The NYC Health Department has developed the New York City HIV Status Neutral Prevention and Treatment Cycle (PDF) to highlight several key messages that are not included in the traditional HIV care continuum. This new paradigm outlines the steps that can lead to an undetectable viral load (when HIV medications work and you have so little HIV in your blood that tests cannot detect it) and steps for effective HIV prevention (such as using condoms and taking Pre-Exposure Prophylaxis, also known as PrEP).
The traditional HIV care continuum maps the journey of people living with HIV as a straight line, from diagnosis to successful treatment. Although it is a useful tool to measure how the city is doing, it fails to highlight important efforts to end HIV. The new cycle recognizes that HIV care does not end with the first undetectable viral load. High-quality, culturally affirming care empowers New Yorkers who are living with HIV to get treatment and stay engaged in care. Similarly, high-quality preventive services for people who are at-risk of HIV exposure help keep them HIV-negative. In short, whether you are HIV-negative or HIV-positive, there are options to keep you and your partners healthy.
The first step in the care journey is to get an HIV test. All New Yorkers should know their HIV status. People who test negative but are at risk of HIV exposure can access resources to prevent HIV, including condoms and PrEP. People who test positive can stay healthy and prevent transmitting HIV to others by taking medications and using condoms.
People at risk of HIV exposure taking daily PrEP and people with HIV with sustained viral load suppression do not acquire or transmit HIV. The HIV divide ends here.