Closing the Gap in HIV Care and Prevention, With Antonio Urbina, M.D.

As World AIDS Day shines a spotlight on the theme “Overcoming Disruption: Transforming the AIDS Response,” Antonio Urbina, M.D., medical director at the Mount Sinai Institute for Advanced Medicine, emphasizes both progress and ongoing challenges in the fight against HIV. While global new HIV infections have dropped 61% since their peak in 1996 and U.S. diagnoses decreased 12% from 2018 to 2022, the epidemic is far from over. In 2023, nearly 40,000 new HIV cases were diagnosed in the U.S., and someone still dies from an HIV-related cause every minute worldwide.

Disparities remain a significant barrier. The southern U.S. accounts for more than half of all new diagnoses, and Black and Latino communities continue to be disproportionately affected. Only 67% of people living with HIV in the U.S. have achieved an undetectable viral load, far below the 95% needed to truly curb transmission.

Exciting advancements in HIV treatment and prevention offer new hope. Long-acting injectables such as cabotegravir for treatment and prevention have already transformed patient care, and the recently FDA-approved injectable pre-exposure prophylaxis (PrEP) lenacapavir (Yeztugo) represents a breakthrough, requiring only twice-yearly administration. Clinical trials have shown nearly 100% efficacy, making HIV prevention more accessible and convenient.

Treatment has also become a form of prevention through the U = U concept: undetectable equals untransmittable. Scaling up oral PrEP has already shown reductions in HIV diagnoses in states with high coverage. Yet gaps remain — out of 1.2 million Americans who could benefit from PrEP, only 36% are accessing it. Urbina emphasizes that the biggest obstacles are not medical but societal, including stigma and fear of judgment.

Addressing myths is critical. HIV cannot be identified by appearance, is no longer a death sentence and cannot be transmitted through casual contact. Anyone who could benefit from HIV prevention should have access to PrEP without fear or judgment.

Urbina stresses that the fight against HIV is at a pivotal moment. With the right combination of tools, funding and political will, the epidemic can be brought under control. Testing, open discussions about PrEP and access to innovative therapies are key to ensuring that people living with HIV can lead long, healthy lives and that new infections continue to decline.