"Turning the Tide Together" is the theme of the International AIDS Conference taking place this week in the United States for the first time in 22 years. More than 34 million people around the world are living with HIV/AIDS, including 1.2 million in the U.S. and more than 2,450 in Hawaii.

This week, after 30 years of the epidemic, we can reflect on the status of HIV/AIDS in the U.S. and Hawaii. We may now be able to finally turn the tide in both HIV prevention and care. Since the 1980s, Hawaii has been a leader in the fight against HIV/AIDS.

The trailblazing work was done by local AIDS Service Organizations (ASOs) and dedicated health care providers who treated the early cases of AIDS. They had deep roots in the gay community, which was the most impacted and active in its response to AIDS. Hawaii provided needed state funding to the Department of Health for direct services and to help expand the work of ASOs.

Hawaii also established the county’s first state-funded syringe exchange program. It has dramatically reduced the spread of HIV, saving lives and dollars.

In recent years, there have been major advances in HIV research. We now have accurate HIV rapid tests that give results in less than 20 minutes. Highly effective HIV medications are available for those who test positive, and funding is available for those who cannot afford them.

These medications greatly improve the health of people with HIV and can dramatically help reduce transmission to others. These medications, taken appropriately, decrease the level of HIV to the point where it is undetectable in laboratory tests. The individual still has HIV, and viral levels can come roaring back if treatment is interrupted. Because research has shown that undetectable virus leads to significant reduction in transmission, we now consider "treatment is prevention." It is only through prevention that we will ultimately end this epidemic.

So, with the availability of many scientific advances to effectively test for and treat HIV, what remains to be done?

Significant challenges remain: How to ensure all people with HIV are tested, in care and successfully treated. National data indicate how far we still have to go: of every 100 persons with HIV, only 80 have been tested and diagnosed, with about 60 accessing HIV medical care, often months or even years later. Startlingly, only 40 remain in HIV care and less than 30 of the original 100 persons are on treatment with the virus undetectable.

In light of such statistics, we in Hawaii will have to increase targeted testing for high-risk populations, particularly men who have sex with men, while health care providers will need to increase routine HIV screening for all patients who may not know they are at risk. Health insurance providers, and others involved with implementation of the Affordable Care Act, will need to ensure reimbursement for HIV screening and treatment.

The Department of Health will have to strengthen its outreach and testing for the partners of people living with HIV. The HIV and broader community will need to find more effective ways to help people impacted by homelessness, mental health, substance abuse, poverty and other issues get into and stay in care and on treatment.

Public funding needs to continue to provide a safety net so all HIV-positive persons can receive treatment. Above all, we will need to end the stigma, discrimination and fear around HIV that remains a barrier to accessing services. It’s time for us to turn the tide together.