One of the first things you notice about Dashiell Sears is his frequent use of words like eradicate and eliminate when discussing HIV. He’s here to end it.

 

Sears, 33, is regional director for North America for the Fast-Track Cities Institute, whose global mission is to help municipalities in their efforts to strengthen and accelerate their response to HIV, tuberculosis and viral hepatitis.

 

“Our goal is to strategize and develop that road map, along with our global partners at UNAIDS and the World Health Organization, to create a pathway toward HIV eradication,” Sears says.

 

According to Sears, the Fast-Track Cities Institute has prioritized the same HIV testing, treatment and viral suppression targets that United Nations member states adopted in June 2021. These goals are lofty indeed. The aim is to have 95% of people with HIV worldwide know their status; to have 95% of those individuals on medication suppress the virus; and to have 95% of those on medication achieve an undetectable viral load, which means they are healthier and cannot transmit the virus.

 

Sears, a Lancaster, Pennsylvania, native who is HIV negative, says cities often lead the way in combating society’s greatest challenges, citing as motivation the higher concentration of at-risk populations living in urban settings. He says what happens in cities affects the rest of the world, especially the battle to end HIV and AIDS.

 

“Once you start influencing how cities approach and get to HIV elimination, which we know will be HIV control, elimination and eradication, then you see the national trends take shape around what’s been working,” he says.

 

Sears notes that while HIV science has evolved dramatically in his lifetime, the stigma surrounding this disease remains very formidable indeed, even after all these years. In fact, Sears believes stigma is one of the biggest obstacles to ending HIV and AIDS.

 

“When you compartmentalize something like HIV, for which there still isn’t a cure, you allow other things, other influences to take charge of the epidemic. And that often comes in the form of stigma,” Sears adds. “And stigma means you can compartmentalize HIV away if you don’t want to think about it, and you can pretend it’s not happening because people aren’t necessarily dying in the streets. So stigma constantly rears its ugly head.”

 

Tools such as antiretroviral therapy and pre-exposure prophylaxis allow Sears to contemplate an HIV-free future in his lifetime, especially if recent medical advances are leveraged to destigmatize this disease.

 

According to Sears, the Undetectable Equals Untransmittable (U=U) message, which communicates the fact that people on effective HIV treatment do not transmit the virus via sex, is a powerful but underutilized tool against stigma, especially in health care settings. It’s something Sears remains committed to changing.

 

“We have a responsibility as a medical community to continue talking about things like U=U and what viral suppression is,” Sears says. “We know that over half of people who live with HIV have not heard about U=U from their primary health care provider. That’s troubling, and it means we should redeploy efforts in the medical education community, including standardizing HIV education in medical schools.”