Strategies
The first cases of AIDS were reported in the United States in 1981, and there have been more than 675,000 AIDS-related deaths over the past 40 years, according to the Centers for Disease Control and Prevention. But medical inroads have been made since the ’80s. They include the development of new medicine and faster tests, notes Tawnya Brown, vice president of operations at Vivent Health in St. Louis. “I was a freshman in college when Magic Johnson announced [in 1991] he had tested positive for HIV,” Brown says. “That prompted me to take an HIV test. It was negative, but it took me two weeks before I knew the results. Test results are available in 15 minutes today.”
A Fast-Track Cities dashboard shows that in 2019, 3,440 residents of St. Louis city and 2,263 county residents were living with HIV. Statewide in 2019, the number of Missourians living with HIV totaled 12,453, according to the dashboard. The largest number of new cases of HIV in 2019 were individuals between the ages of 25 and 44, according to the Missouri Department of Health and Senior Services. Still, of the 1.2 million people in the United States living with HIV, as many as 13 percent of them do not know it, according to the CDC, which says Black and Brown people continue to be disproportionately affected. Some individuals may forgo tests because of concern they’ll be judged. Others may worry about costs of tests and follow-up treatment should they test positive, notes Dr. Elvin Geng, a professor of infectious diseases at Washington University School of Medicine.
But “people with HIV who take HIV medicine daily as prescribed and get and keep an undetectable viral load have effectively no risk of sexually transmitting HIV to their HIV-negative partners,” says the National Institutes for Health. The most common ways that HIV is spread in the United States, according to the NIH, is through sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV, and sharing injection drug equipment, such as needles, with someone who has HIV.
Bill Keeton, Vivent Health’s vice president and chief advocacy officer, says the tools to end the HIV epidemic are already in place: new medicines, improved testing, continued research. “Now, we need to look at strategies on how to best implement those tools,” he says.
Fast-Track Cities is regaining momentum after the onset of the COVID-19 pandemic, according to Cory Bradley, Ph.D., acting co-chair of Fast-Track Cities St. Louis and a post-doctoral research associate in HIV implementation science at Washington University’s Institute of Public Health. Implementation science involves identifying, developing, and measuring the impact of efforts to improve HIV services, programs, and policies—which is what Bradley stresses when talking about the work ahead for Fast-Track Cities St. Louis. Health, government, and education partners, Bradley says, will work with individuals at heightened risk for HIV transmission and those living with HIV on identifying and rectifying barriers to health and wellness, such as access, lack of insurance, and historical distrust of health care providers. “The goal of zero new infections by 2030 is achievable but will involve providing compassionate outreach to diverse populations, allocating resources, and evaluating who is being affected, and how we can use resources to reach them,” he says.
It’s also important, Bradley says, to make conversations about HIV tests, prevention, and treatment more routine. Ways to do that, he notes, are to provide HIV information in “emergency departments, urgent care facilities, community-based organizations and initiatives, and even spiritual communities. It might be an interesting consideration to think about offering information and testing opportunities with COVID vaccinations.”
The St. Louis Department of Health is “fully committed to working with our partners in bringing the HIV epidemic to an end,” according to Dr. Mati Hlatshwayo Davis, director of the St. Louis Department of Health and former co-chair of Fast-Track Cities St. Louis. HIV, says Hlatshwayo Davis, “affects all of us, our neighbors, our families, our friends and others.”
As Parkinson looks back on the HIV test that she took more than 20 years ago, she recalls the health care provider who tried to convince her that she didn’t need the test as part of an annual well-woman exam. But Parkinson moved forward and received the test. Among the messages about HIV that Parkinson wants teens and adults to hear and act on: “Get tested.”
