Parool: Why is Amsterdam so good at fighting HIV?

Amsterdam is at the international forefront when it comes to HIV control and HIV prevention. At AIDS2018, other cities are hoping to learn a few tricks on the way to an AIDS free world in 2030.

It is no coincidence that the international mega congress AIDS2018 is held in Amsterdam. Apart from its rich history in HIV research and tolerant reputation, the city has another edge: it is exceptionally good at HIV prevention.

In numbers: in five years, the number of new HIV diagnoses in the city has halved to 162 in 2015. In 2016 this number was 168, which is still significantly lower compared to the 300 to 360 new diagnoses each year that the city had faced for years.

Last year, the United Nations complimented Amsterdam on reaching the UN targets on the way to an AIDS free world in 2030. Only the cities of London and San Francisco are at the same level.

PrEP

How is this possible? Why is Amsterdam so good at fighting HIV? A combination of factors, says Godelieve de Bree, internist-infectiologist of the Amsterdam UMC and scientific coordinator of the H-TEAM. Since 2014, all parties involved in the fight against HIV, such as the Public Health Service Amsterdam (GGD Amsterdam) and hospitals, are working together in the H-TEAM with the goal of eradicating new HIV infections. GGD Amsterdam distributes preventive pill PrEP (Pre Exposure Prophylaxis) as part of a study and local GP’s are educated on how to talk about HIV with their patients.

Next to that, a campaign has been launched to make people aware of the symptoms of an acute HIV infection which can appear shortly after being infected: Hebikhiv.nl. According to De Bree, this has resulted in gay men getting tested earlier. “This can happen on the same day now. With an HIV diagnose, someone can start treatment within a few hours at one of the HIV treatment centres.”

Starting treatment early is crucial – not only for the prognosis of the individual patient, but also for the fight against HIV. Because in almost everyone who receives HIV medication, the virus can no longer be detected in the blood after about a month and thus can no longer be transmitted. “The fact that PrEP will be reimbursed will further push the number of new HIV infections down. We are doing well but we have to do even better.”

Stigmas and taboos

Representatives from other cities are coming to see how Amsterdam is accomplishing this feat. The H-TEAM exchanges experiences with London, San Francisco and Paris. “Amsterdam has a good foundation for decreasing HIV infections: it’s politics are cooperative, health care is good and the lines of communication between parties involved in combating HIV are short. This is very different in London, with its 33 districts, but there are similarities: we all struggle to reach certain population groups.”

About three quarters of new HIV infections are found in gay men. The other HIV infections occur mainly in people with a migration background. “Forty per cent of the people with an HIV infection are only showing up for a test when they already show symptoms related to AIDS. Here we also see a lot of people with a migration background.” Shame, stigma and taboos create huge barriers on the way to an HIV test.

This is where the H-TEAM has another ace up its sleeve. If these people are not coming to the test, the test will come to them. “We see that these people come from neighborhoods with a lot of overweight and diabetes. That gives us starting points. If we make this HIV test part of a broader health check, when for example you are looking at other things in the blood, the barrier to take the test will be lower.”

Read the full article here (Dutch only).

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