A New Era in HIV Prevention and Care

Alftan Dyson, PharmD

Credit: CBC Power 100

Over the past decade, the landscape of HIV prevention and treatment has transformed from crisis management to long-term health and empowerment. Thanks to scientific innovation, what was once a life-threatening diagnosis is now a manageable condition — and in many cases, completely preventable. Alftan Dyson, PharmD, head of Strategic Medical Partnerships at ViiV Healthcare, has witnessed this transformation firsthand, from his early days as an HIV-specialized pharmacist to his current leadership role. This Educated Patient conversation highlights how long-acting injectable therapies, greater patient choice, and stigma-free dialogue are shaping the next frontier in ending the HIV epidemic.

How has the HIV epidemic changed over the past decade, and what progress have we made in prevention and treatment?

Alftan Dyson, PharmD: The changes over the past decade alone have been significant, and I've had the privilege of seeing so much of it firsthand throughout my career, first as an HIV-specialized pharmacist, and now in my role as head of Strategic Medical Partnerships at ViiV Healthcare. What was once a devastating diagnosis is now, for many, a manageable, long-term health condition, allowing people living with HIV to anticipate a long and healthy life, similar to that of the general population.

For HIV treatment, modern medications are so effective that people living with HIV can achieve what we call an "undetectable viral load." This means the virus is so low in their body that they cannot sexually transmit HIV to others. We call it “U=U” or “Undetectable = Untransmittable.”

For HIV prevention, we have also made great strides with highly effective tools like pre-exposure prophylaxis (PrEP). It's a medicine available for people who are HIV-negative to prevent them from acquiring HIV through sex.

One of the most exciting advancements was the introduction of long-acting injectable options for both prevention and treatment. These offer a whole new level of flexibility, privacy and ultimately choice, which is so important for each person in finding an option that fits their needs.

What are long-acting HIV prevention therapies, and how do they work compared to daily pills like PrEP?

AD: Long-acting HIV prevention therapies, like Apretude (cabotegravir), have made a real impact on the community since first coming to market in 2021. Think about it: instead of taking a daily pill every day, which can be a mental and emotional burden for many, you can receive injections every other month.

Both daily oral PrEP and long-acting injectables are highly effective at preventing HIV. But the long-acting option offers a level of discretion and flexibility that can make a real difference in someone's life. For many, remembering a daily pill is a constant stress, or they worry about privacy. An every-other-month shot removes that daily thought process, providing two months of continuous protection with each dose. It also allows for regular check-ins with your doctor or care team to discuss your health or conduct routine sexually transmitted infection (STI) testing. While it doesn’t protect against other STIs, PrEP, in addition to safer sex, can be a really important part of HIV prevention and overall sexual health.

This concept of reduced daily burden isn't just for prevention. It's also a significant benefit for people living with HIV who are on treatment. A daily pill can serve as a constant reminder of a person’s diagnosis, which can carry a heavy emotional weight. Long-acting treatments, like Cabenuva (cabotegravir/rilpivirine), the only complete long-acting HIV treatment, similarly offers less frequent, every-other-month dosing, which can significantly reduce that daily mental burden.

And for both prevention and treatment, this less frequent dosing can also help improve adherence, which is crucial for staying protected from HIV or for maintaining an undetectable viral load if you're living with HIV.

Who might benefit most from these new long-acting options, and how can patients know if they’re a good fit?

AD: The absolute best way to figure out if a long-acting option is right for you is to have an open, honest conversation with your doctor or care team. Don't hold back! Talk about your lifestyle, your preferences and your medical history. You should talk about it if you find it tough to remember a daily pill, or if you're concerned about privacy and stigma around medication, want a discreet way to protect yourself, and if there are other medications you might be taking. These questions and open conversation can help you consider all the options and decide, together with your doctor or care team, what PrEP option may truly align with your needs. You owe it to yourself to explore everything available!

In fact, ViiV Healthcare has created some great conversation guides to help both people living with HIV and those exploring prevention speak up about what they need. You can find them here.

What challenges still exist in making HIV prevention and treatment accessible to everyone who needs it?

AD: Despite all our scientific breakthroughs, we still face significant hurdles. Having worked as a pharmacist directly with patients in clinics, especially in the South, which accounts for the highest burden of HIV in the US, for many years, I've seen these challenges firsthand. One of the biggest hurdles is the shockingly low uptake of PrEP, particularly in communities that are disproportionately impacted by HIV.

While PrEP use has increased, only a small fraction of people who could benefit from it are actually taking the medication. Recent CDC data shows that only 11% of Black individuals who could benefit from PrEP were prescribed it, compared with 78% of White individuals. That's a huge disparity, and it tells us we have a lot of work to do on access and awareness. This challenge is even more pressing given that earlier this year, the CDC updated its estimate of the number of people who may need PrEP in the U.S. from 1.2 million to 2.2 million.

And then, inextricably linked to access, there's stigma, especially around sexual health, which keeps people from getting tested, from talking to their doctors, from accessing prevention and even from staying in care. I've seen firsthand how fear and judgment can prevent someone from getting the care they desperately need, so we need to collectively foster dialogue, increase our empathy and build support systems to fight against stigma.

How close are we to ending the HIV epidemic, and what role can patients and communities play in getting there?

AD: We are closer than ever before, and I truly believe we can get there! We have the tools, including effective PrEP and HIV treatment options that allow people to live full lives and prevent transmission. The science is there, and we all have a role to play.

First, speak up and have those open conversations with your healthcare provider about your sexual health and measures you can take in support of your sexual wellness. If you are interested in HIV prevention with PrEP, discuss with your doctor or care team reasons for your specific interest in HIV prevention, and options that may be available to you. Don't be afraid to ask questions!

Second, stay consistent! If you're on PrEP or HIV treatment, sticking to your regimen is vital – for your own health and for preventing transmission.

And third, be an advocate. Share your story, educate your friends and family, and champion efforts to support access and fight stigma. It’s all about creating spaces where people feel safe and supported. It's about challenging stigma, educating each other, and making sure resources reach the people who need them most.

Share information, talk to your friends, your family, your neighbors. Everyone has a role to play in ending this epidemic.

What advice do you have for someone who feels worried about HIV risk but isn’t sure where to start with prevention?

AD: My strongest advice is to have an open conversation with a doctor or care team. It's completely normal to feel worried and to not have all the answers. Healthcare providers are there to help you navigate these concerns in a confidential, judgment-free space. As a pharmacist who's spent years counseling patients, I know how crucial that first conversation is.

At ViiV Healthcare, we really believe in shifting the conversation from stigmatizing "risk" narratives about HIV to focusing on your "reasons" for HIV prevention and care. This approach helps promote open, honest conversations and truly fosters empowerment around HIV prevention and care. So, when you talk to your doctor, share your concerns about potential reasons for HIV prevention. Talk about your sexual health history, your daily life and routine, and your overall health and wellness. Remember, they're professionals, and their goal is to help you stay healthy. Don't let discomfort stop you.

Specifically, ask about PrEP, both the daily oral pills and the long-acting injectable options, like Apretude. You have choices! The more you know, the more empowered you will be, and you deserve to feel protected and confident in your health decisions.