For nearly 50 years, Callen-Lorde Community Health Center in Chelsea has been a not-for-profit clinic providing quality health care to all, regardless of ability to pay, with an emphasis on LGBTQ health. The clinic is on the front lines of the ongoing war against AIDS, led by Dr. Rona Vail, Callen-Lorde’s clinical director of HIV Services, and one of the leading experts in her field.
When asked to describe the current state of the battle against HIV in New York City in 2021, Dr. Vail’s response was: “We’re better than we’ve ever been, and we still have a ways to go. There’s so many ways in which treatment has gotten better. I’ve actually been doing this since the beginning. I was a second year medical student when those first cases of strange pneumonias in gay men happened in 1981, so I’ve seen the whole evolution, I’ve actually been part of the whole evolution. And so we’re in such a different place today.”
When asked what the most recent success in the fight has been, Dr. Vail said, “I think a couple of different things. One is the fact that we now have effective HIV prevention. If we can just get people in to take the pill and that we can actually get close to 100% prevent HIV infection, that’s tremendous. And the other thing is just having treatments that people can take without experiencing the older toxicities that we had with our medications.”
The biggest recent advancement in HIV prevention for gay men is the use of PrEP – or pre-exposure prophylaxis. The pill — which can be taken either every day, or pre- and post-sex — is 99% effective in preventing HIV infections if taken as directed. Some critics believe the use of PrEP can lead to a feeling of invincibility and result in more risky sexual behavior that can lead to infection. Still, the data shows it has made a big difference.
“It’s huge,” said Dr. Vail. “It’s really, really big, and we’re seeing now the curve start to bend around new HIV infections, particularly in New York where we’re doing a pretty effective job in using PrEP.”
Overall, we’ve seen the HIV infection rate go down here in New York City, but there are pockets of groups where the infection rates are actually going up.
“That’s a big challenge,” said Dr. Vail. “We know that rates are rising in young gay men, particularly young gay men of color and communities of color in general, and that really has to do with what we call in health care the social determinants of health: access to health care and access to quality health care; access to education and quality education; where people live — are they in health care deserts? Are they financially stable? All of the different things that lead to health and being a healthy person.”
Finally, I asked Dr. Vail what’s the most hopeful thing she can tell New Yorkers about fighting this horrible disease.
“If your image of being HIV positive is an image of what it used to be like — of death and dying and despair and illness — it really doesn’t have to be that way,” she responded. “You don’t have to get sick from HIV. We can keep you healthy for a lifetime if we get you in early, and if you’re negative we can prevent it. So I think it’s really about getting people over the fear of HIV because I don’t think you have to be afraid of HIV anymore.”
