By Erin Jester
After four decades of hard-won progress toward curbing the HIV epidemic, the face of the disease is changing.
To say the science has come a long way is an understatement. With no treatments available for the first several years of the most profound health crisis of the 20th century, patients typically survived only one to two years after an HIV diagnosis progressed to AIDS, the final, fatal stage of the disease.
Today, with timely diagnosis and treatment, life expectancy for people with HIV is close to those without it, and more than half of people with HIV in the U.S. are 50 or older. Antiretroviral drugs can suppress HIV in the body to levels that are undetectable, and therefore untransmissible. Pre-exposure prophylactic drugs can prevent transmission from occurring at all.
An estimated 44 million people have died from HIV-related causes since the beginning of the global epidemic, according to the World Health Organization. But because of aggressive research and outreach, the lives of more than 47 million people living with HIV have been saved.
Despite these successes, a long road lies ahead. Health care barriers, stigma and misinformation remain major obstacles to eradication, and people living with HIV face chronic health conditions.
Robert Cook, M.D.
Researchers at UF’s College of Public Health and Health Professions and Southern HIV and Alcohol Research Consortium are up for the challenge.
“I think we could say the end is in sight,” said Robert Cook, M.D., an epidemiology professor and director of the consortium, also known as SHARC.
SHARC, a multi-institution research hub housed at UF, conducts HIV and alcohol research with the mission of reducing transmission and improving health outcomes. It was founded in 2012 and is primarily funded by the National Institutes of Health and the National Institute of Alcohol Abuse and Alcoholism.
At the end of 2022, the last year for which CDC data was publicly available, there were 135,400 people living with HIV in Florida. New infections totaled 4,606, the third highest in the country.
“There’s bad news and good news. We have the third highest rate in the country, but it’s only 4,000 to 5,000 new persons diagnosed a year,” Cook said, adding that only a few babies have been born with HIV in Florida in the last three years. “We are capable of containing it.”
With no cure or vaccine, HIV is uniquely challenging to control, particularly in Florida, home to a wide variety of groups at risk for contracting HIV. Compared to more culturally homogenous states, Cook said prevention and treatment outreach must include more tailored messaging to reach everyone.
“Unfortunately, even though we’re decades out from the beginning of the HIV epidemic, we still see a lot of stigma, misinformation and lack of knowledge around HIV in the general community,” said Jacob Bleasdale, Ph.D., a former SHARC postdoctoral fellow who is now an assistant professor at the University of Central Florida.
People with HIV or those seeking pre-exposure prophylactic medication, known as PrEP, might fear judgment about their diagnosis or being part of a group with higher risk of contracting HIV, such as gay and bisexual men and intravenous drug users.
Still, Bleasdale said, the biggest barrier to treatment or prevention is financial.
Bleasdale worked with Drew Westmoreland, Ph.D., an assistant professor in the Department of Epidemiology and assistant director of SHARC, to disseminate findings from a 2021 study examining PrEP uptake and competing material needs.
“Most people who don’t have health insurance are just not able to afford it,” Bleasdale said. “They’re choosing between having to pay rent or pay for groceries, rather than being able to afford health care, and that really limits their ability and willingness to be on PrEP.”
Without insurance, Truvada, one of the three FDA-approved PrEP drugs, costs nearly $2,000 a month. A generic version costs about $60 per month, but that can still be too expensive. Some health departments and outreach programs distribute the drugs at no cost, but if a person doesn’t have access to reliable transportation, PrEP is still out of reach.
Fortunately, the internet can help.
Westmoreland’s remote methodology studies eliminate the need for participants to come to a clinic, allowing her to recruit more participants and remove more barriers to access.
In an NIH-funded study called Together 5000, led by Christian Grov, Ph.D., of the City University of New York, Westmoreland and co-researchers were able to retain 5,000 participants throughout a four-year study that involved remote surveys and mail-in HIV test kits — no small feat.
“There are a lot of medical appointments required for receipt of PrEP, and one of the benefits of telehealth and remote studies is being able to help facilitate HIV prevention and engage people in research in ways that meet people where they are,” she said.
Mattia Prosperi, Ph.D., a professor of epidemiology and PHHP’s associate dean for artificial intelligence and innovation, is bringing AI into the HIV prevention mix.
Prosperi and Jiang Bian, Ph.D., formerly of the UF College of Medicine and now at Indiana University, are conducting a four-year study using advanced AI modeling to identify practical barriers to effective HIV treatment in Florida.
Funded by the National Institutes of Health, the project supports the broader federal initiative “Ending the HIV Epidemic in the U.S. by 2030,” supporting targeted efforts that demonstrate measurable impact and cost-effectiveness.
SHARC’s community engagement team provides education, promotes understanding of SHARC-related research and builds relationships with community members. Team members (from left) Andre Fedd, Ph.D., Kayla McNeely, Nanyangwe Siuluta, Elena Kalina, Isaac Payton and Jahmeel Scott shared information at HealthStreet’s annual Night of Dance held in downtown Gainesville.
In Florida, nearly one-third of individuals diagnosed with HIV are not receiving consistent treatment. Prosperi’s team is analyzing over 9,000 variables to uncover actionable insights that can improve care delivery. The study prioritizes real-world factors such as insurance coverage, access to medication and logistical challenges that hinder treatment adherence.
Existing AI models offer predictive capabilities, but UF’s causal AI approach goes further by integrating complex variables that affect treatment access, including the availability of PrEP and health care infrastructure.
“This is a prime example of how AI can be used to enhance precision in public health,” Prosperi said. “We’re not just identifying risk — we’re creating tools that help providers deliver personalized, effective care.”
Aside from prevention, SHARC members also study ways to mitigate the effects of chronic conditions as people with HIV live longer.
In his research, Eric Porges, Ph.D., an associate professor in the Department of Clinical and Health Psychology and an associate director of the Center for Cognitive Aging and Memory, focuses on factors that accelerate brain aging in people with HIV. Everyone experiences the cognitive and neurophysical consequences of aging, Porges said, but data shows those changes happening at a faster rate for people with HIV.
Porges and his team’s work allows them to better understand brain changes that occur in people with HIV as they age, but their findings can also translate to other populations.
“It’s part of a collaborative, integrative research program that is very much focused on people with HIV but also informed by and integrated with our general aging program as well,” he said.
Porges leads a study examining the use of probiotics and transcutaneous irregular vagus nerve stimulation in people living with HIV who are high-risk alcohol users. Researchers hope the combination of modulating the vagus nerve and the gut microbiome could reduce inflammation that contributes to accelerated cognitive aging.
Getting to this stage in HIV treatment was once a fantasy, said Cook, who has been involved in HIV/AIDS research for more than 30 years. At the time he was in medical residency in the 1990s, he said, all his patients with AIDS died.
“It takes people from all kinds of different disciplines to accomplish something that we used to think was impossible,” Cook said, referring to the “full spectrum of translational science” that yielded PrEP and treatments that prevent HIV from progressing to AIDS.
“There’s still a dream that we can find a true cure,” Cook said. “I think we’ve done a great job getting to the point of making it easier to manage, but we still need a moonshot effort to truly wipe it out.”