Diane Havlir on Nearing the End of HIV/AIDS

By Niall Kavanagh

Diane Havlir, Larry Corey, and Siobhan O'Connor on stage at Fortune's Brainstorm Health Conference
Diane Havlir (left), MD, discusses HIV elimination at Fortune’s Brainstorm Health Conference on May 2. Photo by Fortune/TIME

It’s easy to forget that until recently, an HIV diagnosis was a death sentence. Today, transmission rates have gone down, people with HIV live longer and talk of elimination is reasonable.

There has been much progress but work remains. The number of people living with HIV on antiretroviral therapy (ART) – an effective treatment for HIV – is growing, yet 20 million (of 37 million infected) still live without treatment.

Diane Havlir, MD, was a training physician at UC San Francisco when the AIDS epidemic emerged in the 1980s.

“We didn’t know what caused [AIDS],” said Havlir. “We didn’t know how to treat it. We didn’t know how to prevent it.”

Havlir spearheaded early studies of ART that led to its widespread use in the mid-1990s.

Since her days as a trainee, Havlir, now Chief of the HIV, Infectious Diseases and Global Medicine Division at UCSF, has continued the crusade to end AIDS. On May 2, she spoke with Siobhan O’Connor of Time, and Larry Corey, MD, of HIV Vaccine Trials Network, about global HIV elimination. The discussion was part of Fortune's second Brainstorm Health Conference in San Diego.

Getting to Zero

Havlir spoke of a pivotal moment, several years ago, when a patient asked if various groups – including medical providers, policymakers and people living with HIV – were working together to fight HIV/AIDS.

“We weren’t. And we realized from that point on: we need to work together to reduce infections.”

The resulting collaboration, Getting to Zero, is a promising citywide effort to end HIV transmission in San Francisco. Its success is driven by three ideas: expanded use of PrEP (Pre-Exposure Prophylaxis) medicines to protect against infection; initiation of treatment immediately after diagnosis; and a focus on care retention.

“We have testing sites all over the city,” said Havlir. “We have people get in an Uber and they come to start therapy that day. It’s not expensive and it’s completely exportable.”

San Francisco is on track to become the first city to “Get to Zero” in terms of new HIV infections.

Thinking Locally, Acting Globally

To build upon local successes, Havlir and collaborators are exporting ideas from San Francisco to sub-Saharan Africa, an area highly impacted by HIV/AIDS. A result is UCSF’s SEARCH (Sustainable East Africa Research in Community Health) Study, which surpassed an ambitious UNAIDS goal – to have 90 percent of all HIV infections identified, treated and virally suppressed by 2020 – in 2016, two years after its start.

Speaking to an audience of business, government, health care and technology leaders, Havlir highlighted growing opportunities for applications of high technology in healthcare.

“There is so much opportunity,” said Havlir. “Almost all people [in sub-Saharan Africa] have access to cell phones. We shouldn’t consider AI [artificial intelligence] only in developed countries.”

Despite advances in the understanding and treatment of HIV/AIDS, a stigma persists, largely tied to sex and sexuality.

Why is HIV still a problem? “Number one, the virus is smart,” said Havlir. “The second reason is stigma and shame – even in San Francisco. We have a long way to go.”

Continued education and discussion about HIV may help. “I saw a young patient recently,” said Havlir. “He called his mom and said, ‘I’m HIV infected. But don’t worry, I started treatment today.’ There was something liberating about him saying he was doing something about this disease.”

Lessons Learned

In considering how to improve global health, Havlir reflected on her life’s work.

“We’ve gone from grim to optimistic. My goal is to end the AIDS epidemic. One way to do this is find everyone who’s infected, offer them treatment, and to find people who are at risk, and offer them preventative treatment.”

“Invest in research. Invest in care,” she added. “And finally, talk to the communities. We can end the AIDS epidemic but the community’s going to need to want to.”

Brainstorm Health 2017 featured global leaders in business, government, healthcare and technology. Speakers included Joe Biden, former Vice President of the United States; and CEOs Chip Bergh of Levi Strauss & Co., Mark Bertolini of Aetna, and Arianna Huffington of Thrive Global.