By Isabella Magg, C’24
Source: https://www.iapac.org/fast-track-cities/about-fast-track/
Cities are the epicenter of social transformation. Whether it be rallying people in the fight for civil rights, enabling the exchange of ideas, or promoting economic development, cities are microcosms of larger political and cultural phenomena. When it comes to the AIDS pandemic, in particular, cities are in the unique position to enact lasting change.
High population density and unequal distribution of resources, for instance, makes certain communities more vulnerable to infection. Lack of access to reliable healthcare reinforces this problem. At the same time, cities provide networks through which HIV services and prevention awareness can reach a vast number of people. Both the challenges and benefits of cities in shaping public health are well understood.
When it comes to the HIV epidemic in particular, cities have the potential to both relieve and exacerbate vulnerability to infection. Cities, for instance, endow many with the freedom to express their sexuality, something that can lead to higher rates of HIV transmission. Urban spaces also tend to attract and enable sex work, which contributes to the spread of infection. On the other hand, cities can provide vast and comprehensive health services to their inhabitants. Some cities, for example, have established networks with multiple nongovernmental organizations to provide access to services and commodities like sterile needles and syringes.
Eight years ago, significant steps were taken to acknowledge and take advantage of the role and reach of the city. Meeting in Paris, France, mayors from 26 cities around the world signed on to the Paris Declaration on Fast-Track Cities Ending the Aids Pandemic in partnership with UNAIDS. This proclamation, now signed by more than 200 municipalities around the world, expresses a commitment to ending the epidemic by 2030.
One of the main components of this goal included achieving the 90-90-90 treatment target, whereby 90% of people with HIV are aware of their diagnosis, 90% of people who are aware of their HIV status are receiving treatment, and 90% of people getting treatment have suppressed viral loads. In 2016, this objective was amended to target 95% of the population in all three categories. This progression means that the cities under the declaration are well on track to eliminating new positive HIV cases and AIDS-related deaths. In addition to this goal, cities have also committed themselves to prevention efforts by taking a multisectoral approach to epidemic and acknowledging the intersection of health and socioeconomic issues like access to affordable housing.
Despite its relative success, the city of Philadelphia has never officially committed itself to the Paris Declaration. Is this a problem? How exactly do HIV statistics in Philadelphia compare to the declaration’s goals and projections? Looking at the most recent HIV Surveillance Report from the Philadelphia Department of Public Health, the city’s estimates fall slightly behind UNAIDS’ threshold. By 2030, for example, the city is expecting to reduce new infections by 90%. Similarly, Philadelphia is struggling to get people to continue their treatment and report a suppressed viral load - a number that comes in at only about 67% of Philadelphians living with HIV. Covid-19 also presented unique challenges that interrupted its progress. At the start of the pandemic, for instance, many HIV services were shut down, something that prevented people from either getting an early diagnosis, or receiving post-diagnosis treatment. Without people testing, Philadelphia has essentially lost sight of its true HIV statistics. Without knowing who to cater treatment towards, the city runs the risk of seeing a dramatic increase in transmission rates.
While Philadelphia’s efforts are still significant and commendable, joining the Paris Declaration would still be beneficial to the city’s mission. As of now, there has been no indication that Philadelphia has considered joining the Paris Declaration. The Philadelphia HIV Integrated Planning Council, the city’s main care and prevention organization, takes most of its direction and funds from the federal government. If Philadelphia was to sign on to the Paris Declaration, however, it would gain access to a collaborative network of cities with similar goals and intentions. The partnership would also endow the city with a comprehensive framework for success as well as technical support from the International Association of Providers of AIDS Care, both of which could address the issues the city is facing as a result of the Covid pandemic. More than this, joining the declaration would send a clear message of the city’s commitment to supporting its 21,000 affected residents.
Ending the HIV epidemic must be a joint effort, one that incorporates the voices of both local and global communities. Becoming a Fast-Track City is one step that Philadelphia can take to create a more inclusive and sustainable future for its most vulnerable inhabitants.